Download N2O/O2 CONSCIOUS SEDATION: Progress Notes:

N2O/O2 CONSCIOUS SEDATION: Progress Notes
Name
Date
Patient Informed Consent: 
NIL BY MOUTH FOR 2 HOURS prior to sedation 
MH Review
CONTRAINDICATIONS TO N2O? 
Respiratory Infections
Sinus/ Nasopharyngeal Obstruction
COPD
Ear Infection / Middle Ear problems
Psychiatric or Personality Disorders
Colostomy
Other Medical Conditions/Medications
SURGERY IN THE LAST
THREE MONTHS?
Eye Surgery (especially retinal surgery).
Ear Surgery
Abdominal (especially endoscopic)
Other:
Pre-Op Vital Signs: B/P ______/_____ Hg mm Pulse______/min Resp______/min
Pre-Op 100% O2 administered for 5 minutes
TITRATION: Administered by:
Time:_______am/pm______% N2O______% O2
Time:_______am/pm______% N2O______% O2
Time:_______am/pm______% N2O______% O2
Time:_______am/pm______% N2O______% O2
Vital Signs: B/P ______/_____ Hg mm Pulse______/min Resp______/min
Observations: Colour 
Resp
Pupils 
N2O/O2 Total Flow Rate______Litres/min for _____minutes
Post-Op 100% O2 administered for 5 minutes
Post-Op Vital Signs: B/P ______/_____ Hg mm Pulse______/min Resp______/min
Patient ALERT and ORIENTATED upon dismissal
Post-Op Instructions given: Written Verbal 
Notes:
Normal Values (adult ): B/P <120/80mmHg Pulse: 60-100/ min Resp: 15-20/min FBS: 3.6 -5.8 mM