What's Your Diagnosis? Procedural Sedation and Analgesia in the ED

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got last month’s case on Emergency Department Management of Cellulitis and Other Skin and Soft-Tissue Infections correct.

Case Presentation: Procedural Sedation and Analgesia in the Emergency Department

A 30-year-old man with no past medical history presents to the ED after falling off a ladder, landing on his right shoulder…

You perform a 3-view shoulder x-ray and find that his right shoulder is anteriorly dislocated. The patient states that he had eaten lunch just prior to this event. The patient is in pain and very resistant to any manipulation. You know that procedural sedation will be needed, but you wonder if he is eligible since he just ate…

Case Conclusion

After attempting to reduce his shoulder without sedation, you decided to perform procedural sedation to reduce his anteriorly dislocated right shoulder. After you consented the patient for procedural sedation and placed him on capnography, you decided to use 1 mg/kg of propofol IV immediately, without preprocedural fasting. The procedure went well, with adequate reduction of the right shoulder. You monitored him in the ED for 30 minutes until he was back to baseline mental status. You placed procedural sedation discharge instructions in his discharge papers, made sure he had a safe ride home, and discharged him.