Procedural sedation and analgesia for adults in the emergency department
Bibliographic record
Abstract
A 59 year old woman presents to the emergency department with an isolated anterior dislocation of her left shoulder after a fall. Other than controlled asthma, she is healthy. Her last meal was four hours before the injury. After adequate analgesia using intravenous fentanyl, and despite an initial attempt to reduce her dislocation using relaxation techniques, it becomes evident that she needs sedation to complete the procedure successfully. Patients in the emergency department often need to undergo painful, distressing, or unpleasant diagnostic and therapeutic procedures as part of their care. The use of various analgesic, sedative, and anaesthetic agents has been outlined in several well referenced guidelines.1 2 3 4 The American Society of Anesthesiologists (ASA) describes four levels of non-dissociative sedation—from minimal sedation to general anaesthesia—in addition to dissociative sedation (box).2 In practice, prolonged deep sedation or general anaesthesia is rarely used in the emergency department in the absence of a clinician with appropriate training in anaesthesia. #### Levels of sedation as described by the American Society of Anesthesiologists2 ##### Non-dissociative sedation
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".