Question regarding procedural sedation. During a recent call we had a patient that was believed to be flash pulmonary oedema (audible crackles, blood tinged frothy sputum, confusion). The patient was quite agitated, wouldnt answer questions, resistive to any intervention or assessment, resistant to vitals and non-tolerable of O2 via any route and had difficulty remaining still. Is it reasonable to consider sedation for these patients? Would this be considered a special circumstance requiring BHP consultation? Would Ketamine be the drug of choice over Midazolam?

Under the Procedural Sedation Medical Directive, the Indications are Post intubation OR transcutaneous pacing€. Therefore, the use of procedural sedation for other indications, such as you describe, would require a BHP patch.

The drug of choice would depend on multiple factors and can be discussed with the BHP during the consult.

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BHP Patch, Indications

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