Generic consent for sedation

candidate brief

Mrs Lee is a 72yo with a prosthetic hip dislocation. Orthopaedics would like to attempt reduction under sedation in resus. You are the senior doctor in resus today. Obtain informed consent for sedation from Mrs Lee. Appropriate consent has already been done for the joint reduction.

80% Communication 20% knowledge

actor brief

You were told when you had your hip operation that it couldn't be done under GA as you were too high risk. You are anxious about this procedure now despite the pain.

PMH: osteoporosis, previous CABG x2,

examiner brief

  • Wash hands, introduce self
  • Confirms patient identity
  • Gains relevant history
    • event history
    • PMH, DHx
    • last food/drink
    • weight
    • previous anaesthetic history

Suitable patient?

  • States will do an airway assessment
  • asks for specific contraindications
    • ketamine: active respiratory disease, allergy, porphyrias, breastfeeding/pregnant, <12 months old, hyperthyroidism
      Suitable procedure?
  • Explain indication for sedation
  • Complications of sedation
    • ketamine: laryngospasm, N+V, emergence phenomenon, breathing support (quoted as 0.02%)
    • propofol: hypotension, stinging at injection site
  • What will happen if complications occur
    Suitable place? Suitable team?
  • Explains process
    • Appropriate staffing - 2 doctors (proceduralist, 1 for sedation), 1 nurse
    • monitoring including etCO2, positioning
    • IV access needed
  • Explains expected effect
    • Calm and painfree but verbal contact maintained
    • spontaneously breathing
    • may have memory of event
  • Explains recovery
    • Ketamine: about 90 mins
    • If child - parent remain with patient
  • Invites questions
  • Addresses concerns
  • Gains informed consent

#mrcem-osce #osce-answer-questions

Ketamine side effects as quoted in WAHT guidelienes:

  • Mild Agitation (20%)
  • Hypersalivation and lacrimation (<10%) – recent evidence suggests anticholingeric (e.g. atropine) co-administration is not necessary. 11,12
  • Involuntary movements / ataxia (5%) 14
  • Vomiting – 5-10% of children will vomit in the recovery period 14
  • Transient Rash (10%) 14
  • 0.3% incidence laryngospasm - higher risk during active respiratory disease