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Emergency Sedation and Treatment Strategies in Challenging Cases

This document outlines five complex clinical scenarios involving emergency cases that require sedation and treatment strategies. The scenarios include a toddler with a head injury, an intoxicated man with a shoulder dislocation, a child with a painful boil, a patient with schizophrenia and severe burns, and an elderly man with dementia who has been bitten by a dog. Each situation presents unique challenges, including patient cooperation, appropriate medication choices, and the need for procedural sedation in a non-surgical setting.

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Emergency Sedation and Treatment Strategies in Challenging Cases

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  1. Scenario 1 A two year old fell 3 feet and hit his head on concrete. 3 hours prior to the visit. He is cranky and has vomited 3x but has a normal neuro exam and a bump on his forehead. He will not hold still for a CT head exam. Your choice of sedation?

  2. Scenario 2 • A 45 year old highly intoxicated man rolled his 4 wheeler in the ditch. His shoulder hurts and on x-ray shows an anterior dislocation. His blood alcohol level is 350 and when awake he cries about his shoulder and curses you. • How would you reduce his shoulder? • What choice of meds and dose?

  3. Scenario 3 • A three year old presents with a 5 cm loil on his buttocks. The boil is painful and fluctuant. You have no surgeon or anest…in your town. • What do you do?

  4. Scenario 4 • A 51 year old with Schizophrenia has a 4 day old 2o burn 4x 5” on his left leg. The blisters have popped and there is dead skin and pusulant drainage. It hurst so bad he tried to chut his leg off and has a 5” laceration to his mid ant. Thight down to the fascia. • You believe procedural sedation might be helpful. • Your choice of meds? • Same pt but no psychosis. • Meds?

  5. Scenario 5 • An 81 year old male with dementia, COPD, CHF got bit by his dog on the leg. He’s DPOA for HC says treat but he won’t hold still to clean out the cut. The ER is a zoo. • What do you do?

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