Case 3
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Question 1 of 4
1. Question
An 80-year-old female has presented to the ED with shortness of breath, mild chest pain and palpitations. She is fully orientated and alert. She is currently in the resuscitation room.The following observations can be seen on the monitor at her bedside (Click on the ECG showing ventricular tachycardia to enlarge).
- Pulse 200
- Blood pressure 80/55
- SaO2 90% on air
You decide that you need to perform synchronised DC cardioversion; your supervising consultant emergency physician is currently employed in minors.
Which answer best describes the most appropriate immediate management?
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Question 2 of 4
2. Question
The consultant attends and states that he wants to supervise you performing the sedation. A nurse will perform the cardioversion. You consider the risks of sedation in this particular lady.
Describe three features of this patient's presentation that may modify your sedation technique or choice of sedative agent.
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Question 3 of 4
3. Question
Many adverse events are common to several sedative agents. Which drug is most typically associated with the adverse effects described?
Select the relevant agent for each adverse effect.
Sort elements
- Midazolam
- Propofol
- Ketamine
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Increased sensitivity to dose with age resulting in increased depth of sedation
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Profound hypotension
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Tachycardia and hypertension resulting in increased myocardial oxygen demand
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Question 4 of 4
4. Question
You have decided to sedate this 80-year-old female with VT for DC cardioversion. Her pulse remains 200, BP 86/55 and her SaO2 is 98% on high flow oxygen.
What sedative agent are you going to administer?
Describe the dose, route, method of administration and one reason why you are going to use this particular agent.
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Key Points
- Some procedures demand urgency. In these circumstances it is essential to be aware of modifications to the sedation technique that are required to perform the sedation safely
- A senior emergency physician (or anaesthetist) should be available to provide or supervise the procedure
- When sedating the elderly or chronically ill, the dose of sedative agent required is approximately half of that required by a healthy younger adult. This is especially so with midazolam and propofol
- Patients who have a reduced cardiac output and delayed venous return may have a delay in the onset of action of the sedative agent. It is important to allow for this during titration of the drug