Paediatric Emergency Medicine

Objectives and Limitations

The Emergency Department (ED) Paediatric Procedural Sedation Programme has been developed to minimise risks associated with procedural sedation of children in Cork University Hospital (CUH) ED. As a risk reduction strategy this programme strives to ensure that doctors and nurses are familiar with the theoretical background and have the practical skills to participate in safe procedural sedation of children in the ED setting.

The programme is multifaceted: in addition to this manual, the programme includes lectures, a multiple choice examination, simulations and direct bedside sedation training. Standardised materials are used, including an ED Sedation Record (checklist and risk assessment), parent handout and consent form. The programme requires the completion of basic life support (BLS), paediatric life support (PLS) and, for staff assisting in ketamine sedations, advanced paediatric life support (APLS) training. The programme does not specifically include airway training. Paediatric airway training is provided as part of ED teaching for junior doctors and nurses.

The materials were specifically developed for use in the ED at CUH, and are closely based on the ED Sedation Programme of Our Lady’s Children’s Hospital, Crumlin, Dublin. The agents used, staffing and training background of doctors and nurses and the back-up systems available are specific to the ED where this programme was originally developed. Transferring this programme into other settings or other hospitals will require the adjustment of the materials and processes outlined and co-ordination with relevant hospital departments such as Anaesthesia. The methods described in this manual cannot be guaranteed to be safe and efficacious in all circumstances. Unexpected adverse events are possible even in healthy children. Sedative agents should only be used by those with appropriate training and experience in a hospital environment with facilities and back up to the standards recommended by the American Academy of Pediatrics and other relevant bodies.

Sedation Competency: The Process

All doctors and nurses working in CUH ED must be sedation ‘accredited’ prior to administering or assisting with the administration of any sedative agents. The process of accreditation is as follows:

  • Read sedation manual
  • Attend sedation lecture
  • Complete online MCQ – “General Sedation and Nitrous oxide” and “Ketamine administration” enrolled students will receive an email inviting tghem to participate in tehquiz)
  • A pass mark of 90% is required for the multiple choice questions
  • Practical demonstration of nitrous oxide delivery systems
  • Practical competency assessment of nitrous oxide delivery system undertaken by one of the sedation education team
  • Practical competency assessment of ketamine sedation through a simulated sedation
  • Demonstration of a current Basic Life Support (BLS) certification. Paediatric Life Support (PLS) or Advanced Paediatric Life Support (APLS) certification is expected for junior doctors and nurses.