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Discipline

: Emergency

Sub Discipline

: Emergency

Document Title

: ETD Procedural Sedation and Analgesia Note (PSA)

Procedure Name

Performing Staff

Location

Consent

YesNo

Date Time Start

Date Time End

VITALS PRIOR TO PROCEDURAL SEDATION

Vital Signs & Other Observations

OXYGEN DELIVERY DURING PROCEDURAL SEDATION

Method Of Oxygen Delivery

Flow Rate Delivered

MEDICATION

Administration Of Resuscitation Drugs

Please Update Method

SEDATION DOCUMENTATION

Patient's Behaviour Immediately Prior To The Administration Of The Sedation Drugs

Sedation Was Unsuccessful

YesNo

ADVERSE OUTCOME DOCUMENTATION

Oxygen Desaturation <90%

YesNo

Clinically Apparent Pulmonary Aspiration

YesNo

Bradycardia

YesNo

Hypotension

YesNo

Excitatory Movements

YesNo

Unpleasant Recovery Reactions

YesNo

Permanent Complications

YesNo

Respiratory Depression

YesNo

Requiring Endotracheal Intubation After The Procedure

YesNo

Others

SIGNATURES

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