ER Procedural Sedation Dr Bocks Checklist patient label

ER Procedural Sedation Dr. Bock’s Checklist patient label wt_____kg Patient Assessment for Procedural Sedation q Relevant PMHx: ___________________________ q Prior anesthetic difficulty/in family None / _________________ q Allergies confirmed q Planned procedure: __________________________ q Loose/false teeth? None / ____________________ q Mallampati : 1 2 3 4 q Neck mobility: Normal / ____________________ q TM distance, mouth opening Normal / ______________ q Anticipated difficult airway? No / Yes: ______________ Any concerns preventing safe procedural sedation? No / Yes Final Bedside Checklist q Informed consent obtained? q Pt on cardiac/sat/capno/bp cycling? q O 2 applied via 100% NRB >3 minutes? q BVM bedside and running? q Suction connected and bedside? q Location of RSI kit confirmed? q Crash cart with airway equipment bedside? q Any patient or team concerns? Notes: _________________________________________________________ _____________________________ Date: Time: Signature: