LA SEacuteDATION- ANALGEacuteSIE

04thinsp2015LIGNESDIRECTRICES

Publication du Collegravege des meacutedecins

du Queacutebec

CollegravegethinspdesthinspmeacutedecinsthinspduthinspQueacutebec

2170thinspboulevardthinspReneacute-LeacutevesquethinspOuestthinsp

Montreacutealthinsp(Queacutebec)thinspH3Hthinsp2T8thinsp

Teacuteleacutephonethinspthinsp514thinsp933-4441thinspouthinsp

1thinsp888thinspMEacuteDECINthinsp

Teacuteleacutecopieurthinspthinsp514thinsp933-3112thinsp

SitethinspWebthinspthinspwwwcmqorgthinsp

Courrielthinspthinspinfocmqorg

Coordination

Servicethinspdesthinspcommunications

Graphisme

FrancisthinspBernier

Reacutevision linguistique

OdettethinspLord

Cethinspdocumentthinsppreacuteconisethinspunethinsppratiquethinsp

professionnellethinspinteacutegrantthinsplesthinspdonneacuteesthinsp

scientifiquesthinsplesthinspplusthinspreacutecentesthinspauthinsp

momentthinspthinspdethinspsathinsppublicationthinspCependantthinsp

ilthinspestthinsppossiblethinspquethinspdethinspnouvellesthinspconnais-

sancesthinspscientifiquesthinspfassentthinspeacutevoluerthinsplathinsp

compreacutehensionthinspduthinspcontextethinspdeacutecritthinspdansthinsp

cethinspdocument

Lethinsppreacutesentthinspdocumentthinspestthinspvalidethinspdansthinsplathinsp

mesurethinspougravethinspaucunethinspdispositionthinspleacutegislativethinsp

outhinspreacuteglementairethinspagravethinsplrsquoeffetthinspcontrairethinspouthinsp

incompatiblethinspnrsquoestthinspsusceptiblethinspdethinsplethinsp

modifierthinspouthinspdethinsplrsquoaffecterthinspdirectementthinspouthinsp

indirectementthinspetthinspcethinspdethinspquelquethinspfaccedilonthinsp

quethinspcethinspsoit

La reproduction est autoriseacutee agrave condition

que la source soit mentionneacutee

Deacutepocirctthinspleacutegalthinspthinsp2ethinsptrimestrethinsp2015

BibliothegravequethinspetthinspArchivesthinspnationalesthinspthinsp

duthinspQueacutebec

BibliothegravequethinspetthinspArchivesthinspCanada

CMQthinspthinspISBNthinsp978-2-9815140-0-4thinsp(PDF)thinsp

OIIQthinspthinspISBNthinsp978-2-89229-654-9thinsp(PDF)

OPIQthinspthinspISBNthinsp978-2-9815269-1-5thinsp(PDF)

copythinspCollegravegethinspdesthinspmeacutedecinsthinspduthinspQueacutebecthinsp

Ordrethinspdesthinspinfirmiegraveresthinspetthinspinfirmiersthinspduthinsp

QueacutebecthinspetthinspOrdrethinspprofessionnelthinspdesthinsp

inhalotheacuterapeutesthinspduthinspQueacutebecthinsp

avrilthinsp2015

NotethinspthinspDansthinspcettethinsppublicationthinsplethinspmasculinthinsp

estthinsputiliseacutethinspsansthinsppreacutejudicethinspetthinspseulementthinsp

pourthinspfaciliterthinsplathinsplecture

2440

Publication du Collegravege des meacutedecins

du Queacutebec

CollegravegethinspdesthinspmeacutedecinsthinspduthinspQueacutebec

2170thinspboulevardthinspReneacute-LeacutevesquethinspOuestthinsp

Montreacutealthinsp(Queacutebec)thinspH3Hthinsp2T8thinsp

Teacuteleacutephonethinspthinsp514thinsp933-4441thinspouthinsp

1thinsp888thinspMEacuteDECINthinsp

Teacuteleacutecopieurthinspthinsp514thinsp933-3112thinsp

SitethinspWebthinspthinspwwwcmqorgthinsp

Courrielthinspthinspinfocmqorg

Coordination

Servicethinspdesthinspcommunications

Graphisme

FrancisthinspBernier

Reacutevision linguistique

OdettethinspLord

Cethinspdocumentthinsppreacuteconisethinspunethinsppratiquethinsp

professionnellethinspinteacutegrantthinsplesthinspdonneacuteesthinsp

scientifiquesthinsplesthinspplusthinspreacutecentesthinspauthinsp

momentthinspthinspdethinspsathinsppublicationthinspCependantthinsp

ilthinspestthinsppossiblethinspquethinspdethinspnouvellesthinspconnais-

sancesthinspscientifiquesthinspfassentthinspeacutevoluerthinsplathinsp

compreacutehensionthinspduthinspcontextethinspdeacutecritthinspdansthinsp

cethinspdocument

Lethinsppreacutesentthinspdocumentthinspestthinspvalidethinspdansthinsplathinsp

mesurethinspougravethinspaucunethinspdispositionthinspleacutegislativethinsp

outhinspreacuteglementairethinspagravethinsplrsquoeffetthinspcontrairethinspouthinsp

incompatiblethinspnrsquoestthinspsusceptiblethinspdethinsplethinsp

modifierthinspouthinspdethinsplrsquoaffecterthinspdirectementthinspouthinsp

indirectementthinspetthinspcethinspdethinspquelquethinspfaccedilonthinsp

quethinspcethinspsoit

La reproduction est autoriseacutee agrave condition

que la source soit mentionneacutee

Deacutepocirctthinspleacutegalthinspthinsp2ethinsptrimestrethinsp2015

BibliothegravequethinspetthinspArchivesthinspnationalesthinspthinsp

duthinspQueacutebec

BibliothegravequethinspetthinspArchivesthinspCanada

CMQthinspthinspISBNthinsp978-2-9815140-0-4thinsp(PDF)thinsp

OIIQthinspthinspISBNthinsp978-2-89229-654-9thinsp(PDF)

OPIQthinspthinspISBNthinsp978-2-9815269-1-5thinsp(PDF)

copythinspCollegravegethinspdesthinspmeacutedecinsthinspduthinspQueacutebecthinsp

Ordrethinspdesthinspinfirmiegraveresthinspetthinspinfirmiersthinspduthinsp

QueacutebecthinspetthinspOrdrethinspprofessionnelthinspdesthinsp

inhalotheacuterapeutesthinspduthinspQueacutebecthinsp

avrilthinsp2015

NotethinspthinspDansthinspcettethinsppublicationthinsplethinspmasculinthinsp

estthinsputiliseacutethinspsansthinsppreacutejudicethinspetthinspseulementthinsp

pourthinspfaciliterthinsplathinsplecture

2440

CMQ - OIIQ - OPIQ 03

mdash Membres du groupe de travail pour la reacutedaction de lignes directrices conjointes en seacutedation-analgeacutesie

COMITEacute DE REacuteDACTION

SERGEthinspDUPONTthinspMDthinspDirectionthinspdethinsp

lrsquoameacuteliorationthinspdethinsplrsquoexercicethinspCollegravegethinspthinsp

desthinspmeacutedecinsthinspduthinspQueacutebec

SUZANNEthinspDURANDthinspinfthinspMthinspScthinspinfthinsp

DESSthinsp(bioeacutethique)thinspdirectricethinspDirectionthinsp

Deacuteveloppementthinspetthinspsoutienthinspprofessionnelthinsp

Ordrethinspdesthinspinfirmiegraveresthinspetthinspinfirmiersthinspthinsp

duthinspQueacutebec

MICHELthinspGARNERthinspMDthinspurgentologuethinspHocircpitalthinsp

duthinspSacreacute-CœurthinspdethinspMontreacuteal

CEacuteLINEthinspGEacuteLINASthinspinfthinspMthinspScthinspPhthinspDthinspprofesseurethinsp

agreacutegeacuteethinspEacutecolethinspdesthinspsciencesthinspinfirmiegraveresthinspIngramthinsp

UniversiteacutethinspMcGillthinspetthinspchercheurethinspCentrethinspdethinsp

recherchethinspenthinspsciencesthinspinfirmiegraveresthinspetthinspInstitutthinsp

LadythinspDavisthinspHocircpitalthinspgeacuteneacuteralthinspjuif

MARGARETthinspJEANthinspHAIGthinspMDthinsp

anestheacutesiologistethinspCHUthinspSainte-Justine

FRANCcedilOISthinspHEacuteBERTthinspinhthinspHocircpitalthinspdethinspLaSalle

LISEthinspMORINthinspMDthinspanestheacutesiologistethinspHocircpitalthinsp

Pierre-Boucher

JEacuteROcircMEthinspOUELLETthinspinfthinspMAthinspinfirmier-

conseilthinspDirectionthinspDeacuteveloppementthinspetthinspsoutienthinsp

professionnelthinspOrdrethinspdesthinspinfirmiegraveresthinspetthinsp

infirmiersthinspduthinspQueacutebec

JOSEacuteEthinspPARENTthinspMDthinspgastro-enteacuterologuethinsp

preacutesidentethinspdethinsplrsquoAssociationthinspdesthinspthinsp

gastro-enteacuterologuesthinspduthinspQueacutebec

MARISEthinspTEacuteTREAULTthinspinhthinspMAthinspcoordonnatricethinsp

authinspdeacuteveloppementthinspprofessionnelthinspOrdrethinsp

professionnelthinspdesthinspinhalotheacuterapeutesthinspduthinspQueacutebec

REMERCIEMENTS

Lethinspcomiteacutethinspdethinspreacutedactionthinspremerciethinsplesthinsppersonnesthinsp

suivantesthinsppourthinspleurthinspcontributionthinspagravethinsplathinspversionthinsp

preacuteliminairethinspduthinspdocumentthinsp

thinsprsaquo NicolethinspBertrandthinspinhthinspCHUthinspSainte-Justine

thinsprsaquo Maria-HelenathinspDiasthinspchargeacuteethinspduthinspprojetthinspdethinsp

deacuteploiementthinsppourthinsplethinspprojetthinsppilotethinspPQDCCRthinsp

CentrethinspuniversitairethinspdethinspSanteacutethinspMcGillthinspHocircpitalthinsp

geacuteneacuteralthinspdethinspMontreacuteal

thinsprsaquo MichelthinspDussaultthinspinhthinspCliniquethinspdethinspchirurgiethinsp

estheacutetiquethinspYvanthinspLarocquethinsp

thinsprsaquo FreacutedeacutericthinspGrondinthinspinfthinspMthinspScthinspconseillerthinspcadrethinsp

clinicienthinspProgrammethinspclientegravelethinspSoinsthinspmeacutedi-

cauxthinspspeacutecialiseacutesthinspCentrethinsphospitalierthinspuniversi-

tairethinspdethinspSherbrooke

thinsprsaquo EacutemiliethinspLavalleacuteethinspinfthinspMthinspScthinspconseillegraverethinspclini-

ciennethinspenthinspsoinsthinspinfirmiersthinspDSIPSSSthinspassocieacuteethinsp

authinspprogrammethinspclientegravelethinspSanteacutethinspdethinsplathinspfemmethinsp

etthinspdethinsplrsquoenfant

thinsprsaquo FrancinethinspLeHouillierthinspinhthinspCHUthinspdethinspQueacutebec

thinsprsaquo MichegravelethinspMarchandthinspMDthinspDirectionthinspgeacuteneacuteralethinsp

CollegravegethinspdesthinspmeacutedecinsthinspduthinspQueacutebec

thinsprsaquo DaniegravelethinspNormandinthinspinfthinspMthinspScthinspconseillegraverethinsp

cliniciennethinspenthinspsoinsthinspinfirmiersthinspSoinsthinspambu-

latoiresthinspenthinspmeacutedecinethinspDirectionthinspdesthinspsoinsthinsp

infirmiersthinspHocircpitalthinspMaisonneuve-Rosemontthinsp

thinsprsaquo FrancethinspSt-JeanthinspinhthinspDESSthinspenthinspenseignementthinsp

CollegravegethinspdethinspRosemontthinsp

thinsprsaquo JohannethinspSolarithinspinhthinspCHUthinspSainte-Justine

Ainsithinspquethinsplesthinspdiffeacuterentsthinspordresthinspetthinspassociationsthinsp

consulteacutesthinsp

mdash Table des matiegraveres

06Introduction

08Chapitre 1 Patient adulte

08

11thinspthinspDeacutefinitionthinspobjectifsthinspetthinsp

clientegravelethinspcible

11Volet organisationnel

11

12thinspCompeacutetencesthinsp

professionnelles

11

13thinspRessourcesthinspmateacuterielles

15Volet professionnel

15

14thinspPreacuteseacutedation-analgeacutesie

15

Seacutelectionthinspdesthinsppatients

15

Eacutevaluationthinspdesthinsppatients

17

Consentementthinsp(reacutesumeacute)

19

Directivesthinspetthinspconseils

20

15thinspPerseacutedation-analgeacutesie

20

Approchethinsppharmacologique

25

Surveillancethinspclinique

29

16thinspPostseacutedation-analgeacutesie

30

17thinspDocumentationthinspdesthinspsoinsthinsp

etthinsptenuethinspdethinspdossiers

32Chapitre 2 Patient

peacutediatrique

32

Preacuteambule

32

21thinspObjectifsthinspetthinspclientegravelethinsp

ciblethinsp

35Volet organisationnel

35

22thinspCompeacutetencesthinsp

professionnelles

35

23thinspRessourcesthinspmateacuteriellesthinsp

36Volet professionnel

36

24thinspPreacuteseacutedation-analgeacutesiethinsp

36

Seacutelectionthinspdesthinsppatientsthinsp

37

Eacutevaluationthinspdesthinsppatientsthinsp thinsp

thinsp

thinsp

37

Consentementthinsp(reacutesumeacute)

37

Directivesthinspetthinspconseils

38

25thinspPerseacutedation-analgeacutesie

38

Approchethinsppharmacologique

38

Approchethinspnonthinsp

pharmacologique

39

Surveillancethinspclinique

43

26thinspPostseacutedation-analgeacutesie

43

27thinspDocumentationthinspdesthinsp

soinsthinspetthinsptenuethinspdethinspdossiers

44Conclusion

45Annexe I ndash Deacutefinition

de lrsquoanestheacutesie geacuteneacuterale

et des niveaux de

seacutedation-analgeacutesie selon

lrsquoAmerican Society of

Anesthesiologists (ASA)

46Annexe II ndash Information

compleacutementaire - lectures

drsquointeacuterecirct

mdash Table des matiegraveres

47Annexe III ndash Proceacutedures

protocoles ou algorithmes

48Annexe IV ndash Eacutevaluation des

voies aeacuteriennes supeacuterieures

au moyen du score de

Mallampati

49

Annexe V ndash Outil

drsquoeacutevaluation de

lrsquoapneacutee obstructive

du sommeil (AOS)

adapteacute agrave la consultation

preacuteanestheacutesiqueseacutedation-

analgeacutesie

50Annexe VI ndash Anamnegravese

aide mneacutemotechnique

51Annexe VII ndash Examen

physique aide

mneacutemotechnique

53Annexe VIII ndash Le

consentement

57Annexe IX- Eacutevaluation de

lrsquoefficaciteacute de la seacutedation

(exemples)

59Annexe X ndash Eacutevaluation de

lrsquoefficaciteacute de lrsquoanalgeacutesie

(exemples)

61

Annexe XI ndash Fiche

informative sur lrsquoutilisation

de la naloxone et du

flumazeacutenil

63Annexe XII ndash Consignes

pour la surveillance agrave

domicile au moment du

deacutepart

66Reacutefeacuterences

CMQ - OIIQ - OPIQ 06

INTRODUCTIONLesthinsppreacutesentesthinsplignesthinspdirectricesthinspremplacentthinspcellesthinspduthinspCollegravegethinspdesthinspmeacutedecinsthinspduthinspQueacutebecthinsp(Utilisation de la seacutedation-analgeacutesiethinspndashthinsp2009)thinspetthinsplethinspguidethinspdethinsppratiquethinspcliniquethinspdethinsplrsquoOrdrethinspprofessionnelthinspdesthinspinhalotheacuterapeutesthinspduthinspQueacutebecthinsp(La seacutedation-analgeacutesiethinspndashthinsp2009)thinspEllesthinspontthinspeacuteteacutethinspeacutelaboreacuteesthinspconjointementthinspparthinsplethinspCollegravegethinspdesthinspmeacutedecinsthinspduthinspQueacutebecthinsp(CMQ)thinsplrsquoOrdrethinspdesthinspinfirmiegraveresthinspetthinspinfirmiersthinspduthinspQueacutebecthinsp(OIIQ)thinspetthinsplrsquoOrdrethinspprofessionnelthinspdesthinspinhalotheacuterapeutesthinspduthinspQueacutebecthinsp(OPIQ)thinspetthinspellesthinspontthinsppourthinspobjectifthinspdrsquoharmoniserthinsplathinsppratiquethinspcliniquethinspdethinsplathinspseacutedation-analgeacutesiethinsp

Ellesthinspconcernentthinspsurtoutthinsplesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspeffectueacuteesthinspsousthinspseacutedation-analgeacutesiethinspdethinspniveauthinspminimalthinspagravethinspmodeacutereacutethinspchezthinspdesthinsppatientsthinspclasseacutesthinspprincipalementthinspdansthinsplesthinspcateacutegoriesthinspASAthinspPhysicalthinspStatusthinsp1thinspetthinsp2thinspetthinspsousthinspcertainesthinspconditionsthinspdethinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp3thinspetthinsp4thinspLathinspseacutedation-analgeacutesiethinspdethinspniveauthinspprofondthinspetthinsplrsquoanestheacutesiethinspgeacuteneacuteralethinspnethinspfontthinsppasthinsplrsquoobjetthinspdethinspcettethinsppublicationthinspetthinspdoiventthinspecirctrethinspplutocirctthinspreacutealiseacuteesthinspdansthinspdesthinspeacutetablissementsthinspposseacutedantthinsptoutesthinsplesthinspinstallationsthinspetthinsplesthinspressourcesthinspprofessionnellesthinspayantthinsplrsquoexpertisethinspthinsprequisethinsppourthinspassurerthinspunethinspprisethinspthinspenthinspchargethinspoptimalethinspetthinspseacutecuritaire

Ellesthinspdeacutecriventthinsplrsquoensemblethinspdesthinspconditionsthinspexigeacuteesthinsplorsquethinsplrsquoonthinspprocegravedethinspagravethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspsousthinspseacutedation-analgeacutesiethinspquethinspcethinspsoitthinsppourthinspunthinspadultethinspouthinspunthinspenfantthinspEllesthinspsontthinspconccediluesthinspdansthinsplethinspbutthinspdrsquooffrirthinspdesthinsprecommandationsthinspvisantthinspunthinspdegreacutethinspoptimalthinspdethinspseacutecuriteacutethinspnotammentthinspenthinspcethinspquithinspconcernethinsplrsquoeacutevaluationthinsplathinspsurveillancethinspcliniquethinspythinspcompristhinsplethinspmonitoragethinspetthinsplathinspmeacutedicationthinsppeu importethinsplrsquoendroitthinspougravethinsplathinspseacutedation-analgeacutesiethinspestthinspeffectueacuteethinspEllesthinspdeacutecriventthinspeacutegalementthinsplesthinspcompeacutetencesthinspprofessionnellesthinspneacutecessairesthinsppourthinsplathinspreacutealisationthinspdrsquounethinspseacutedation-analgeacutesiethinspoptimalethinspetthinspseacutecuritairethinsplesthinspressourcesthinsphumainesthinspetthinspmateacuteriellesthinsprequisesthinsplathinspmarchethinspagravethinspsuivrethinsplesthinsppreacutecautionsthinsprelativesthinspauthinspbien-ecirctrethinspetthinspagravethinsplathinspseacutecuriteacutethinspduthinsppatientthinspainsithinspquethinsplesthinspeacuteleacutementsthinspquithinspdoiventthinspecirctrethinspinscritsthinspauthinspdossierthinsp

Ellesthinspontthinspeacuteteacutethinspconccediluesthinsppourthinspquethinsplesthinspmembresthinspdethinspchacunthinspdesthinspordresthinsppuissentthinspfacilementthinspsrsquoythinspreconnaicirctrethinspselonthinsplesthinspmodaliteacutesthinspquithinspencadrentthinsplrsquoexercicethinspdethinspleurthinspprofessionthinsprespectivethinspdansthinspunthinspcontextethinspdethinsppratiquethinspinterprofessionnellethinsp

thinspthinspthinsp

CMQ - OIIQ - OPIQ 07

Puisquethinsplrsquoenfantthinsppossegravedethinspdesthinspcaracteacuteristiquesthinspquithinspluithinspsontthinsppropresthinspunethinspsectionthinspparticuliegraverethinspluithinspestthinspconsacreacuteethinsp

Enthinsptoutthinsptempsthinspnousthinspdevonsthinsprecourirthinspagravethinsplathinspseacutedation-analgeacutesiethinspavecthinspthinspcirconspectionthinspetthinspprudencethinspLrsquoeacutevaluationthinspduthinsppatientthinsplrsquoadministrationthinspthinspdethinsplathinspmeacutedicationthinspetthinsplathinspsurveillancethinspcliniquethinspdoiventthinspecirctrethinspeffectueacuteesthinspthinspavecthinsplathinspmecircmethinsprigueurthinspquethinsppourthinsplrsquoanestheacutesiethinspgeacuteneacuteralethinsp

CMQ - OIIQ - OPIQ 08

Chapitre 1 Patient adulte

thinsp11thinspDEacuteFINITIONthinspOBJECTIFSthinspETthinspCLIENTEgraveLEthinspCIBLEthinsp

Lathinspseacutedation-analgeacutesiethinspestthinspunethinspproceacutedurethinspquithinspsethinspdeacutefinitthinspcommethinspeacutetantthinsplrsquoadmi-nistrationthinspdethinspmeacutedicamentsthinspouthinspdethinspsubstancesthinspservantthinspagravethinspalteacutererthinsplethinspniveauthinspdethinspconsciencethinspdrsquounethinsppersonnethinspsathinspperceptionthinspdethinsplathinspdouleurthinspetthinspsathinsptoleacuterancethinspagravethinsplrsquoen-vironnementthinsptoutthinspenthinspluithinsppermettantthinspunethinspreacuteponsethinspagravethinsplathinspstimulationthinspverbalethinspouthinsptactilethinspetthinsplethinspmaintienthinspdrsquounethinspfonctionthinspcardiaquethinspetthinspventilatoirethinspadeacutequatethinspenthinsptousthinsppointsthinsp(OPIQthinsp2009)

Ellethinsppermetthinspdoncthinspdethinspmieuxthinsptoleacutererthinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspdethinspfaccedilonthinspseacutecuritairethinspCertainsthinsppatientsthinsprequerrontthinspsurtoutthinspunethinspseacutedationthinspdrsquoautresthinspunethinspanalgeacutesiethinspetthinsplathinspplupartthinsplesthinspdeuxthinspagravethinsplathinspfoisthinspLesthinspmeacutedicamentsthinspetthinsplathinspproceacutedurethinsputiliseacutesthinspdeacutependrontthinspprincipalementthinspduthinspniveauthinspdethinspseacutedationthinspetthinspdrsquoanal-geacutesiethinspdeacutesireacutethinspselonthinsplathinspnaturethinspetthinsplathinspdureacuteethinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacutera-peutiquethinspetthinspselonthinsplesthinspcaracteacuteristiquesthinspduthinsppatientthinspDrsquoailleursthinsplesthinspbesoinsthinspparticu-liersthinspduthinsppatientthinspdoiventthinspecirctrethinsppristhinspenthinspconsideacuteration

Lesthinspobjectifsthinspviseacutesthinspparthinsplathinspseacutedation-analgeacutesiethinsplorsthinspdrsquounethinspinterventionthinspdiagnos-tiquethinspouthinsptheacuterapeutiquethinspsontthinspdrsquoassurerthinsplathinspseacutecuriteacutethinspetthinsplethinspbien-ecirctrethinspduthinsppatientthinspetthinspdethinsppermettrethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspdethinspqualiteacutethinspenthinsp

a fournissantthinspunethinspanalgeacutesiethinspunethinspseacutedationthinspetthinspunethinspamneacutesiethinspadapteacutees

b controcirclantthinsplesthinspcomportementsthinspmoteursthinspnuisiblesthinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

c minimisantthinsplesthinspreacuteponsesthinsppsychologiquesthinspdeacutefavorablesthinspassocieacuteesthinspauxthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspdouloureusesthinspouthinspanxiogegravenesthinsp

Lathinspseacutelectionthinspdesthinsppatientsthinsppourthinsplathinspseacutedation-analgeacutesiethinspestthinspfondeacuteethinspsurthinsplrsquoeacutevaluationthinspcliniquethinspdethinspleurthinspeacutetatthinspdethinspsanteacutethinspAgravethinspcettethinspfinthinspilthinspestthinsprecommandeacutethinspdrsquoutiliserthinsplathinspclassi-ficationthinspdethinsplrsquoeacutetatthinspphysiquethinspduthinsppatientthinspquethinsplrsquoonthinsptrouvethinspdansthinsplethinsptableauthinspdethinsplathinsppagethinspsuivante

CMQ - OIIQ - OPIQ 09

Classification Eacutetatthinspdethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp1 Patientthinspenthinspbonnethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp2Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspleacutegegravere

ASAthinspPhysicalthinspStatusthinsp3Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgrave

ASAthinspPhysicalthinspStatusthinsp4Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgravethinspquithinsprepreacutesentethinspthinspunethinspmenacethinspconstantethinsppourthinspsathinspvie

ASAthinspPhysicalthinspStatusthinsp5Patientthinspmoribondthinspquithinspnethinspsurvivrathinsppasthinspthinspagravethinspmoinsthinspdrsquounethinspinterventionthinsp

ASAthinspPhysicalthinspStatusthinsp6Patientthinspdeacuteclareacutethinspenthinspeacutetatthinspdethinspmortthinspceacutereacutebralethinspdontthinsplesthinsporganesthinspontthinspeacuteteacutethinsppreacuteleveacutesthinspagravethinspdesthinspfinsthinspdethinspdon

Tableau 1Classification de lrsquoeacutetat physique du patient selon lrsquoAmerican Society of Anesthesiologists (ASA) (ASA Physical Status Classification System) [En ligne] (Notre traduction)

Ainsithinsplorsquethinsplathinspseacutedation-analgeacutesiethinspestthinspreacutealiseacuteethinspparthinspunthinspmeacutedecinthinspsansthinsplathinspcolla-borationthinspdirectethinspdrsquounthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesio-logiethinspouthinspenthinspreacuteanimationthinspcardiorespiratoirethinspavanceacuteethinsplesthinspinterventionsthinspdiagnos-tiquesthinspouthinsptheacuterapeutiquesthinspdoiventthinspecirctrethinspreacuteserveacuteesthinspprincipalementthinspauxthinsppatientsthinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp1thinspouthinspauxthinsppatientsthinspatteintsthinspdrsquounethinspaffectionthinspsysteacutemiquethinspleacutegegraverethinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp2thinsp

CMQ - OIIQ - OPIQ 10

Notonsthinspquethinspdansthinspdesthinspsituationsthinspparticuliegraveresthinspetthinspjustifieacuteesthinspauthinspdossierthinspmeacutedi-calthinsplathinspseacutedation-analgeacutesiethinsppeutthinspecirctrethinspeffectueacuteethinspchezthinsplesthinsppatientsthinspstablesthinspdethinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp3thinspetthinspexceptionnellementthinspdethinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp4thinspToutefoisthinspellethinspdoitthinsplrsquoecirctrethinspdansthinspdesthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspopti-malethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespira-toirethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspDethinspplusthinspcesthinsppatientsthinspdoiventthinspfairethinsplrsquoobjetthinspdrsquounethinspeacutevaluationthinspindividualiseacuteethinspetthinspplusthinspapprofondiethinsp

Lathinspprofondeurthinspdethinsplathinspseacutedationthinspetthinsplethinspniveauthinspdrsquoanalgeacutesiethinsprechercheacutethinspenthinspseacutedation-analgeacutesiethinspdoiventthinspcorrespondrethinspauxthinspniveauxthinsppermettantthinsplrsquoatteintethinspdesthinspobjectifsthinspviseacutesthinspetthinspecirctrethinspmesureacutesthinspagravethinsplrsquoaidethinspdrsquoeacutechellesthinspstandardiseacuteesthinspvalideacuteesthinspdethinsppreacutefeacuterencethinspetthinspadapteacuteesthinspauthinspcontextethinspetthinspagravethinsplathinspconditionthinspduthinsppatientthinspLesthinspniveauxthinspdethinspseacutedation-analgeacutesiethinspviseacutesthinsptelsthinspquethinspdeacutefinisthinspdansthinsplathinspclassificationthinspdethinsplrsquoASAthinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinspASAthinspHousethinspofthinspDelegatethinsp2014a)thinsp(annexethinspI)thinspdoiventthinspcorrespondentthinspagravethinsplrsquounthinspouthinsplrsquoautrethinspdesthinspdeuxthinspniveauxthinspsuivantsthinsp(CMQthinsp2009)thinsp

thinsprsaquo seacutedationthinspminimalethinspouthinsplaquothinspanxiolysethinspraquothinspougravethinsplrsquoappreacutehensionthinspduthinsppatientthinspestthinspdiminueacuteethinspsansthinspchangementthinspdethinspsonthinspniveauthinspdethinspconsciencethinspetthinspsansthinspalteacutererthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsplathinspventilationthinspetthinsplathinspfonctionthinspcardiovasculaire

thinsprsaquo seacutedationthinspmodeacutereacuteethinspougravethinsplathinspreacuteponsethinspauxthinspstimulithinspverbauxthinspouthinsptactilesthinspleacutegersthinspestthinspvolontairethinspsansthinspaffecterthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsplathinspventilationthinspspontaneacuteethinspetthinsplathinspfonctionthinspcardiovasculaire

Notonsthinsptoutefoisthinspquethinsplrsquoeacutequipethinspsoignantethinspparticipantthinspagravethinsplathinspproceacutedurethinspdoitthinspconnaicirctrethinsplethinspniveauthinspdethinspseacutedation-analgeacutesiethinspgeacuteneacuteralementthinspneacutecessairethinsppourthinspunethinspinterventionthinspdonneacuteethinspDethinspmecircmethinspellethinspdoitthinspecirctrethinsppreacutepareacuteethinspagravethinspgeacutererthinsplethinsppassagethinspmomentaneacutethinspagravethinspunthinspniveauthinspdethinspseacutedationthinspsupeacuterieurthinspagravethinspceluithinspquithinspathinspeacuteteacutethinspplanifieacutethinsp(crsquoest-agrave-direthinspplusthinspprofondthinspquethinsppreacutevu)thinspcethinspquithinsppeutthinspsurvenirthinspenthinsptoutthinsptempsthinsplorsthinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsp

CMQ - OIIQ - OPIQ 11

Volet organisationnel

thinsp12thinspCOMPEacuteTENCESthinspPROFESSIONNELLESthinsp

Consideacuterantthinspquethinsplathinspseacutedation-analgeacutesiethinspsrsquoinscritthinspdansthinspunethinsppratiquethinspdethinspcollabo-rationthinspentrethinsplethinspmeacutedecinthinspetthinspdrsquoautresthinspprofessionnelsthinspdethinsplathinspsanteacutethinsp(infirmiegraveresthinspetthinspinhalotheacuterapeutes)thinspilthinspimportethinspdethinsppreacuteciserthinspqursquounethinsputilisationthinspjudicieusethinspdethinspleursthinspcompeacutetencesthinspestthinspdethinspmisethinsppourthinspassurerthinsplathinspqualiteacutethinspetthinsplrsquoefficiencethinspdesthinspsoinsthinspAinsithinsptousthinspdoiventthinspavoirthinsplesthinspqualificationsthinsprequisesthinspdansthinsplethinspdomainethinspdethinsplathinspseacutedation-thinspanalgeacutesie

Dethinspplusthinsplrsquoeacutequipethinspsoignantethinspquithinspreacutealisethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacutera-peutiquethinspsousthinspseacutedation-analgeacutesiethinspdoitthinsp

a ecirctrethinspenthinspmesurethinspdrsquoeacutevaluerthinspadeacutequatementthinsplathinspconditionthinspdethinspsanteacutethinspduthinsppatientthinspetthinspdrsquoenthinspassurerthinsplathinspsurveillancethinspclinique

b connaicirctrethinspetthinsputiliserthinspjudicieusementthinsplathinspmeacutedicationthinspainsithinspquethinspsesthinspantagonistes

c posseacutederthinsplesthinspconnaissancesthinspetthinsplesthinspcompeacutetences1thinspneacutecessairesthinsppourthinspintervenirthinspenthinspsituationthinspdrsquourgencethinsptellethinspquethinsplathinspreacuteanimationthinspcardiorespiratoire2thinsp(dethinsppreacutefeacuterencethinspenthinspsoinsthinspavanceacutes)thinspcrsquoest-agrave-direthinspmaicirctriserthinspenthinspprioriteacutethinsplesthinsptechniquesthinspdethinsplathinspprisethinspenthinspchargethinspdethinsplathinspventilationthinspduthinspmassagethinspcardiaquethinspetthinspdethinsplathinspmeacutedicationthinspassocieacutee

d avoirthinsplrsquoexpertisethinsprequisethinspselonthinsplathinspclientegravelethinspviseacuteethinspetthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspagravethinspreacutealiserthinsp

thinsp13thinspRESSOURCESthinspMATEacuteRIELLESthinsp

1thinspLOCAUX

LrsquoameacutenagementthinspdesthinsplocauxthinspdoitthinsppermettrethinspdethinspreacutealiserthinspdethinspfaccedilonthinspadeacutequatethinspetthinspenthinsptoutthinsptempsthinspunethinspreacuteanimationthinspcardiorespiratoirethinspainsithinspqursquounethinspeacutevacuationthinspdrsquourgencethinsplethinspcasthinspeacutecheacuteantthinspEntrethinspautresthinsplathinspsuperficiethinspdoitthinsppermettrethinspauthinsppersonnelthinspdethinspcircu-lerthinsplibrementthinsplrsquoeacuteclairagethinspdoitthinspecirctrethinspsuffisantthinsplethinspmateacuterielthinspdrsquourgencethinsp(pthinspexthinspthinspdethinspreacuteani-mation)thinspdoitthinspecirctrethinspfacilementthinspaccessiblethinspetthinspentreposeacutethinspdansthinspunthinsplieuthinspconnuthinspdethinsptousthinsp

Selonthinsplesthinspmodaliteacutesthinspdethinspfonctionnementthinspetthinsplethinsptypethinspdrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsppratiqueacutethinspilthinspestthinspdrsquousagethinspdethinspdisposerthinspdrsquounethinspsallethinspdethinspreacutecupeacutera-tionthinspouthinspdrsquoobservation

1thinspthinspthinspthinspOnthinspentendthinspparthinspconnaissancesthinspetthinspcompeacutetencesthinspqursquoellesthinspsoientthinspmisesthinspagravethinspjourthinspselonthinsplesthinsprecommandationsthinspenthinspvigueur2thinspthinspthinspOnthinspentendthinspparthinspcertificationthinspenthinspreacuteanimationthinspcardiorespiratoirethinsplesthinspformationsthinspsuivantesthinspthinsp thinsprsaquothinspReacuteanimationthinspcardiorespiratoirethinspdethinspbasethinspthinspSoinsthinspimmeacutediatsthinspenthinspreacuteanimationthinsp(SIR)thinsppourthinspprofessionnelsthinspdethinsplathinspsanteacutethinspthinspthinspthinspthinspthinspthinspthinspthinspouthinsplrsquoeacutequivalentthinsp thinsprsaquothinspReacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspSoinsthinspavanceacutesthinspenthinspreacuteanimationthinspcardiovasculairethinsp(SARC)thinspouthinsplrsquoeacutequivalent

CMQ - OIIQ - OPIQ 12

Pourthinspinformationthinspcompleacutementairethinsp(annexethinspII)thinspProceacutedures et interventions en milieu extrahospitalierthinsp(CMQthinsp2011)

2thinspEacuteQUIPEMENTthinsp(INTRAthinspETthinspEXTRAHOSPITALIER)

OBLIGATOIRE

Enthinspplusthinspduthinspmateacuterielthinspdirectementthinsplieacutethinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspjustifiantthinsplathinspseacutedation-analgeacutesiethinsponthinspdoitthinsptrouverthinspminimalementthinsplrsquoeacutequipe-

mentthinspsuivant

Dansthinsplathinspsallethinsp

thinsprsaquo tablethinspdrsquoexamenthinspciviegraverethinspouthinsptablethinspdethinspchirurgiethinsprsaquo tablethinsppourthinsplesthinspinstrumentsthinsprsaquo soluteacutesthinspetthinspmateacuterielthinspneacutecessairethinsppourthinsplrsquoinstallationthinspetthinsplethinspmaintienthinspdrsquounethinspvoiethinsp

endoveineusethinsprsaquo saturomegravetrethinsp(oxymegravetrethinspdethinsppouls)thinsp

Lethinspmonitoragethinspdethinsplathinspsaturationthinspenthinspoxygegravenethinsppermetthinsplrsquoeacutevaluationthinspdethinsplrsquooxy-geacutenationthinsp(deacutetectionthinsppreacutecocethinspdrsquounethinsphypoxeacutemie)thinspmaisthinspilthinspnethinsppeutthinsppasthinspdeacutetecterthinsppreacutecocementthinspunethinspobstructionthinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(AmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2012)thinspthinsp

thinsprsaquo steacutethoscopethinspthinsprsaquo sphygmomanomegravetrethinspouthinspappareilthinspautomatiseacutethinspnonthinspinvasifthinsppourthinsplathinspprisethinspdethinsplathinsp

pressionthinsparteacuteriellethinsprsaquo sourcethinspdrsquooxygegravenethinspcomprimeacutethinspenthinspquantiteacutethinspsuffisantethinsppourthinspenthinsppermettrethinsp

llsquoadministrationthinspagravethinspunthinspdeacutebitthinspdethinsp15thinsplitresthinspparthinspminutethinsppendantthinsp60thinspminutesthinspetthinspthinsplethinspmateacuterielthinspneacutecessairethinspagravethinsplrsquooxygeacutenotheacuterapie

thinsprsaquo appareilthinspagravethinspaspirationthinsppouvantthinspgeacuteneacutererthinspunethinsppressionthinspneacutegativethinspdethinsp40ndash60thinspmmthinspHgthinspouthinspunethinspcapaciteacutethinspdethinspflotthinspdethinsp100thinsplitresthinspparthinspminutethinspetthinsplethinspmateacuterielthinspneacutecessairethinspthinspagravethinsplrsquoaspiration

thinsprsaquo lethinspmateacuterielthinspneacutecessairethinspagravethinsplathinspprisethinspenthinspchargethinspventilatoirethinspentrethinspautresthinspreacuteanimateurthinspmanuelthinspautogonflablethinsp(Ambuthinspbag)thinspmasquethinspcanulesthinspnasothinspthinspetthinsporopharyngeacuteesthinspdethinsptaillesthinspvarieacutees

Ce mateacuteriel doit ecirctre disponible agrave porteacutee de la main

CMQ - OIIQ - OPIQ 13

thinsprsaquo appareilthinspdrsquoalimentationthinspeacutelectriquethinspdethinspsecoursthinsppourthinsplethinspfonctionnementthinspdesthinspeacutequipementsthinspdrsquourgence

Peutthinspecirctrethinspagravethinsplrsquoexteacuterieurthinspdethinsplathinspsallethinsp(maisthinspfacilethinspdrsquoaccegravesthinspetthinsprapidementthinspdisponible)thinsp

thinsprsaquo thinsparmoirethinspfermeacuteethinsppourthinspentreposerthinspsousthinspcleacutethinspauthinspbesointhinsplethinspmateacuterielthinspetthinsplesthinspsubstancesthinspcontrocircleacuteesthinspainsithinspquethinsplesthinspbenzodiazeacutepines

thinsprsaquo mateacuterielthinspneacutecessairethinspagravethinsplrsquointubationthinspendotracheacutealethinspentrethinspautresthinspsondesthinspendotracheacutealesthinspetthinsplamesthinspdethinsplaryngoscopethinspdethinsptaillesthinspvarieacuteesthinspainsithinspquethinspdesthinspalternativesthinspagravethinsplrsquointubationthinspdifficilethinsp(pthinspexthinspthinspoutilsthinspextraglottiquesthinsptelsthinspquethinspmasquesthinsplaryngeacutes)

thinsprsaquo deacutefibrillateurthinspcardiaquethinsp(dethinsppreacutefeacuterencethinspunthinspdeacutefibrillateurthinspexternethinspautomatiseacutethinsp[DEA])

thinsprsaquo pharmaciethinsp(troussethinspouthinspchariot)thinspcontenantthinsplesthinspmeacutedicamentsthinspneacutecessairesthinspauthinsptraitementthinspdesthinspsituationsthinspdrsquourgencethinsptellesthinspquethinspthinspsurdosagethinspauxthinspopioiumldesthinspouthinspauxthinspbenzodiazeacutepinesthinspurgencethinspcardiaquethinspreacuteactionthinspallergiquethinspcrisethinspdrsquoasthmethinspcrisethinspconvulsivethinspchocthinspvagalthinsphypoglyceacutemiethinspetc

RECOMMANDEacutethinspSELONthinspLAthinspSITUATION

thinsprsaquo moniteurthinspcardiaquethinspthinspdansthinspcertainsthinspcasthinspbienthinspdeacutefinisthinsplethinspmonitoragethinspcardiaquethinsppeutthinspecirctrethinsprecommandeacutethinspouthinspobligatoirethinsp(tableauthinsp3)

thinsprsaquo capnographethinspthinspdansthinspcertainsthinspcasthinspbienthinspdeacutefinisthinsplethinspmonitoragethinspduthinspCO2thinsppeutthinspecirctrethinsp

recommandeacutethinspouthinspobligatoirethinsp(tableauthinsp3)thinspthinspLethinspmonitoragethinspduthinspCO

2thinsppermetthinspdrsquoidentifierthinsppreacutecocementthinsplesthinspcomplicationsthinsp

tellesthinsplathinspseacutedationthinspexcessivethinsplrsquohypoventilationthinspetthinsplrsquoapneacuteethinspenthinspplusthinspdethinsppermettrethinspdethinspmieuxthinspcontrocirclerthinsplethinspniveauthinspdethinspseacutedationthinspenthinspfonctionthinspdethinsplrsquointerventionthinspthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinspSonthinsputilisationthinsppermetthinspeacutegalementthinspthinspdethinspsuivrethinsplethinspmonitoragethinspventilatoirethinspCelathinspestthinspparticuliegraverementthinspapproprieacutethinspthinsplorsqursquoilthinspnrsquoexistethinsppasthinspdrsquoantagonistesthinspagravethinsplathinspmeacutedicationthinsputiliseacuteethinsp(pthinspexthinspthinsppropofol)thinsp

OPTIONNEL

thinsprsaquo moniteurthinspdethinsptempeacuteraturethinspetthinspdispositifthinspdethinspreacutechauffementthinspduthinsppatientthinspselonthinsplethinsppatientthinspetthinsplathinspdureacuteethinspdethinsplrsquointerventionthinsp

thinsprsaquo systegravemethinspdrsquoantipollutionthinsp(eacutevacuationthinspduthinspprotoxydethinspdrsquoazote)thinspsrsquoilthinspythinspathinsplieuthinsprsaquo analyseurthinspdrsquooxygegravenethinsplorsqursquounthinspmeacutelangethinspestthinsputiliseacutethinsp(pthinspexthinspthinspO

2thinspetthinspprotoxydethinsp

drsquoazote)thinsprsaquo steacutethoscopethinsppreacutecordialthinspouthinsppreacutetracheacutealthinsppourthinspeacutecoutethinspenthinspcontinu

CMQ - OIIQ - OPIQ 14

LrsquoensemblethinspdethinspcesthinspeacutequipementsthinspdoitthinspecirctrethinspadapteacutethinspauthinsppatientthinspIlsthinspdoiventthinspecirctrethinspenthinspeacutetatthinspdethinspfonctionnerthinspetthinsplesthinspattestationsthinspdesthinspveacuterificationsthinsppeacuteriodiquesthinspdoiventthinspecirctrethinspconserveacuteesthinspdansthinspunthinspregistrethinsppreacutevuthinspagravethinspcettethinspfin

Pendantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplesthinspprofessionnelsthinspdoiventthinspthinsprespecterthinsplesthinspregraveglesthinspdethinsppreacuteventionthinspetthinspdethinspcontrocirclethinspdesthinspinfections

Unethinspproceacutedurethinsprelativethinspauxthinspsituationsthinspdrsquourgencethinsp(annexethinspIII)thinspagravethinsplrsquoaccegravesthinspauxthinspser-vicesthinspdrsquourgencethinsppreacutehospitaliersthinspetthinspdethinsptransfertthinspselonthinspunethinspententethinspintereacutetablisse-mentsthinspdoitthinspecirctrethinspeacutelaboreacuteethinspmaintenuethinspagravethinspjourthinspfacilementthinspdisponiblethinspenseigneacuteethinspagravethinsptoutthinsplethinsppersonnelthinspetthinspfairethinsplrsquoobjetthinspdrsquounthinsprappelthinspaupregravesthinspdethinspcethinspdernierthinspsurthinspunethinspbasethinsp

peacuteriodiquethinsp

CMQ - OIIQ - OPIQ 15

Volet professionnel

thinsp14thinspPREacuteSEacuteDATION-ANALGEacuteSIEthinsp

SEacuteLECTIONthinspDESthinspPATIENTS

Lathinspseacutelectionthinspdesthinsppatientsthinspdoitthinsptenirthinspcomptethinspnotammentthinspdethinsplrsquoeacutevaluationthinspdesthinspvoiesthinspaeacuteriennesthinspetthinspdethinsplrsquoeacutetatthinspdethinspsanteacutethinspgeacuteneacuteralthinspduthinsppatientthinspquithinspaurontthinspmisthinspenthinspeacutevi-dencethinsplathinsppreacutesencethinspouthinsplrsquoabsencethinspdrsquoindicateursthinspdethinsppossiblesthinspcomplicationsthinsplorsthinspdethinsplathinspseacutedation-analgeacutesiethinspIlthinspexistethinspdeuxthinsptypesthinspdethinsprisquesthinspenthinspseacutedation-analgeacutesiethinspthinsplesthinsprisquesthinsppreacutevisiblesthinsp(difficulteacutethinsppotentiellethinsplieacuteethinspagravethinsplathinspgestionthinspdesthinspvoiesthinspaeacuteriennesthinspouthinspinstabiliteacutethinspduthinsppatient)thinspetthinsplesthinsprisquesthinspimpreacutevisiblesthinsp(incidentaccidentthinsperreurthinsphu-mainethinspetc)thinspUnethinspeacutevaluationthinspinitialethinsp(histoirethinspexamenthinspphysique)thinspadeacutequatethinspavantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspdiminuethinspdethinsptelsthinsprisques

Agravethinsppartirthinspdethinsplrsquoensemblethinspdesthinspeacutevaluationsthinspeffectueacuteesthinsplethinspmeacutedecinthinspseacutelectionnethinsplesthinsppatientsthinspaptesthinspagravethinsprecevoirthinspunethinspseacutedation-analgeacutesiethinspselonthinspnotammentthinsp

thinsprsaquo lesthinspfacteursthinspdethinsprisquethinspidentifieacutesthinspagravethinsplathinspsuitethinspdethinsplrsquoeacutevaluationthinsp(cardiovasculairethinsprespiratoirethinspheacutepatiquethinspneurologique)thinspdethinsplathinsppossibiliteacutethinspdethinspgrossessethinspchezthinsplathinspfemmethinspenthinspacircgethinspdethinspprocreacuteerthinspouthinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspenvisageacutee

thinsprsaquo lrsquoeacutevaluationthinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(annexethinspIV)thinspafinthinspdethinsppreacuteciserthinsplethinsprisquethinspdrsquoassistancethinspventilatoirethinspetthinspdrsquointubationthinspdifficilethinsp

thinsprsaquo lesthinspanteacuteceacutedentsthinspanestheacutesiquesthinspetthinspchirurgicauxthinspafinthinspdrsquoidentifierthinsplesthinspcomplicationsthinsppotentielles

thinsprsaquo lesthinspcomorbiditeacutesthinspdontthinsplesthinsptroublesthinsprespiratoiresthinspduthinspsommeilthinsp(annexethinspV)thinsprsaquo lathinspmeacutedicationthinspouthinspautresthinspsubstancesthinsp(prescritesthinspouthinspenthinspventethinsplibre)thinspafinthinsp

drsquoidentifierthinsplesthinsprisquesthinspdrsquointeractionsthinspavecthinsplesthinspmeacutedicamentsthinsputiliseacutesthinsplorsthinspdethinsplrsquointerventionthinspouthinspdethinsplathinspseacutedation-analgeacutesie

thinsprsaquo lrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspquithinsppourraitthinspneacutecessiterthinspunethinspseacutedation-analgeacutesiethinspdrsquounthinspniveauthinspsupeacuterieurthinspagravethinspceluithinspdontthinspilthinspestthinspquestionthinspdansthinspcesthinsplignesthinspdirectrices

thinsprsaquo lesthinspcaracteacuteristiquesthinsppropresthinspauthinsppatientthinsp(fonctionsthinspcognitivesthinspisolementthinspsocialthinspautonomiethinspetc)

EacuteVALUATIONthinspDESthinspPATIENTS

Cettethinspeacutevaluationthinspdoitthinspsethinspfairethinsppeuthinspdethinsptempsthinsp(moinsthinspdethinsp3thinspmoisthinspenthinsplrsquoabsencethinspdethinspchangementthinspnotablethinspdansthinsplathinspconditionthinspcliniquethinspduthinsppatient)thinspavantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspetthinspdoitthinspnotammentthinsppreacuteciserthinspcethinspquithinspsuit

CMQ - OIIQ - OPIQ 16

AgravethinspLrsquoANAMNEgraveSEthinspthinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsp

lrsquoeacutevaluationthinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinsp(annexethinspVI)thinsp

thinsprsaquo raison(s)thinspdethinspconsultationthinspetthinsphistoirethinspdethinsplathinspmaladiethinspactuellethinsprsaquo anteacuteceacutedentsthinsprsaquo reacuteactionthinspanteacuterieurethinspagravethinsplathinspseacutedation-analgeacutesiethinspagravethinsplrsquoanestheacutesiethinspetthinspagravethinsplathinspchirurgiethinsprsaquo allergiesthinsprsaquo momentthinspduthinspdernierthinspingestathinsp(preacuteciserthinsplethinsptypethinspetthinsplathinspquantiteacute)thinsprsaquo meacutedicationthinspetthinspautresthinspsubstancesthinsp(prescritesthinspouthinspnon)thinsprsaquo preacutemeacutedicationthinspreccediluethinsp(pthinspexthinspthinspadministrationthinspdethinspmorphinethinspchezthinspunthinsppatientthinspenthinsp

attentethinspdrsquounethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutique)thinsprsaquo habitudesthinspdethinspviethinsp(tabacthinspalcoolthinspouthinspdrogues)thinsprsaquo troublethinsprespiratoirethinspduthinspsommeilthinspetthinsplathinsptheacuterapiethinspassocieacutee

AgravethinspLrsquoEXAMENthinspPHYSIQUEthinsp

Lrsquoexamenthinspphysiquethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinspcherchethinspagravethinspmettrethinspenthinspeacutevi-dencethinspcertainsthinspcritegraveresthinspreconnusthinsppourthinspecirctrethinspassocieacutesthinspagravethinspunethinspassistancethinspventila-toirethinspdifficilethinspquithinsppeutthinspsurvenirthinspdansthinsplethinspcasthinspdrsquounthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquethinspceluithinspviseacutethinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsplrsquoeacutevaluationthinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinsp(annexethinspVII)thinsp

Lrsquoexamenthinspphysiquethinspdoitthinspecirctrethinspadapteacutethinspagravethinspchaquethinsppatientthinspetthinspporterthinspnotammentthinspsurthinspdesthinspeacuteleacutementsthinsptelsthinspquethinspceux-cithinsp

thinsprsaquo preacutesencethinspdrsquoobeacutesiteacutethinsprsaquo tecirctethinspetthinspcouthinsp

thinsprsaquo mobiliteacutethinspcervicalethinspcompromisethinsprsaquo couthinspcourtthinspouthinsplargethinsp(circonfeacuterencethinsp )thinsprsaquo pathologiethinspouthinspanomaliethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(pthinspexthinspthinspmassethinsp

cervicale)thinspthinsprsaquo bouchethinsp

thinsprsaquo petitethinspouverturethinsprsaquo dentitionthinsp(pthinspexthinspthinspbouchethinspeacutedenteacuteethinspdentsthinspinstablesthinspincisivesthinspproeacuteminentesthinsp

outhinspappareilthinspdentairethinspmalocclusionthinspimportante)thinsp

LethinspscorethinspdethinspMallampatithinspmodifieacutethinspestthinspunthinspoutilthinspagravethinspprivileacutegierthinsp(annexethinspIV)

CMQ - OIIQ - OPIQ 17

UnethinspbonnethinspeacutevaluationthinspdethinsptousthinsplesthinspaspectsthinsprelatifsthinspauthinspmaintienthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspestthinspessentiellethinspDethinspplusthinspchezthinsplethinsppatientthinspsymptomatiquethinspthinsp(pthinspexthinspthinspdyspneacutee)thinspcettethinspeacutevaluationthinspdoitthinspecirctrethinspcompleacuteteacuteethinspparthinsplrsquoauscultation cardiorespiratoirethinspFinalementthinspsithinspdrsquoautresthinspexamensthinspdoiventthinspecirctrethinspfaitsthinspleurthinspchoixthinspserathinspguideacutethinspparthinsplesthinspproblegravemesthinspmeacutedicauxthinspsous-jacents

Bienthinspquethinsplathinspseacutedation-analgeacutesiethinspnethinsppreacutevoitthinspnormalementthinsppasthinspdethinspprisethinspenthinspchargethinspcomplegravetethinspdethinsplathinspventilationthinsp(assistancethinspventilatoirethinspouthinspintubationthinspthinspendotracheacuteale)thinspilthinspestthinspimportantthinspdrsquoeffectuerthinspcettethinspeacutevaluationthinsppuisqursquoagravethinspthinsptoutthinspmomentthinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspunethinspventilationthinspthinspassisteacuteethinspavecthinspouthinspsansthinspintubationthinspendotracheacutealethinsppeutthinspsrsquoaveacutererthinspneacutecessairethinspthinspsithinsplathinsprespirationthinspestthinspcompromisethinsp

Lorsthinspdethinspsituationsthinspparticuliegraveresthinspouthinspcomplexesthinsplethinspmeacutedecinthinspdevraitthinspconsulterthinspunthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinsp

cardiorespiratoirethinspavanceacutee

CONSENTEMENTthinsp(REacuteSUMEacute)

LethinsplecteurthinspdoitthinspsethinspreacutefeacutererthinspagravethinsplrsquoannexethinspVIIIthinsppourthinsplethinsptextethinspcomplet

SelonthinsplethinspdroitthinspenthinspvigueurthinspauthinspQueacutebecthinspilthinspestthinspobligatoirethinspdrsquoobtenirthinsplethinspconsentementthinspdrsquounthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspintervention

LethinspCode civil du QueacutebecthinspeacutetablitthinspdesthinspregraveglesthinspgeacuteneacuteralesthinspconcernantthinsplethinspconsentementthinspauxthinspsoinsthinspquithinspsrsquoappliquentthinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspdispenseacutesthinspOnthinspythinspfaitthinspcependantthinspcertainesthinspdistinctionsthinspselonthinspquethinsplethinsppatientthinspestthinspaptethinspouthinspnonthinspagravethinspconsentirthinspetthinspselonthinspquethinsplesthinspsoinsthinspsontthinsprequisthinspouthinspnonthinsp

parthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspLathinspLoi sur les services de santeacute et les services sociaux (LSSSS)thinspeacutetablitthinspquantthinspagravethinspellethinsplesthinspregraveglesthinspapplicablesthinspenthinspeacutetablissementthinspenthinspmatiegraverethinspdethinspconsentementthinspauxthinspinterventionsthinspchirurgicalesthinspetthinspagravethinsplrsquoanestheacutesiethinsp

LethinspCode de deacuteontologie des meacutedecinsthinspstipulethinspquethinsplethinspmeacutedecinthinspdoitthinspobtenirthinspunthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspavantthinsptoutethinspinterventionthinspilthinspestthinsppreacuteciseacutethinspquethinsplethinspmeacutedecinthinspdoitthinspsrsquoassurerthinspquethinsplrsquoinformationthinsppertinentethinspathinspeacuteteacutethinsptransmisethinspfaciliterthinsplathinspprisethinspdethinspdeacutecisionthinspduthinsppatientthinspetthinsplathinsprespecterthinspLethinspCode de deacuteontologie

des infirmiegraveres et infirmiersthinspstipulethinspquantthinspagravethinspluithinspquethinsplrsquoinfirmiegraverethinspouthinsplrsquoinfirmierthinspdoitthinspfournirthinspauthinspclientthinsptoutesthinsplesthinspinformationsthinsprequisesthinsplorsquethinsplrsquoobligationthinspdrsquoobtenirthinspunthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspincombethinspagravethinsplrsquoinfirmiegraverethinspouthinspagravethinsplrsquoinfirmierthinspIlthinspnrsquoythinspathinsppasthinspdethinspdispositionthinsptouchantthinsppreacuteciseacutementthinsplethinspconsentementthinspdansthinsplethinspCode de

CMQ - OIIQ - OPIQ 18

deacuteontologie des inhalotheacuterapeutes du QueacutebecthinspCependantthinspilthinspestthinsppreacuteciseacutethinspqursquoenthinspplusthinspdesthinspavisthinspetthinspdesthinspconseilsthinsplrsquoinhalotheacuterapeutethinspdoitthinspfournirthinspagravethinspsonthinspclientthinsplesthinspexplicationsthinspneacutecessairesthinspagravethinsplathinspcompreacutehensionthinspetthinspagravethinsplrsquoappreacuteciationthinspdesthinspservicesthinspqursquoilthinspluithinsprend

TousthinsplesthinspprofessionnelsthinspsontthinspeacutevidemmentthinsptenusthinspdethinsprespecterthinsplesthinspdispositionsthinspleacutegalesthinspexistantesthinspndashthinspincluantthinspleurthinspcodethinspdethinspdeacuteontologiethinsprespectifthinspndashthinspetthinsplesthinspnormesthinspdethinsppratiquethinspeacutetabliesthinspparthinspleurthinspordrethinspprofessionnelthinspToutefoisthinsplathinspquestionthinspsethinspposethinspdethinspsavoirthinspcommentthinspcesthinspexigencesthinspdoiventthinspsrsquoappliquerthinspmaintenantthinspquethinspplusieursthinspinterventionsthinspreacutealiseacuteesthinspautrefoisthinspenthinspeacutetablissementthinspsontthinspeffectueacuteesthinspenthinspdehorsthinspthinspdethinspceux-cithinspetthinspquethinsplesthinspprofessionnelsthinsppartagentthinspcertainesthinspactiviteacutesthinspetthinsptravaillentthinsp

enthinspeacutetroitethinspcollaboration

Mecircmethinspsithinsplathinsploithinspnethinsplrsquoexigethinsppasthinsptoujoursthinspilthinspestthinsprecommandeacutethinsp

thinsprsaquo quethinsplethinsppatientthinspdonnethinspunthinspconsentementthinspeacutecritthinsplorsqursquoilthinspythinspathinspseacutedation-analgeacutesiethinspthinspetthinspcethinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspprodigueacutes

thinsprsaquo quethinsplethinspconsentementthinspportethinspagravethinsplathinspfoisthinspsurthinsplathinspseacutedation-analgeacutesiethinspetthinspsurthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspquethinspcettethinspderniegraverethinsppermet

thinsprsaquo quethinsplrsquoinformationthinsptransmisethinspauthinsppatientthinspverbalementthinspouthinspparthinspeacutecritthinspcomprennethinsplesthinsprisquesthinspdethinsplathinspseacutedation-analgeacutesiethinspetthinsplesthinsprisquesthinspdethinsplrsquointerventionthinspelle-mecircme

thinsprsaquo quethinsplethinspmeacutedecinthinspouthinsplethinspprofessionnelthinspagravethinspquithinspilthinspathinspconfieacutethinsplathinsptacircchethinspversethinspauthinspdossierthinspduthinsppatientthinspunethinspnotethinspexplicativethinspsurthinsplesthinspinformationsthinspfourniesthinspetthinsplethinspconsentementthinspobtenu

Lrsquoobtentionthinspdrsquounthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspdemeurethinspunethinspobligationthinspthinspinheacuterentethinspagravethinsplrsquointerventionthinspmeacutedicalethinspelle-mecircmethinspIlthinsprelegravevethinspdoncthinspdethinsplathinspresponsabiliteacutethinspduthinspmeacutedecinthinspdethinspsrsquoassurerthinspdethinsplathinsptransmissionthinspdethinsplrsquoinformationthinsppertinentethinspauthinsppatientthinspetthinspdethinspsathinspcompreacutehensionthinspdethinsplathinspnaturethinspduthinspbutthinspetthinspdesthinsprisquesthinsprelatifsthinspagravethinsplrsquointerventionthinspToutefoisthinsplathinsptacircchethinspdethinsptransmettrethinspdethinsplrsquoinformationthinspcompleacutementairethinsppeutthinspecirctrethinspconfieacuteethinspagravethinspdrsquoautresthinspprofessionnelsthinspthinspetthinspcellethinspdethinsprecueillirthinsplathinspsignaturethinspdrsquounthinspformulairethinspdethinspconsentementthinspagravethinspdrsquoautresthinspmembresthinspdethinsplrsquoeacutequipethinspdethinspsoins

CMQ - OIIQ - OPIQ 19

DIRECTIVESthinspETthinspCONSEILSthinsp

Avantthinspdethinspsubirthinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspsousthinspseacutedationthinsp-analgeacutesiethinsplethinsppatientthinspdoitthinsprecevoirthinsplesthinspdirectivesthinspneacutecessairesthinspdethinsppreacutefeacuterencethinspdansthinsp

unthinspdocumentthinspcontenantthinspentrethinspautresthinsplesthinsprecommandationsthinspsuivantesthinsp

a eacuteviterthinspdethinspconsommerthinsptoutethinspboissonthinspalcooliseacuteethinspdroguethinspouthinspsubstancethinspenthinspventethinsplibrethinsp(agravethinspmoinsthinspqursquoellethinspsoitthinspprescrite)thinsppouvantthinspalteacutererthinsplethinspniveauthinspdethinspconsciencethinspthinsp24thinspheuresthinspavantthinspetthinspapregravesthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

b observerthinspunethinsppeacuteriodethinspdethinspjeucircnethinspquithinspsrsquoappliquethinspagravethinsptoutthinspacircgethinspauxthinspcasthinspeacutelectifsthinsp(nonthinspurgents)thinspetthinspselonthinsplrsquoeacutevaluationthinspduthinsplaquothinsprapportthinsprisquebeacuteneacuteficethinspraquothinsppourthinsplesthinspcasthinspurgents

c suivrethinsplesthinsprecommandationsthinspduthinspmeacutedecinthinspquithinsppreacutecisethinspsithinsplesthinspmeacutedicamentsthinspprescritsthinspsurthinspunethinspbasethinspreacuteguliegraverethinsppeuventthinspecirctrethinspadministreacutesthinspcommethinspagravethinsplrsquoaccoutumeacuteethinspetthinspquithinspfaitthinsppartthinspdesthinspexceptionsthinsp(pthinspexthinspthinspanticoagulantthinsppsychotropethinspetc)thinspsrsquoilthinspythinspathinsplieuthinsp

Unethinspseacutedation-analgeacutesiethinspleacutegegraverethinspougravethinsplesthinspreacuteflexesthinspdethinspprotectionthinspdesthinspvoiesthinspthinspaeacuteriennesthinspsontthinsppreacuteserveacutesthinspestthinsppeuthinspsusceptiblethinspdrsquoinduirethinspunethinspaspirationthinspduthinspcon-tenuthinspgastriquethinspcontrairementthinspagravethinspunethinspseacutedationthinspplusthinspprofondethinspIlthinspestthinsptoutthinspdethinspmecircmethinspraisonnablethinspdethinsppenserthinspquethinsplethinsprisquethinspdrsquoaspirationthinspestthinspdiminueacutethinsplorsquethinsplrsquoestomacthinspestthinspvidethinspetthinspqursquounethinsppeacuteriodethinspdethinspjeucircnethinspavantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacutera-peutiquethinspestthinsppreacutefeacuterablethinspToutefoisthinspdansthinsptousthinsplesthinspcasthinsplrsquourgencethinspdethinsplrsquointerventionthinspetthinsplethinspniveauthinspdeacutesireacutethinspdethinspseacutedation-analgeacutesiethinspdoiventthinspecirctrethinspsoupeseacutesthinspauthinspregardthinspdesthinsprisquesthinspassocieacutesthinspagravethinspunthinspjeucircnethinspinadeacutequatthinspAinsithinsplethinspdeacutelaithinspentrethinsplrsquoheurethinspduthinspdernierthinsprepasthinspetthinsplethinspmomentthinspdethinsplathinspblessureaccidentthinspdoitthinspecirctrethinsppristhinspenthinspconsideacuterationthinsppourthinspestimerthinsplrsquoeacutetatthinspdethinspjeucircnethinspetthinspcethinspenthinspraisonthinspdethinsplrsquoileacuteusthinspreacuteflexethinsp

Avantthinsplathinspseacutedation-analgeacutesiethinspdrsquounethinspinterventionthinspnonthinspurgentethinsp(eacutelective)thinsplethinsppatientthinspdoitthinsprespecterthinsplesthinspdeacutelaisthinspsuivantsthinspselonthinsplathinspnaturethinspetthinsplathinspquantiteacutethinspingeacutereacuteethinspdethinspthinsp(Merchantthinspetthinspcollabthinsp2014a)thinsp

thinsprsaquo liquidethinspclairthinsp(pthinspexthinspthinspeauthinspjusthinspdethinspfruitthinsp[sansthinsppulpe]thinsptheacutethinspetthinspcafeacutethinspnoir)thinspthinspjeucircnethinspdethinsp2thinspheures

thinsprsaquo repasthinspleacutegerthinsp(pthinspexthinspthinsppainthinspgrilleacutethinsp+thinspliquidethinspclair)thinspthinspjeucircnethinspdethinsp6thinspheuresthinsprsaquo repasthinspcomposeacutethinspdethinspviandethinspouthinspdrsquoalimentsthinspfritsthinspouthinspgrasthinspthinspjeucircnethinspdethinsp8thinspheuresthinsp

CMQ - OIIQ - OPIQ 20

15thinspPERSEacuteDATION-ANALGEacuteSIEthinsp

APPROCHEthinspPHARMACOLOGIQUE

Lrsquoadministrationthinspdethinsptoutthinspmeacutedicamentthinspneacutecessitethinsplrsquoobtentionthinspdrsquounethinspordonnancethinsp

faitethinspenthinspvertuthinspdethinsplrsquoarticlethinsp393thinspduthinspCode des professions du QueacutebecthinspDrsquoailleursthinspthinsplathinspmeilleurethinspfaccedilonthinspdrsquoencadrerthinsplathinsppratiquethinspdethinsplrsquoinfirmiegraverethinspetthinspdethinsplrsquoinhalotheacuterapeutethinspestthinsplrsquoadoptionthinspdrsquounthinspprotocoleordonnancethinspcollectivethinspcomprenantthinspunthinspeacuteventailthinsptheacuterapeutiquethinspquithinsplaissethinspplacethinspauthinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspthinspUnthinsptelthinspdocumentthinspdoitthinspparthinspcontrethinspecirctrethinspenteacuterineacutethinspparthinsplesthinspresponsablesthinspmeacutedicauxthinspthinspdethinsplrsquoeacutetablissementthinspqursquoilthinspsoitthinsppublicthinspouthinsppriveacutethinsp

Soulignonsthinsplrsquoimportancethinspdrsquounthinspaccegravesthinspveineuxthinspfonctionnelthinspquithinspfaciliterathinsplrsquoadmi-nistrationthinspdesthinspagentsthinspseacutedatifsthinspetthinspanalgeacutesiquesthinspainsithinspquethinsplesthinsptraitementsthinsppharma-cologiquesthinspdesthinspcomplications

LethinspmeacutedecinthinsplrsquoinfirmiegraverethinspetthinsplrsquoinhalotheacuterapeutethinspdoiventthinsputiliserthinspunethinspmeacutedicationthinspqursquoilsthinspconnaissentthinspetthinspquithinspestthinspreconnuethinspRappelonsthinspqursquoilsthinspdoiventthinspecirctrethinspenthinspmesurethinspdethinspprendrethinspenthinspchargethinsptoutethinspcomplicationthinsppotentiellethinspythinspcompristhinsplathinspgestionthinspdrsquounthinsppassagethinspmomentaneacutethinspagravethinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspsupeacuterieurthinspagravethinspceluithinspquithinspthinspathinspeacuteteacutethinspplanifieacute

LethinspchoixthinspdethinsplathinspmeacutedicationthinsppeutthinspvarierthinspselonthinsplathinspsituationthinspcliniquethinspetthinsplesthinspfacteursthinsppropresthinspauthinsppatientthinspParthinspexemplethinspcertainsthinsppatientsthinspnethinsptolegraverentthinsppasthinsplesthinspdosagesthinsphabituelsthinspouthinsppreacutesententthinspdesthinspcontre-indications

Ilthinspestthinspimportantthinspdethinspretenirthinspquethinsplethinsptitragethinspdethinsptoutethinspmeacutedicationthinspdoitthinspecirctrethinspthinspprivileacutegieacutethinspetthinspquethinspsonthinspadministrationthinspdoitthinspsethinspfairethinspparthinsppetitesthinspdosesthinspdethinspthinspfaccedilonthinspprogressivethinspjusqursquoagravethinsplrsquoobtentionthinspduthinspniveauthinspdethinspseacutedationthinspetthinspdrsquoanalgeacutesiethinspthinspdeacutesireacutethinsptoutthinspenthinsplaissantthinspsrsquoeacutecoulerthinspsuffisammentthinspdethinsptempsthinspentrethinspdeuxthinspdosesthinsppourthinspquethinsplethinspmeacutedicamentthinspproduisethinspsesthinspeffetsthinsp

Lesthinspmeacutedicamentsthinsputiliseacutesthinspenthinspseacutedation-analgeacutesiethinspontthinspunthinspeffetthinspsynergiquethinspthinspParthinspexemplethinsplrsquoassociationthinspdrsquounethinspbenzodiazeacutepinethinspavecthinspunthinspopioiumldethinspaugmentethinspthinsplesthinsprisquesthinspdethinspdeacutepressionthinsprespiratoirethinspLeurthinspdosagethinspdoitthinspdoncthinspecirctrethinspajusteacutethinspenthinspconseacutequencethinspSithinsplrsquoobstructionthinspdesthinspvoiesthinspaeacuteriennesthinsplrsquoapneacuteethinspetthinsplrsquohypotensionthinspthinspsontthinsplesthinspcomplicationsthinsplesthinspplusthinspfreacutequentesthinspenthinspseacutedation-analgeacutesiethinspilthinspfautthinspretenirthinspquethinspcertainesthinspcomplicationsthinsppeuventthinspecirctrethinspparticuliegraveresthinspagravethinsplathinspmeacutedicationthinsputiliseacuteethinspthinspCitonsthinspagravethinsptitrethinspdrsquoexemplethinsplrsquoassociationthinsplaryngospasmethinspetthinspkeacutetaminethinsp

CMQ - OIIQ - OPIQ 21

Lorsquethinspdesthinspbenzodiazeacutepinesthinspouthinspdesthinspopioiumldesthinspsontthinspadministreacutesthinspparthinspvoiethinspthinspintraveineusethinspleursthinspantagonistesthinsprespectifsthinsp(pthinspexthinspthinspflumazeacutenilthinsp[Anexatereg]thinspthinspnaloxonethinsp[Narcanreg])thinspdoiventthinspecirctrethinsprapidementthinspdisponiblesthinspIlsthinspserontthinsputiliseacutesthinspthinspauthinspmomentthinspdrsquounethinspdeacutepressionthinsprespiratoirethinspinduitethinspparthinsplathinspmeacutedicationthinspet non en prophylaxiethinspchezthinsplethinsppatientthinspstablethinspIlthinspestthinsphabituellementthinsppreacutefeacuterablethinspdethinspthinsprenverserthinspdrsquoabordthinsplrsquoagentthinspseacutedatifthinspafinthinspdethinspmaintenirthinspintactthinsplrsquoeffetthinspanalgeacutesiquethinspthinspSithinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspdemeurethinspcompromisethinspilthinspserathinspalorsthinspthinspneacutecessairethinspdethinsprenverserthinsplrsquoeffetthinspanalgeacutesique

IlthinspfautthinspsethinsprappelerthinspquethinsplathinspdureacuteethinspdrsquoactionthinspdesthinspantagonistesthinspestthinspbienthinspinfeacuterieurethinspthinspagravethinsplathinspdureacuteethinspdrsquoactionthinspduthinspmeacutedicamentthinspdevantthinspecirctrethinspneutraliseacutethinspParthinspconseacutequentthinspthinsplathinspreacuteapparitionthinspdethinsplrsquoeffetthinspindeacutesirablethinspestthinspagravethinspsurveillerthinspchezthinsplethinsppatientthinspquithinspreccediloitthinspunthinspantagonistethinsp

VousthinsptrouverezthinspunethinspfichethinspinformativethinspsurthinsplrsquoutilisationthinspdethinsplathinspnaloxonethinspetthinspduthinspflumazeacutenilthinspagravethinsplrsquoannexethinspXI

Lesthinspdirectivesthinspeacutenonceacuteesthinspdansthinspcesthinsplignesthinspdirectricesthinspnrsquoontthinsppasthinsppourthinspobjectifthinspdethinspdeacutecrirethinspdansthinsplethinspdeacutetailthinsplathinspmeacutedicationthinsputiliseacuteethinspenthinspseacutedation-analgeacutesiethinspleursthinspagentsthinsp

antagonistesthinspetthinsplesthinspmeacutedicamentsthinspdrsquourgencethinspIlthinsprevientthinspauthinspmeacutedecinthinspdethinspbienthinsp

connaicirctrethinsplathinspmeacutedicationthinspetthinspdethinspchoisirthinspunethinspmeacutedicationthinspouthinspunethinspcombinaisonthinspdethinspmeacutedicamentsthinspreconnuethinspEtthinspilthinsprevientthinspauxthinspprofessionnelsthinspquithinsplesthinspadministrentthinsp

dethinspbienthinsplesthinspconnaicirctrethinspeacutegalementthinsp(eacuteleacutementsthinspdethinspsurveillancethinspcliniquethinsptechniquethinspdrsquoadministrationthinspeffetsthinspsecondairesthinspinteractionsthinspcontre-indicationsthinspseuilsthinspthinsptoxiquesthinspetc)thinspetthinspdethinspmaintenirthinspagravethinspjourthinspleursthinspconnaissancesthinspdansthinspcethinspdomaine

thinspPRINCIPALESthinspCLASSESthinspPHARMACOTHEacuteRAPEUTIQUESthinspUTILISEacuteESthinspthinspthinspENthinspSEacuteDATION-ANALGEacuteSIEthinsp

Lathinsplistethinspdesthinspmeacutedicamentsthinspabordeacutesthinspci-dessousthinspnrsquoestthinsppasthinsplimitativethinsp

a BenzodiazeacutepinesthinspProprieacuteteacutesthinspthinspanxiolytiquethinspamneacutesiquethinsphypnotiquethinsprelaxantthinspmusculairethinspetthinspanticonvulsivantthinspthinspIlthinspfautthinspprivileacutegierthinsplesthinspmoleacuteculesthinspagravethinspcourtethinspdemi-viethinsp(pthinspexthinspthinspmidazolamthinsp[Versedreg])thinspenthinspretenantthinspqursquoilthinspfautthinspajusterthinsplethinspdosagethinspchezthinspcertainsthinsppatientsthinsp(pthinspexthinspthinspacircgeacutesthinspouthinspaffaiblis)thinspetthinsplorsthinspdethinsplrsquoutilisationthinspconcomitantethinspdrsquoautresthinspmeacutedicamentsthinspaffectantthinsplethinspsystegravemethinspnerveuxthinspcentralthinspDethinspplusthinsplathinspdemi-viethinsp

CMQ - OIIQ - OPIQ 22

dethinspcesthinspmeacutedicamentsthinsppeutthinspecirctrethinspaugmenteacuteethinsplorsthinspdethinspleurthinspadministrationthinspenthinspperfusionthinspcontinuethinsp(context sensitive half-life)thinsp

b OpioiumldesthinspProprieacuteteacutesthinspthinspanalgeacutesiquethinspetthinspseacutedativethinspLathinspmorphinethinspconstituethinspunthinspopioiumldethinspdontthinsplrsquoefficaciteacutethinspestthinspreconnuethinspCependantthinspellethinspfavorisethinsplathinsplibeacuterationthinspdrsquohistaminethinspcethinspquithinsppeutthinspcauserthinspduthinsppruritthinspetthinspdethinsplrsquohypotensionthinspUnethinspdysfonctionthinspreacutenalethinspseacutevegraverethinspentraicircnethinsplrsquoaccumulationthinspdethinspsesthinspmeacutetabolitesthinspactifsthinsp

thinsprsaquo lethinspfentanylthinsp(Sublimazereg)thinspestthinspunthinspopioiumldethinspsyntheacutetiquethinsppuissantthinspetthinspdethinspcourtethinspdureacuteethinspdrsquoactionthinspIlthinspnethinspdeacuteclenchethinsppasthinspdethinsplibeacuterationthinspdrsquohistaminethinsp(doncthinsppeuthinspdrsquoeffetthinspheacutemodynamique)thinspIlthinspfautthinspcependantthinspsethinspmeacutefierthinspdesthinspdosesthinspeacuteleveacuteesthinspetthinspdesthinspinjectionsthinsprapidesthinspquithinsppeuventthinspprovoquerthinspunethinsprigiditeacutethinspmusculairethinspthinspetthinspunethinspdeacutepressionthinsprespiratoire

thinsprsaquo lrsquohydromorphonethinsp(Dilaudidreg)thinspestthinspunthinspopioiumldethinspsemi-syntheacutetiquethinspdontthinsplesthinspmeacutetabolitesthinspconnusthinspsontthinsprarementthinspprobleacutematiquesthinspMoinsthinsputiliseacuteethinspenthinspthinspseacutedation-analgeacutesiethinspellethinspestthinspauthinspmoinsthinsp5thinspfoisthinspplusthinsppuissantethinspquethinsplathinspmorphinethinspthinspcethinspquithinspestthinspparfoisthinspsous-estimeacute

thinsprsaquo lathinspmeacutepeacuteridinethinsp(Demerolreg)thinspestthinspunthinspopioiumldethinspsyntheacutetiquethinspposseacutedantthinspunthinspmeacuteta-bolitethinspactifthinspneurotoxiquethinspEllethinspnrsquoestthinsphabituellementthinsppasthinsprecommandeacuteethinsp

c Anestheacutesiques geacuteneacuterauxthinspLethinspmeacutedecinthinspquithinspprocegravedethinspagravethinspunethinspinterventionthinspsousthinspseacutedation-analgeacutesiethinspenthinsputilisantthinspunthinspouthinspdesthinspanestheacutesiquesthinspgeacuteneacuterauxthinspdoitthinspecirctrethinspexpeacuterimenteacutethinspenthinspseacutedation-analgeacutesiethinspetthinspenthinspreacuteanimationthinspcardiorespiratoirethinspDansthinsplethinspcasthinspcontrairethinspilthinspdoitthinspsrsquoassurerthinspdethinsplathinspcollaborationthinspdrsquounthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspParthinspailleursthinsplethinspmeacutedecinthinspdoitthinspenthinsptoutthinsptempsthinspecirctrethinspsoutenuthinspparthinspunthinspouthinspdesthinspprofessionnelsthinspqualifieacutesthinsp

thinsprsaquo propofolthinsp(Diprivanreg)thinspProprieacuteteacutesthinspseacutedativethinsphypnotiquethinspamneacutesiquethinspanxiolytiquethinspAgravethinspnoterthinspqursquoilthinspnrsquoathinspaucune proprieacuteteacute analgeacutesiquethinsp

thinspIlthinsppossegravedethinspunethinspdemi-viethinspcourtethinsppeutthinspecirctrethinspcumulatifthinspetthinspnrsquoathinsppas drsquoantago-nistethinspIlthinspnrsquoestthinsppasthinsprecommandeacutethinspchezthinsplathinspfemmethinspenceintethinspouthinspquithinspallaitethinspEnthinspregraveglethinspgeacuteneacuteralethinspetthinspselonthinsplethinsptypethinspdrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspilthinsppeutthinspecirctrethinspplusthinspjudicieuxthinspdethinsplrsquoadministrerthinspenthinspinfusionthinspIVthinspplutocirctthinspthinspqursquoenthinspbolusthinspthinspthinspIlthinsppeutthinsprapidementthinspcauserthinspunethinspdiminutionthinspmarqueacuteethinspduthinspniveauthinspdethinspcon-sciencethinspetthinspunethinspdeacutepressionthinsprespiratoirethinsppouvantthinspconduirethinspmomentaneacute-

CMQ - OIIQ - OPIQ 23

mentthinspagravethinspunethinspanestheacutesiethinspgeacuteneacuteralethinspnonthinspdeacutesireacuteethinspLesthinspprofessionnelsthinspenthinspplacethinspdoiventthinspecirctrethinspenthinspmesurethinspdethinspprendrethinspenthinspchargethinspunethinsptellethinspsituationthinspLrsquoASAthinsp(AmericanthinspSocietythinspofthinspAnesthesiologiststhinspASAthinspHousethinspofthinspDelegatesthinsp2004bthinsp[Notrethinsptraduction])thinsprecommandethinspnotammentthinspquethinsplethinsppatientthinspagravethinspquithinsplrsquoonthinspadministrethinspduthinsppropofolthinspreccediloivethinspdesthinspsoinsthinspenthinsplienthinspavecthinspunethinspseacutedationthinsppro-fondethinsp(niveauthinspnonthinspviseacutethinspdansthinspcesthinsplignesthinspdirectrices)thinspetthinspquethinsplethinspprofessionnelthinsp(nonthinspanestheacutesiologiste)thinspadministrantthinsplethinsppropofolthinsppossegravedethinsplathinspformationthinsptheacuteoriquethinspetthinsppratiquethinspneacutecessairethinspagravethinsplrsquoidentificationthinspetthinspagravethinsplathinspprisethinspenthinspchargethinspdesthinspvoiesthinspaeacuteriennesthinspetthinspdesthinspchangementsthinspcardiovasculairesthinspquithinspsurvien-nentthinspchezthinspunthinsppatientthinspeacutevoluantthinspversthinspunthinspeacutetatthinspdrsquoanestheacutesiethinspgeacuteneacuteralethinsp(niveauthinspnonthinspviseacutethinspdansthinspcesthinsplignesthinspdirectrices)thinsp

thinspthinspLorsquethinsplethinsppropofolthinspestthinspadministreacutethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspthinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspthinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspthinspobligatoirethinsp(tableauthinsp3)thinspthinspthinsp

thinsprsaquo keacutetaminethinsp(Ketalarreg)thinspProprieacuteteacutesthinspthinspseacutedativethinspetthinspanalgeacutesiquethinspthinspUtiliseacuteethinspenthinsppeacutediatriethinspetthinspchezthinsplrsquoadultethinspEllethinspproduitthinspaussithinspunethinspbroncho-thinspdilatationthinspparfoisthinspsouhaiteacuteethinsplorsthinspdrsquointerventionsthinspdiagnostiquesthinspouthinsptheacutera-peutiquesthinspchezthinsplesthinsppatientsthinspasthmatiquesthinspEllethinspsrsquoaccompagnethinspdrsquounethinsplibeacutera-tionthinspdethinspcateacutecholaminesthinspetthinspdrsquoeffetsthinspsympathomimeacutetiquesthinsp(augmentationthinspdethinsplathinspsalivation)thinspEllethinsppeutthinspprovoquerthinspdesthinspsymptocircmesthinsppsychotiquesthinspouthinspdesthinspcomportementsthinspanormauxthinspCesthinspsymptocircmesthinsppeuventthinspnuirethinspagravethinsplrsquoeacutevaluationthinspdesthinsppatientsthinspsousthinspseacutedationthinspEllethinspabaissethinsplethinspseuilthinspconvulsifthinsp

Lorsquethinsplathinspkeacutetaminethinspestthinspadministreacuteethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspobligatoirethinsp(tableauthinsp3)thinspthinsp

thinsprsaquo protoxydethinspdrsquoazotethinsp(N2O)thinsp

ProprieacuteteacutesthinspthinspgazthinspseacutedatifthinspetthinspanalgeacutesiquethinspthinspActionthinspanalgeacutesiquethinspsemblablethinspagravethinspcellethinspdethinsplathinspmorphinethinspIlthinsppotentialisethinsplesthinspanalgeacutesiquesthinspcentrauxthinspetthinsplesthinspagentsthinsphypnotiquesthinspetthinsppeutthinspaussithinspdiminuerthinsplesthinspreacuteservesthinspenthinspoxygegravenethinspduthinsppatientthinspUtiliseacutethinspenthinspcombinaisonthinspavecthinsplrsquooxygegravenethinspIlthinsppeutthinsppolluerthinsplrsquoenvironnementthinspdethinsptravailthinsp(voirthinspnormesthinspCSST)thinspIlthinsppeutthinspecirctrethinsp

CMQ - OIIQ - OPIQ 24

utiliseacutethinspenthinsppeacutediatriethinspchezthinsplrsquoadultethinspetthinspchezthinsplathinspfemmethinspenceintethinsp(saufthinspauthinspthinsppremierthinsptrimestre)thinsp

thinspDansthinsplethinspcasthinspougravethinsplethinspprotoxydethinspdrsquoazotethinspestthinsputiliseacutethinspenthinspcombinaisonthinspavecthinspunthinspagentthinspseacutedatifthinspouthinspunthinspopioiumldethinspouthinspsithinsplrsquoappareilthinsputiliseacutethinsppermetthinspdethinspmodifierthinsplathinspconcentrationthinspdrsquooxygegravenethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivement agravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspthinsp

thinsprsaquo dexmeacutedeacutetomidinethinsp(PreacuteceacutedexMC)thinsp(Agonistethinspalpha2-adreacutenergique)thinspProprieacuteteacutesthinspthinspseacutedativethinspanalgeacutesiquethinspetthinspanxiolytiquethinspthinspLathinspdexmeacutedeacutetomidinethinspenthinspperfusionthinspintraveineusethinspcontinuethinspestthinspindiqueacuteethinspnotammentthinsppourthinsplathinspseacutedationthinspdethinsppatientsthinspnonthinspintubeacutesthinspavantthinspetouthinsppendantthinspunethinspinterventionthinspchirurgicalethinspouthinspdrsquoautresthinsptypesthinspdrsquointerventionsthinspthinspNethinspcausethinspaucunethinspdeacutepressionthinsprespiratoirethinspmaisthinsppeutthinspcauserthinspunethinspbradycar-diethinspetthinspunethinsphypotensionthinspthinsp

thinspLrsquoutilisationthinspdethinspdexmeacutedeacutetomidinethinspdevraitthinspecirctrethinspreacuteserveacuteethinspauthinspmilieuthinspthinsphospitalierthinspouthinspauxthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspthinspEllethinspdevraitthinspecirctrethinspadministreacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspthinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspetthinsprapidementthinspdisponiblethinspthinspLorsquethinspdethinsplathinspdexmeacutedeacutetomidinethinspestthinspadministreacuteethinspunthinspprofessionnelthinspthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspthinspduthinsppatientthinsp(tableauthinsp2)thinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspobligatoirethinsp(tableauthinsp3)thinspthinsp

Agravethinspnoterthinspqursquoilthinspestthinspobligatoirethinspdethinsptenirthinspunthinspregistrethinspdesthinspsubstancesthinspcontrocircleacuteesthinspetthinspdesthinspbenzodiazeacutepinesthinspcomportantthinspdesthinspsignatures

thinsp

CMQ - OIIQ - OPIQ 25

SURVEILLANCEthinspCLINIQUEthinspLathinspsurveillancethinspcliniquethinspcomprendthinspplusieursthinspeacuteleacutementsthinspquithinspconcernentthinspthinspnotammentthinsplesthinspsystegravemesthinsprespiratoirethinspcardiaquethinspetthinspneurologiquethinspEllethinspdoitthinspthinsptenirthinspcomptethinspentrethinspautresthinsp

thinsprsaquo dethinsplathinspconditionthinspduthinsppatientthinspavantthinspetthinsppendantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

thinsprsaquo dethinsplathinspcomplexiteacutethinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinsprsaquo dethinsplathinspmeacutedicationthinsputiliseacuteethinsp(dosethinspdureacuteethinspetthinsppicthinspdrsquoactionthinspvoiethinspetthinspvitessethinspthinsp

drsquoadministrationthinspcombinaisonthinspetthinspantagonistes)

thinsprsaquo dethinsplrsquoassistancethinspagravethinspapporterthinspauthinspmeacutedecin

Lethinspmeacutedecinthinspquithinsppratiquethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspchezthinspunthinsppatientthinspsousthinspseacutedation-analgeacutesiethinspdoitthinspcompterthinspsurthinsplathinsppreacutesencethinspdrsquoauthinspmoinsthinspunthinspautrethinspprofessionnelthinsphabiliteacutethinspduthinspmilieuthinspdethinsplathinspsanteacutethinsp(infirmiegraverethinspinhalotheacuterapeutethinspouthinspautrethinspmeacutedecin)thinsp(annexethinspII)thinspEnthinspeacutetroitethinspcollaborationthinspavecthinsplethinspmeacutedecinthinspreacuteali-santthinsplrsquointerventionthinspceux-cithinspassurentthinspthinsplathinspgestionthinspdethinsplathinspseacutedationthinspetthinspdethinsplrsquoanalgeacutesiethinspqui comprend entre autres la surveillance clinique du patientthinspresponsabiliteacutethinspthinspagravethinsplaquellethinspilsthinspdoiventthinspenthinsptoutthinsptempsthinspsethinspconsacrerthinspenthinspprioriteacutethinsp

Dansthinspcertainsthinspcasthinsplethinspprofessionnelthinspquithinspassurethinspen prioriteacutethinsplathinspsurveillancethinspthinspcliniquethinspduthinsppatientthinsppeutthinspecirctrethinspappeleacutethinspagravethinspassisterthinsplethinspmeacutedecinthinspdansthinsplathinspreacutealisationthinspthinspdethinspsonthinspinterventionthinspCettethinspassistancethinspquithinspdoitthinspsrsquoeffectuerthinspdansthinsplathinspmecircmethinsppiegravecethinspdoitthinspecirctrethinspdethinsptregravesthinspcourtethinspdureacuteethinspDethinspplusthinspellethinspdoitthinsppouvoirthinspecirctrethinspinterrompuethinspthinspagravethinsptoutthinspmomentthinsppourthinspintervenirthinspimmeacutediatementthinspaupregravesthinspduthinsppatientthinspenthinspcasthinspdethinsp

complicationsthinspouthinspdethinspbesoin

Parthinspailleursthinsplorsquethinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspthinspneacutecessitentthinspunethinspassistancethinsptechniquethinspcontinuellethinspauthinspmeacutedecinthinsplrsquoajoutthinspdrsquounthinsptroisiegravemethinspprofessionnelthinspdethinsplathinspsanteacutethinsphabiliteacutethinsp(meacutedecinthinspinfirmiegraverethinspouthinspinhalotheacuterapeute)thinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinspestthinsprequisthinsp

CMQ - OIIQ - OPIQ 26

Tableau 2 Tableau reacutecapitulatif du nombre de professionnels habiliteacutes requis en seacutedation-analgeacutesie - Clientegravele adulte

Toutthinspauthinsplongthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplathinspsurveillancethinspcliniquethinspthinspduthinsppatientthinspdoitthinspecirctrethinspcontinuethinspetthinsplathinspcommunicationthinspavecthinspcelui-cithinspmaintenue

Proceacutederthinspagravethinsplathinspsurveillancethinspcliniquethinspcrsquoestthinspeacutevaluerthinspqualitativementthinspetthinspquantitative-mentthinspdethinspfaccedilonthinspsoutenuethinspetthinspenthinspcontinuthinsplrsquoensemblethinspdesthinspparamegravetresthinspsuivantsthinsp(listethinsp

nonthinsplimitative)thinsp(tableauthinsp3)thinsp

thinsprsaquo mesurethinspdethinsplathinsppressionthinsparteacuteriellethinspduthinsppouls3thinspetthinspdethinsplathinsprespiration4thinsprsaquo lecturethinspdethinsplathinspsaturationthinspcapillairethinspenthinspoxygegravene

Ilthinspfautthinspnoterthinspquethinsplathinsptonaliteacutethinspdethinsppoulsthinspdoitthinspecirctrethinspactiveacuteethinspenthinsptoutthinsptempsthinspetthinspsonthinspniveauthinspdoitthinspecirctrethinspajusteacutethinspdethinspfaccedilonthinspagravethinspecirctrethinspentenduthinspclairement

thinsprsaquo eacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplathinspseacutedationthinsp(eacutevaluationthinspdethinsplathinspseacutedationagitationthinspetthinspduthinspniveauthinspdethinspconscience)thinsp(annexethinspIX)thinsp

thinsprsaquo eacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplrsquoanalgeacutesiethinsp(eacutevaluationthinspdethinsplathinspdouleur)thinspdethinsplrsquoanxieacuteteacutethinspetthinspdethinsplathinspreacuteactionthinspduthinsppatientthinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsp(annexethinspX)

thinsprsaquo eacutevaluationthinspdethinsplrsquoeacutetatthinspdethinsplathinspcolorationthinspetthinspdethinsplathinsptempeacuteraturethinspdethinsplathinsppeauthinsprsaquo eacutevaluationthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsprsaquo niveauthinspdrsquoO

2thinspdethinspCO

2thinspetthinspmonitoragethinspcardiaquethinspselonthinsplethinspcas

3thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp4thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

Nombrethinspdethinspprofessionnelsthinsphabiliteacutesthinsprequis

2 Nombrethinspmimimalthinsprequis

3 Sithinsputilisationthinspdethinsppropofolthinspkeacutetaminethinspouthinspdethinspdexmeacutedeacutetomidine

3 SithinsputilisationthinspconcomitantethinspdethinspN2Othinspetthinspdrsquounthinspagentthinspseacutedatifthinspouthinspthinsp

dunthinspopioiumldethinspouthinspsithinspconcentrationthinspdethinspN2Othinspmodifiable

3 Sithinsplassistancethinsptechniquethinspauthinspmeacutedecinthinspestthinspcontinuelle

CMQ - OIIQ - OPIQ 27

Tableau 3 Surveillance des paramegravetres cliniques en seacutedation-analgeacutesie - Clientegravele adulte

Paramegravetrethinspdethinspthinspsurveillancethinspthinspclinique

PatientNiveauthinspdethinspthinspseacutedation

MeacutedicationInterventionthinspdiagnostiquethinspouthinsptheacuterapeutique

TAthinspRC5thinspthinspRR6thinspthinspetthinspsaturationthinspdrsquoO

thinsp2thinspthinsp

rsaquothinspObligatoireChezthinsptousthinsplesthinsppatients

Niveauthinspdethinspthinsp-thinspseacutedationthinspthinspthinspagitationthinspthinspthinspthinspconscience-thinspdouleur

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

NiveauthinspdethinspCO2

SelonthinsplesthinspthinspcaracteacuteristiquesthinspAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspthinspmeacutedication

Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire

rsaquothinspAccegravesthinspindirectthinspthinspthinspthinspthinspouthinsprestreintthinspthinspthinspthinspauthinsppatientthinspthinspthinspthinsp(pthinspexthinspthinspIRM)

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

rsaquothinspRecommandeacute

rsaquothinspASAthinspgethinsp3thinsprsaquothinspApneacuteethinspthinspobstructivethinspthinspthinspthinspduthinspsommeilthinsprsaquothinspMaladiethinspthinspthinspthinsprespiratoirethinsprsaquothinspObeacutesiteacutethinspmorbide

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

Monitoragethinspcardiaque

SelonthinsplesthinspcaracteacuteristiquesAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

SelonthinsplathinspmeacutedicationSelonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoirersaquothinspASAthinspgethinsp3thinsprsaquothinspMaladiethinspthinspthinspthinspcardiaque

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

Interventionthinspdiagnostiquethinspthinspouthinsptheacuterapeutiquethinspprolongeacuteethinsp(effetthinspcumulatifthinspdethinsplathinspmeacutedication)

rsaquothinspRecommandeacute

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

thinspthinspthinspthinspthinspIlthinspnethinspsrsquoagitthinsppasthinspdrsquounethinsplistethinsplimiteacuteethinspdesthinspsituationsthinspcliniquesthinspDrsquoautresthinspsituationsthinspcliniquesthinsppeuventthinspneacutecessiterthinsplethinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspmonitoragethinspcardiaquethinspouthinspduthinspCO

2thinspIlthinsprevientthinspauxthinspprofessionnelsthinspdethinspjugerthinspdethinsplathinspsituationthinspenthinspfonctionthinspdethinspchaquethinspthinspthinsp

thinspthinspthinspthinspthinspthinsppatient5thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp6thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

CMQ - OIIQ - OPIQ 28

LethinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspimpliqueacutesthinspestthinspprimordialthinspetthinspcethinspmecircmethinspsithinsplrsquoappareillagethinspenthinspplacethinspestthinspcompletthinspetthinspfonctionnelthinspUnethinspbonnethinspcommunica-tionthinspentrethinspcesthinspderniersthinspestthinspdoncthinspessentiellethinspafinthinspdethinspbienthinspcoordonnerthinsplathinspseacutedationthinsp

etthinsplrsquoanalgeacutesiethinspavecthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspLes alarmes (audibles et visuelles) de chaque appareil doivent ecirctre en fonction et les paramegravetres ajusteacutes aux caracteacuteristiques du patient et agrave sa condition clinique

IlthinspfautthinspsrsquoassurerthinspdethinsplathinsptraccedilabiliteacutethinspdethinsplrsquoeacutevaluationthinspetthinspdethinsplathinspsurveillancethinspcliniquethinspthinspeffectueacuteesthinspparthinspunethinsptenuethinspdethinspdossiersthinspconformethinspauxthinspnormesthinspenthinspvigueurthinspLesthinspoutilsthinspdrsquoeacutevaluationthinsputiliseacutesthinspdoiventthinspecirctrethinspsimplesthinspstandardiseacutesthinspvalideacutesthinspdethinsppreacutefeacuterencethinspetthinspadapteacutesthinspauthinspcontextethinspetthinspauxthinspcaracteacuteristiquesthinspduthinsppatientthinspnotam-mentthinsppourthinsplrsquoeacutevaluationthinspduthinspniveauthinspdethinspseacutedationagitationthinspdethinspconsciencethinspetthinspdethinspdouleurthinsp(annexesthinspIXthinspetthinspX)

Lathinspfreacutequencethinspdethinsplathinspmesurethinspdethinspcesthinspparamegravetresthinspetthinspleurthinspenregistrementthinspdoiventthinspecirctrethinspdeacutetermineacutesthinspentrethinspautresthinspenthinspfonctionthinspdethinsplathinspmeacutedicationthinspetthinspdethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsp

Ideacutealementthinsplethinspprofessionnelthinspdoitthinsplesthinspdocumenterthinsp

thinsprsaquo avantthinsplethinspdeacutebutthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsprsaquo apregravesthinsplrsquoadministrationthinspdrsquounthinspagentthinspdethinspseacutedation-analgeacutesiethinspouthinspdrsquounthinspantagonistethinsprsaquo authinsppicthinspdrsquoactionthinspdethinspchacunthinspdesthinspagentsthinspadministreacutesthinspthinsprsaquo agravethinspintervallesthinspreacuteguliersthinsp(pthinspexthinspthinsp5thinspminutes)thinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-thinsp

analgeacutesiethinsprsaquo agravethinspintervallesthinspplusthinsprapprocheacutesthinsplorsquethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsplrsquoexigethinsprsaquo durantthinsplathinsppeacuteriodethinspdethinspreacutecupeacuterationthinspetthinspjusqursquoauthinspretourthinspduthinspniveauthinspdethinspconsciencethinsp

initialethinspselonthinsplathinspconditionthinspcliniquethinspduthinsppatientthinsprsaquo authinspmomentthinspduthinspcongeacute

ILthinspFAUTthinspSAVOIRthinspQUE

LathinspSocieacuteteacutethinspcanadiennethinspdesthinspanestheacutesiologistesthinsp(SCA)thinspindiquethinspquethinsplesthinspthinspdirectivesthinspgeacuteneacuteralesthinspdethinspsoinsthinsp(ythinspcompristhinsplethinspmonitorage)thinsppourthinsplathinspseacutedationthinspconscientethinspsontthinsplesthinspmecircmesthinspquethinsppourthinsplesthinspautresthinspformesthinspdrsquoanestheacutesiethinsp[]thinsp(Merchantthinspetthinspcollabthinsp2014b)thinspDethinspplusthinspellethinspindiquethinspquethinsplethinspcapnographethinspthinspestthinsprequisthinsplorsthinspdethinspseacutedation-analgeacutesiethinspdethinspniveauthinspplusthinspeacuteleveacutethinsp(pthinspexthinspthinspRamsaythinspthinsp4-6)thinsp(Merchantthinspetthinspcollabthinsp2014athinspop cit)

CMQ - OIIQ - OPIQ 29

thinsp16thinspPOSTSEacuteDATION-ANALGEacuteSIEthinsp

Lethinsppatientthinspestthinspagravethinsprisquethinspdethinspdeacutevelopperthinspdesthinspcomplicationsthinspagravethinsplathinspsuitethinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspsurtoutthinspsithinspcettethinspproceacutedurethinspestthinspdethinspcourtethinspdureacuteethinsp(pthinspexthinspthinspdeacutepressionthinsprespiratoirethinsphypotension)thinspEnthinspeffetthinspcertainsthinspmeacutedicamentsthinsptelsthinspquethinsplethinspmidazolamthinspetthinsplethinspfentanylthinspnethinspserontthinsppasthinspcomplegravetementthinspeacutelimineacutesthinspsithinsplathinspdureacuteethinspdethinsplrsquointerventionthinspestthinspmoinsthinspdethinsp30thinspminutesthinspDrsquoautresthinspfacteursthinsptelsthinspquethinsplethinspmanquethinspthinspdethinspstimulationthinspouthinsplrsquoabsorptionthinspretardeacuteethinspdrsquounthinspmeacutedicamentthinsppeuventthinspcontribuerthinspthinspagravethinspunethinspseacutedationthinspprolongeacuteethinspouthinsprebond

Unethinspdeacutepressionthinsprespiratoirethinsppeutthinspsurvenirthinspjusqursquoagravethinspeacuteliminationthinspcomplegravetethinspthinspduthinspmeacutedicamentthinsp

ParthinspconseacutequentthinspjusqursquoagravethinspsonthinspdeacutepartthinsplethinsppatientthinspdoitthinspecirctrethinspsousthinsplathinspsurveillancethinspdrsquounthinspprofessionnelthinsphabiliteacutethinspagravethinspreconnaicirctrethinsplesthinspcomplicationsthinspetthinspagravethinspintervenirthinsprapidementthinspplusthinspparticuliegraverementthinsppourthinspmaintenirthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspetthinspassurerthinsplrsquoassistancethinspventilatoirethinspLethinspmeacutedecinthinspayantthinspproceacutedeacutethinspagravethinsplrsquointerventionthinspsousthinspseacutedation-analgeacutesiethinspouthinspunthinspmeacutedecinthinspdeacutesigneacutethinspdoitthinspecirctrethinspdisponiblethinspenthinsptoutthinsptempsthinspafinthinspdethinsppouvoirthinspintervenirthinspsansthinspdeacutelaithinsplethinspcasthinspeacutecheacuteant

Rappelonsthinspquethinsplesthinspappareilsthinspdethinspmonitoragethinspdoiventthinspecirctrethinspenthinspfonctionthinspmaisthinspthinspenthinspaucunthinsptempsthinspilsthinspnethinspremplacentthinsplathinspsurveillancethinspdirectethinspduthinsppatientthinspparthinspthinsplethinspprofessionnel

Lethinsppatientthinspdoitthinspresterthinspagravethinsplathinspsallethinspdethinspreacutecupeacuterationthinspouthinspdrsquoobservationthinsppendantthinspthinsp30thinspminutesthinspauthinspminimumthinspapregravesthinspavoirthinspreccediluthinsplathinspderniegraverethinspdosethinspdethinspseacutedationthinspouthinspthinspdrsquoanalgeacutesiethinspintraveineusethinsp(Merchantthinspetthinspcollabthinsp2014bthinspop cit)

Sithinspunethinspmeacutedicationthinspantagonistethinspathinspeacuteteacutethinspadministreacuteethinsplethinsppatientthinspserathinspgardeacutethinspsousthinspthinspobservationthinsplethinsptempsthinspneacutecessairethinsp(lethinsptempsthinspserathinspaugmenteacutethinspdethinspgethinsp2thinspheuresthinspthinsp[Merchantthinspetthinspcollabthinsp2014bthinspop cit]thinspenthinspfonctionthinspdethinsplrsquoeacutetatthinspcliniquethinspduthinsppatient)thinsppourthinspsrsquoassurerthinspqursquoilthinspnrsquoythinspathinsppasthinspdethinspseacutedationthinsprebond

Parmithinsplesthinspcritegraveresthinspagravethinsprespecterthinspauthinspmomentthinspduthinspcongeacutethinsp

thinsprsaquo voiesthinspaeacuteriennesthinsppermeacuteablesthinspetthinspventilationthinspadeacutequatethinsprsaquo stabiliteacutethinspcardiovasculairethinspadeacutequatethinsprsaquo niveauthinspdethinspconsciencethinspduthinsppatientthinsprevenuthinspagravethinspsonthinspeacutetatthinspinitialthinsprsaquo douleurthinspreacutesiduellethinsptoleacuterablethinspabsentethinspouthinspcommethinspagravethinspsonthinspeacutetatthinspinitial

CMQ - OIIQ - OPIQ 30

thinsprsaquo mobiliteacutethinsprevenuethinspagravethinspsonthinspeacutetatthinspinitialthinsprsaquo peuthinspouthinsppasthinspdethinspvomissementsthinsprsaquo patientthinspouthinsppersonnethinspresponsablethinspduthinsppatientthinsppeutthinspcomprendrethinsplesthinspdirectivesthinsp

dethinspdeacutepart

thinsprsaquothinsprsaquo Cesthinspcritegraveresthinspdoiventthinspecirctrethinsprespecteacutesthinspdethinspfaccedilonthinspsysteacutematiquethinsp

Lesthinspprofessionnelsthinspdoiventthinspsrsquoassurerthinspquethinspquandthinsplethinsppatientthinspquittethinsplrsquoeacutetablis-sementthinspilthinspestthinspaccompagneacutethinspdrsquounthinspadultethinspresponsablethinspetthinspqursquounthinspdocumentthinsprelatifthinspauthinspcongeacutethinspcomprenantthinspdesthinspconsignesthinspclairesthinsppourthinsplathinspsurveillancethinspagravethinspdomicilethinsp(pthinspexthinspthinspquoithinspfairethinspenthinspcasthinspdrsquourgence)thinspleurthinspsoitthinspremisthinspetthinspexpliqueacutethinsp(annexethinspXII)thinsp

thinspthinsp17thinspDOCUMENTATIONthinspDESthinspSOINSthinspETthinspTENUEthinspthinspDEthinspDOSSIERSthinsp

Commethinsppourthinsptoutethinspautrethinspinterventionthinsplesthinspmecircmesthinspnormesthinspsrsquoappliquentthinsppourthinsplathinspreacutedactionthinspdesthinspnotesthinspenthinspseacutedation-analgeacutesiethinspthinsp

Enthinspplusthinspdesthinspeacuteleacutementsthinspgeacuteneacuteralementthinspverseacutesthinspauthinspdossierthinspcelui-cithinspdoitthinspcontenirthinsptoutesthinsplesthinspinformationsthinsprelativesthinspagravethinsplathinsppeacuteriodethinsppreacutethinspperthinspetthinsppostseacutedation-analgeacutesiethinspAinsithinsplesthinspeacuteleacutementsthinspsuivantsthinspdoiventthinspecirctrethinspdocumenteacutesthinspauthinspdossierthinspduthinsppatientthinsp

(listethinspnonthinsplimitative)thinsp

1 lrsquoidentificationthinspdesthinspfacteursthinspdethinsprisquethinsplieacutesthinspagravethinsplrsquointerventionthinspdiagnostiquethinspthinspouthinsptheacuterapeutiquethinspouthinspagravethinsplathinspseacutedation-analgeacutesie

2 lrsquoheurethinspduthinspdeacutebutthinspetthinspdethinsplathinspfinthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplrsquoheurethinspdrsquoarriveacuteethinspagravethinsplathinspsallethinspdethinspreacutecupeacuterationthinspouthinspdrsquoobservationthinsp(sithinspdiffeacuterente)thinspetthinsplrsquoheurethinspduthinspdeacutepart

3 lesthinspordonnancesthinspmeacutedicalesthinspcomplegravetes4 lathinspmeacutedicationthinspthinspdosagethinspquantiteacutethinspvoiethinspvitessethinspetthinspheurethinspdrsquoadministration5 lathinspconcentrationthinspouthinsplethinspdeacutebitthinspdethinsplrsquooxygegravenethinsp(outhinspduthinspmeacutelangethinspgazeux)thinspadministreacutethinspthinsp

lethinspcasthinspeacutecheacuteant

6 lathinspsurveillancethinspeffectueacuteethinspa lesthinspsignesthinspvitauxthinspavecthinsplrsquoheurethinspdesthinsplecturesb lethinsptauxthinspdethinspsaturationthinspcapillairethinspenthinspoxygegravenethinspavecthinsplrsquoheurethinspdesthinsplecturesc lethinspniveauthinspdethinspCO

2thinspthinsplethinspcasthinspeacutecheacuteantthinspavecthinsplrsquoheurethinspdesthinsplectures

d lathinspdescriptionthinsppeacuteriodiquethinspduthinspniveauthinspdethinspseacutedationagitationthinspetthinspdethinspthinspconsciencethinsplrsquoutilisationthinspdrsquounethinspeacutechellethinspestthinsprecommandeacuteethinsp(annexethinspIX)

e lathinspdescriptionthinsppeacuteriodiquethinspduthinspniveauthinspdethinspdouleurthinsplrsquoutilisationthinspdrsquounethinspeacutechellethinspestthinsprecommandeacuteethinsp(annexethinspX)

CMQ - OIIQ - OPIQ 31

f lathinspdescriptionthinspdethinsptoutethinspreacuteactionthinspdeacutefavorablethinsplethinspcasthinspeacutecheacuteantg lathinspdescriptionthinspdethinsplrsquoeacutetatthinspduthinsppatientthinspagravethinsplathinspfinthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-thinsp

analgeacutesieh lathinspdescriptionthinspdethinsplrsquoeacutetatthinspduthinsppatientthinspauthinspmomentthinspduthinspcongeacutethinspouthinsplathinspreacutefeacuterencethinspthinsp

agravethinspunthinspprotocolethinsp(critegraveresthinspdethinspcongeacute)7 lethinspmonitoragethinspthinspappareilthinspalarmethinspemplacementthinsplethinspcasthinspeacutecheacuteant8 lethinspconsentement9 unethinspcopiethinspdesthinsprecommandationsthinspeacutecritesthinspremisethinspauthinsppatientthinspauthinspmomentthinspduthinsp

congeacutethinsp(annexethinspXII)thinspouthinspagravethinspdeacutefautthinspunethinspnotethinspattestantthinsplathinspremisethinspdethinspcethinspdocumentthinspstandardiseacutethinspdontthinspunethinspcopiethinspestthinspconserveacutee

10 thinsplethinspprotocolethinspopeacuteratoire11 thinsplathinspnotethinspdethinspdeacutepart12 thinsptoutethinspautrethinspinformationthinspjugeacuteethinsppertinentethinsp(pthinspexthinspthinspreacutesultatthinspdrsquoauscultationthinspthinsp

complication)

Enfinthinsptousthinsplesthinspprofessionnelsthinspimpliqueacutesthinspdoiventthinspsrsquoassurerthinspduthinsprespectthinspdethinspleurthinspreacuteglementationthinspouthinspnormesthinsprespectivesthinspenthinspmatiegraverethinspdethinspdocumentationthinspdesthinspsoinsthinspetthinspdethinsptenuethinspdethinspdossiers

CMQ - OIIQ - OPIQ 32

Chapitre 2Patient peacutediatrique

thinspPREacuteAMBULEthinsp

Puisquethinsplrsquoenfantthinsppossegravedethinspdesthinspcaracteacuteristiquesthinspquithinspluithinspsontthinsppropresthinspetthinspquithinspeacutevoluentthinspenthinspfonctionthinspdethinspsonthinspstadethinspdethinspdeacuteveloppementthinspilthinspestthinspdoncthinspopportunthinspdrsquoeacutetablirthinspdesthinsplignesthinspdirectricesthinspparticuliegraveresthinspagravethinspcettethinspclientegravelethinsp

Cesthinsplignesthinspdirectricesthinspvisentthinsplesthinspenfantsthinspacircgeacutesthinspdethinspplusthinspdethinsp3thinspansthinsp

Unethinspseacutedation-analgeacutesiethinspreacuteussiethinspameacuteliorethinsplathinspqualiteacutethinspdesthinspexamensthinspdemandeacutesthinspdiminuethinsplathinspneacutecessiteacutethinspdethinsprecourirthinspagravethinspdesthinspcontentionsthinspphysiquesthinspameacuteliorethinsplathinspcollaborationthinspetthinsplathinspconfiancethinspdethinsplrsquoenfantthinspetthinspdesthinspparentsthinspquantthinspauxthinspsoinsthinspprodigueacutesthinspetthinspauxthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspreacutealiseacuteesthinsp

Lathinspseacutedation-analgeacutesiethinsp(tousthinspniveaux)thinspenthinsppeacutediatriethinspdoitthinspecirctrethinspreacuteserveacuteethinspauthinspmilieuthinsphospitalierthinspouthinspauxthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacuteces-sairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspetthinspcethinspenthinspraisonthinspduthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquithinspestthinspgeacuteneacuteralementthinspneacutecessairethinspEllethinspcomportethinspdesthinsprisquesthinspseacuterieuxthinsppeuthinspimportethinsplrsquoeacutetatthinspdethinspsanteacutethinspdethinsplrsquoenfantthinspLesthinspcomplicationsthinsplesthinspplusthinspfreacutequentesthinspsontthinsplrsquoobstructionthinspdesthinspvoiesthinspaeacuteriennesthinsplrsquoapneacuteethinsplrsquoaspirationthinspdethinspseacutecreacutetionsthinspthinspetthinsplesthinspvomissements

thinsp21thinspOBJECTIFSthinspETthinspCLIENTEgraveLEthinspCIBLEthinsp

OBJECTIFS

Outrethinsplesthinspobjectifsthinspdethinspseacutedation-analgeacutesiethinspdeacutefinisthinsppourthinsplathinspclientegravelethinspadultethinsp(pthinsp8)thinspthinsp

lathinspseacutedation-analgeacutesiethinsppourthinsplathinspclientegravelethinsppeacutediatriquethinspvisethinspeacutegalementthinspagravethinspthinsp

thinsprsaquo eacuteviterthinspunthinsptraumatismethinsppsychologiquethinsprsaquo diminuerthinsplrsquoanxieacuteteacutethinspetthinsplathinsppeurthinspdethinsplrsquoenfantthinspetthinspdesthinspparentsthinsprsaquo obtenirthinsplathinspcollaborationthinspdethinsplrsquoenfant

CMQ - OIIQ - OPIQ 33

CLIENTEgraveLEthinspCIBLE

EnthinsppeacutediatriethinsplethinspniveauthinspdethinspseacutedationthinsprequisthinspestthinsptributairethinspdethinsplrsquoacircgethinspduthinspstadethinspdethinspdeacuteveloppementthinspdethinsplathinspcapaciteacutethinspcognitivethinspetthinspdethinsplathinspcollaborationthinspdethinsplrsquoenfantthinspAinsithinspchezthinsplrsquoenfantthinspdethinsp

thinsprsaquo 3thinspagravethinsp6thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspmodeacutereacutethinspsrsquoavegraverethinsprarementthinspsuffisantethinspLathinspplupartthinspdesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspneacutecessitentthinspunthinspniveauthinspprofondthinsp(voirethinspunethinspanestheacutesiethinspgeacuteneacuterale)thinsp

thinsprsaquo 7thinspagravethinsp13thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspmodeacutereacutethinspsrsquoavegraverethinspgeacuteneacuteralementthinspsuffisantethinspToutefoisthinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinsppeuventthinspneacutecessiterthinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspprofondthinsp

thinsprsaquo gethinsp14thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspleacutegerthinspouthinspmodeacutereacutethinspsrsquoavegraverethinspsuffisantethinspToutefoisthinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinsppeuventthinspneacutecessiterthinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspprofond

Chezthinsplrsquoenfantthinspdethinspmoinsthinspdethinsp3thinspansthinspouthinspdansthinsplethinspcasthinspdrsquounethinspseacutedationthinspprofondethinspviseacuteethinsplethinspmeacutedecinthinspdoitthinspsrsquoassurerthinspdethinsplathinspcollaborationthinspdrsquounthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespira-toirethinsppeacutediatriquethinspavanceacutee

Dethinspplusthinspilthinspestthinsprecommandeacutethinspdrsquoutiliserthinsplathinspclassificationthinspdethinsplrsquoeacutetatthinspphysiquethinspduthinspthinsppatientthinspquethinsplrsquoonthinsptrouvethinspdansthinsplethinsptableauthinspdethinsplathinsppagethinspsuivante

CMQ - OIIQ - OPIQ 34

Tableau 4 Classification de lrsquoeacutetat physique du patient selon lrsquoAmerican Society of Anesthesiologists (ASA) (ASA Physical Status Classification System [En ligne]) (Notre traduction)

Classification Eacutetatthinspdethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp1 Patientthinspenthinspbonnethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp2Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspleacutegegravere

ASAthinspPhysicalthinspStatusthinsp3Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgrave

ASAthinspPhysicalthinspStatusthinsp4Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgravethinspquithinsprepreacutesentethinspunethinspmenacethinspconstantethinsppourthinspsathinspvie

ASAthinspPhysicalthinspStatusthinsp5Patientthinspmoribondthinspquithinspnethinspsurvivrathinsppasthinspthinspagravethinspmoinsthinspdrsquounethinspinterventionthinsp

ASAthinspPhysicalthinspStatusthinsp6Patientthinspdeacuteclareacutethinspenthinspeacutetatthinspdethinspmortthinspceacutereacutebralethinspdontthinsplesthinsporganesthinspontthinspeacuteteacutethinsppreacuteleveacutesthinspagravethinspdesthinspfinsthinspdethinspdon

CMQ - OIIQ - OPIQ 35

Volet organisationnelthinsp22thinspCOMPEacuteTENCESthinspPROFESSIONNELLESthinsp

Outrethinsplesthinspcompeacutetencesthinspprofessionnellesthinspmentionneacuteesthinsppourthinsplethinsppatientthinspadultethinspthinsp(pthinsp11)thinsptousthinsplesthinspprofessionnelsthinspdethinsplathinspsanteacutethinsp(meacutedecinthinspinfirmiegraverethinspetthinspinhalotheacutera-peute)thinspquithinspprocegravedentthinspagravethinspunethinspseacutedation-analgeacutesiethinspaupregravesthinspdethinsppatientsthinsppeacutediatriquesthinspdoiventthinspposseacutederthinsp

athinsp lesthinspconnaissancesthinspetthinsplesthinspcompeacutetences73neacutecessairesthinspagravethinsplathinspreacuteanimationthinspthinspcardiorespiratoirethinsppeacutediatrique84(dethinsppreacutefeacuterencethinspenthinspsoinsthinspavanceacutes)thinspcrsquoest-agrave-direthinspmaicirctriserthinspenthinspprioriteacutethinsplesthinsptechniquesthinspdethinsplathinspprisethinspenthinspchargethinspdethinsplathinspventilationthinspduthinspmassagethinspcardiaquethinspetthinspdethinsplathinspmeacutedicationthinspassocieacutee

bthinspunethinspexpertisethinspcliniquethinspspeacutecifiquethinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspagravethinspreacutealiserthinspthinsp

thinspthinsp23thinspRESSOURCESthinspMATEacuteRIELLESthinsp

Sithinsplesthinspressourcesthinspmateacuteriellesthinspdethinspbasethinspetthinsplrsquoemplacementthinspsontthinspessentiellementthinsplesthinspmecircmesthinspquethinspchezthinsplrsquoadultethinsp(pthinsp11)thinspcelles-cithinspdoiventthinsptoutefoisthinspecirctrethinspadapteacuteesthinspauthinsp

patientthinsppeacutediatriquethinsp(crsquoest-agrave-direthinsptaillethinsppoidsthinspetthinspparticulariteacutes)thinsp

Agravethinsptitrethinspdrsquoexemplethinsp(listethinspnonthinsplimitative)thinsp

thinsprsaquo capteurthinspduthinspsaturomegravetrethinspdethinspmodegravelethinsppeacutediatriquethinsprsaquo reacuteanimateurthinspautogonflantthinsp(Ambuthinspbag)thinspetthinspmasquesthinspdethinspdiffeacuterentesthinsptaillesthinspthinsprsaquo lamesthinspdethinsplaryngoscopethinspsondesthinspendotracheacutealesthinsp(avecthinspouthinspsansthinspballonnet)thinspdethinsp

taillesthinspdiffeacuterentesthinsprsaquo canulesthinsporonasopharyngeacuteesthinspdethinspdiffeacuterentesthinsptaillesthinsprsaquo tubulurethinspagravethinspsoluteacutethinspdethinsptypethinspmicrogouttesthinspavecthinspouthinspsansthinspburettethinsprsaquo outilsthinspsupraglottiquesthinsp(pthinspexthinspthinspmasquethinsplaryngeacute)thinspdethinspdiffeacuterentesthinsptaillesthinsprsaquo deacutefibrillateurthinspavecthinspeacutelectrodesthinsppeacutediatriquesthinsprsaquo steacutethoscopethinspdethinsptaillethinsppeacutediatriquethinsp(preacutecordialthinspouthinsppreacutetracheacutealthinsppourthinspeacutecoutethinspenthinsp

continuethinspsrsquoilthinspythinspathinsplieu)thinsprsaquo appareilthinspagravethinspaspirationthinsppouvantthinspgeacuteneacutererthinspunethinsppressionthinspneacutegativethinspdethinsp40thinspagravethinsp60thinspmmthinsp

Hgthinspouthinspunethinspcapaciteacutethinspdethinspflotthinspdethinsp100thinsplitresthinspparthinspminutethinspetthinsplethinspmateacuterielthinspneacutecessairethinspdethinsptaillethinspadapteacutee

7thinsp Onthinspentendthinspparthinspconnaissancesthinspetthinspcompeacutetencesthinspqursquoellesthinspsoientthinspmisesthinspagravethinspjourthinspselonthinsplesthinsprecommandationsthinspenthinspvigueur

8thinsp Onthinspentendthinspparthinspcertificationthinspenthinspreacuteanimationthinspcardiorespiratoirethinsplesthinspformationsthinspsuivantesthinspthinsp rsaquothinspReacuteanimationthinspcardiorespiratoirethinspdethinspbasethinspthinspSoinsthinspimmeacutediatsthinspenthinspreacuteanimationthinsp(SIR)thinsppourthinspprofessionnelsthinspdethinsplathinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspsanteacutethinspouthinsplrsquoeacutequivalentthinsp rsaquothinspReacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspSoinsthinspavanceacutesthinspenthinspreacuteanimationthinsppeacutediatriquethinsp(SARP)thinspouthinsplrsquoeacutequivalent

CMQ - OIIQ - OPIQ 36

Volet professionnelthinsp24thinspPREacuteSEacuteDATION-ANALGEacuteSIEthinsp

SEacuteLECTIONthinspDESthinspPATIENTS

Sithinspunethinspseacutelectionthinsprigoureusethinspdesthinsppatientsthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinspattentionthinspquethinspchezthinsplrsquoadultethinsp(pthinsp15)thinspcertainesthinspparticulariteacutesthinsppropresthinspagravethinsplrsquoenfantthinspdoiventthinsp

toutefoisthinspecirctrethinspprisesthinspenthinspcomptethinsp

LorsthinspdethinspsituationsthinspparticuliegraveresthinspouthinspcomplexesthinspapregravesthinsplrsquoeacutevaluationthinspduthinsppatientthinsplethinspmeacutedecinthinspdevraitthinspconsulterthinspunthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspCitonsthinspagravethinsptitrethinspdrsquoexemplethinspmaisthinspsansthinspsrsquoythinsplimiterthinsp

thinsprsaquo preacutesencethinspdethinspcertainsthinspsyndromesthinspdontthinsplathinsptrisomiethinsp21thinsprsaquo anomaliethinspdesthinspvoiesthinspaeacuteriennesthinsprsaquo anomaliethinspcranio-facialethinsprsaquo infectionthinsprespiratoirethinspasthmethinsprsaquo maladiethinspneuromusculairethinsprsaquo maladiethinspcardiaquethinsprsaquo troublethinsprespiratoirethinspduthinspsommeilthinspetthinsplathinsptheacuterapiethinspassocieacuteethinsprsaquo obeacutesiteacutethinspimportantethinsprsaquo refluxthinspgastro-œsophagienthinsprsaquo eacutetatthinspdethinspconsciencethinspalteacutereacutethinsprsaquo troublethinspenvahissantthinspduthinspdeacuteveloppementthinsp(pthinspexthinspthinspautisme)

Dethinspmecircmethinsptoutthinspcommethinspchezthinsplrsquoadultethinsplesthinspinterventionsthinspeffectueacuteesthinspsousthinspseacutedation-analgeacutesiethinspdoiventthinspecirctrethinspreacuteserveacuteesthinspprincipalementthinspauxthinsppatientsthinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp1thinspouthinspauxthinsppatientsthinspatteintsthinspdrsquounethinspaffectionthinsp

systeacutemiquethinspleacutegegraverethinspclasseacuteethinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp2thinsp

Notonsthinspquethinsplorsquethinspcestthinspjustifieacutethinspauthinspdossierthinspmeacutedicalthinsplathinspseacutedation-analgeacutesiethinsppeutthinspecirctrethinspeffectueacuteethinspchezthinsplesthinsppatientsthinspstablesthinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp3thinspetthinspexceptionnellementthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp4thinspToutefoisthinspellethinspdoitthinsplrsquoecirctrethinspdansthinspdesthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspDethinspplusthinspcesthinsppatientsthinspdoiventthinsp

fairethinsplrsquoobjetthinspdrsquounethinspeacutevaluationthinspindividualiseacuteethinspetthinspplusthinspapprofondiethinspEacuteVALUATIONthinspDESthinspPATIENTSthinsp

CMQ - OIIQ - OPIQ 37

EacuteVALUATIONthinspDESthinspPATIENTS

Sithinspunethinspeacutevaluationthinsprigoureusethinspdesthinsppatientsthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinspatten-tionthinspquethinspchezthinspladultethinsp(pthinsp15)thinspcettethinspeacutevaluationthinspdoitthinspaussithinspinclurethinspsansthinspsrsquoythinsplimiterthinsplrsquoacircgethinsplathinsptaillethinsplethinsppoidsthinsplethinspstadethinspdethinspdeacuteveloppementthinsplathinspcapaciteacutethinspcognitivethinsplesthinspallergiesthinsplesthinspproblegravemesthinspmeacutedicauxthinspouthinspfamiliauxthinsppertinentsthinsplesthinspmeacutedicamentsthinsp(outhinspautrethinspsubstancethinspnonthinspprescrite)thinsppristhinspreacuteguliegraverementthinspouthinspreacutecemmentthinspetthinsplrsquoheurethinspduthinspdernierthinspingestathinspainsithinspquethinsplethinsptypethinspetthinsplathinspquantiteacutethinspconsommeacutee

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsplrsquoeacutevaluationthinsp(anamnegravesethinspetthinspexamenthinspphysique)thinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinspthinsp

CONSENTEMENTthinsp(REacuteSUMEacute)

LethinsplecteurthinspdoitthinspsethinspreacutefeacutererthinspagravethinsplrsquoannexethinspVIIIthinsppourthinsplethinsptextethinspcomplet

ToutthinspcommethinspchezthinsplrsquoadultethinspilthinspestthinspobligatoirethinspauthinspQueacutebecthinspdrsquoobtenirthinsplethinspconsente-mentthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspinterventionthinspCelathinspditthinsppourthinsplathinspclientegravelethinsppeacutediatriquethinspilthinspfautthinspajouterthinspunethinsppreacutecisionthinspextraitethinspduthinsp

Code civil du QueacutebecthinspthinspSithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsp(traitementsthinspdethinspmeacutedecinethinspetthinspdethinspchirurgiethinspestheacutetiquethinspexpeacuterimentationthinspetthinspdonsthinspdrsquoorganes)thinsplethinsppatientthinspdoitthinspecirctrethinspinformeacutethinspdethinsptousthinsplesthinsprisquesthinsppossiblesthinspmecircmethinspsrsquoilsthinspsontthinspraresthinspthinspetthinsplethinspconsentementthinspdoitthinspecirctrethinspdonneacutethinspparthinspeacutecrit

thinsprsaquo Unethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsp(gethinsp14thinspans)thinsppeutthinspconsentirthinspseulethinspthinspagravethinspmoinsthinspqursquoilthinspsrsquoagissethinspdethinspsoinsthinspnonthinsprequisthinspetthinspcomportantthinspdesthinsprisques

thinsprsaquo Pourthinspunethinsppersonnethinspmineurethinspdethinspmoinsthinspdethinsp14thinspansthinsp(ltthinsp14thinspans)thinsplethinspconsentementthinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentale

Srsquoilthinspsrsquoagitthinspdethinspsoins requisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsplrsquoobligationthinspdrsquoinformerthinsp

croicirctthinspenthinspfonctionthinspdethinsplathinsppreacutevalencethinspetthinspdethinsplathinspgraviteacutethinspdesthinspcomplications

thinsprsaquo Lethinspconsentementthinspdrsquounethinsppersonnethinspmineurethinsp(ltthinsp18thinspans)thinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinsp

thinsprsaquo Unethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsp(gethinsp14thinspans)thinsppeutthinspconsentirthinspmaisthinspnethinsppeutthinsppasthinsprefuserthinspseulethinspdesthinspsoinsthinspquithinspseraientthinspjugeacutesthinsprequisthinsp

DIRECTIVESthinspETthinspCONSEILSthinsp

Toutthinspcommethinsppourthinsplrsquoadultethinsp(pthinsp19)thinsplrsquoenfantthinspetthinspsonthinspparentthinsp(outhinspremplaccedilant)thinspdoiventthinsprecevoirthinsplesthinspdirectivesthinspneacutecessairesthinspCelathinspditthinspauxthinspdirectivesthinsprelativesthinspauthinspjeucircnethinsp

CMQ - OIIQ - OPIQ 38

preacute-interventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspnonthinspurgentethinsp(eacutelective)thinspilthinspfautthinspajouterthinspcecithinsp(Merchantthinspetthinspcollabthinsp2014a op cit)thinsp

thinsprsaquo liquidethinspclairthinsp(pthinspexthinspthinspeauthinspjusthinspdethinspfruitthinsp[sansthinsppulpe])thinspthinspjeucircnethinspdethinsp2thinspheuresthinsprsaquo laitthinspmaternelthinspthinspjeucircnethinspdethinsp4thinspheuresthinsprsaquo formulesthinsplacteacuteesthinspnonthinsphumaniseacuteesthinspouthinsppreacuteparationsthinspcommercialesthinsppourthinsp

nourrissonsthinspthinspjeucircnethinspdethinsp6thinspheuresthinspthinspAucunthinspajoutthinspnrsquoestthinsppermisthinspauthinsplaitthinspmaternelthinsptireacutethinsp

thinsp25thinspPERSEacuteDATION-ANALGEacuteSIEthinsp

APPROCHEthinspPHARMACOLOGIQUEthinsp

Sithinsplathinspmeacutedicationthinspgeacuteneacuteralementthinsputiliseacuteethinspestthinsplathinspmecircmethinspquethinspchezthinsplrsquoadultethinsp(pthinsp20)thinsplathinspdosethinspdoitthinspecirctrethinspadapteacuteethinspnotammentthinspenthinspfonctionthinspduthinsppoidsthinspetthinspdethinsplathinspcondi-tionthinspcliniquethinspdethinsplrsquoenfantthinspParthinspailleursthinspilthinspfautthinspretenirthinspquethinsplathinsppharmacocineacutetiquethinspetthinsplathinsppharmacodynamiquethinspdesthinspagentsthinspdethinspseacutedation-analgeacutesiethinspsontthinspinfluenceacuteesthinspparthinsplrsquoacircgethinspduthinsppatientthinspAgravethinsptitrethinspdrsquoexemplethinsppourthinspunthinspenfantthinspacircgeacutethinspdethinspunthinspagravethinspsixthinspansthinsplathinspclairancethinspdesthinspagentsthinspdethinspseacutedation-analgeacutesiethinspestthinspsupeacuterieurethinspagravethinspcellethinspdethinsplrsquoadultethinspIlthinspfaudrathinspdoncthinspajusterthinsplesthinspdosesthinspchezthinspunthinspenfantthinspdrsquoacircgethinsppreacutescolairethinsp(Saunderthinspetthinsp

collabthinsp2008)thinsp

Lrsquoutilisationthinspdrsquounethinsppommadethinspanalgeacutesiquethinsp(pthinspexthinspthinsplathinspcregravemethinspEMLAreg)thinsppeutthinspecirctrethinspavantageusethinsppourthinspcontrerthinsplathinspdouleurthinspassocieacuteethinspagravethinsplathinspposethinspdrsquounthinspcatheacuteterthinspintra-veineuxthinspparthinspexemplethinsp(lethinsptempsthinspdrsquoattentethinspdethinsp60thinspagravethinsp90thinspminutesthinspdoitthinspecirctrethinsppristhinspenthinspconsideacuteration)thinsp

APPROCHEthinspNONthinspPHARMACOLOGIQUE

Pourthinsplrsquoenfantthinspquithinspnethinspbeacuteneacuteficiethinspquethinspdrsquounethinspanalgeacutesiethinsp(aucunethinspseacutedation)thinspilthinspfautthinspretenirthinspquethinsplathinspdistractionthinsp(attirerthinsplrsquoattentionthinspversthinspquelquethinspchosethinspdethinsppositif)thinsppen-dantthinspunthinspsointhinspdouloureuxthinsp(outhinspquithinspinquiegravete)thinsppeutthinspsrsquoaveacutererthinspunthinspmoyenthinspefficacethinsppourthinspdiminuerthinspsonthinspanxieacuteteacutethinspetthinsplathinspperceptionthinspdethinspsathinspdouleurthinsp(AssociationthinspSparadrapthinspthinsp[Enthinspligne])

Agravethinsptitrethinspdrsquoexemplethinspetthinspsansthinspsrsquoythinsplimiterthinsp

thinsprsaquo discuterthinspavecthinsplrsquoenfantthinspouthinsplrsquoadolescentthinspdethinspsesthinsppreacutefeacuterencesthinsprsaquo utiliserthinspunthinspjouetthinspchanterthinspunethinspchansonthinspouthinspraconterthinspunethinsphistoirethinspagravethinsplrsquoenfantthinspthinsp

plusthinspjeunethinsprsaquo lathinsppreacutesencethinspetthinsplathinspcollaborationthinspdrsquounthinspparentthinsppeuventthinspecirctrethinsppertinentes

CMQ - OIIQ - OPIQ 39

SURVEILLANCEthinspCLINIQUE

Lathinspsurveillancethinspcliniquethinspcomprendthinspplusieursthinspeacuteleacutementsthinspquithinspconcernentthinspnotam-mentthinsplesthinspsystegravemesthinsprespiratoirethinspcardiaquethinspetthinspneurologiquethinspetthinspellethinspdoitthinsptenirthinspcomptethinspentrethinspautresthinsp

thinsprsaquo dethinsplathinspconditionthinspduthinsppatientthinspavantthinspetthinsppendantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

thinsprsaquo dethinsplathinspcomplexiteacutethinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinsprsaquo dethinsplathinspmeacutedicationthinsputiliseacuteethinsp(dosethinspdureacuteethinspetthinsppicthinspdrsquoactionthinspvoiethinspetthinspvitessethinsp

drsquoadministrationthinspcombinaisonthinspetthinspantagonistes)thinsprsaquo dethinsplrsquoassistancethinspagravethinspapporterthinspauthinspmeacutedecin

Lethinspmeacutedecinthinspquithinsppratiquethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspchezthinspunthinspenfantthinspsousthinspseacutedation-analgeacutesiethinspdoitthinspcompterthinspsurthinsplathinsppreacutesencethinspdrsquoauthinspmoinsthinspunthinspautrethinspprofessionnelthinsphabiliteacutethinspduthinspmilieuthinspdethinsplathinspsanteacutethinsp(infirmiegraverethinspinhalotheacuterapeutethinspouthinspautrethinspmeacutedecin)thinsp(annexethinspII)thinspEnthinspeacutetroitethinspcollaborationthinspavecthinsplethinspmeacutedecinthinspreacuteali-santthinsplrsquointerventionthinspceux-cithinspassurentthinsplathinspgestionthinspdethinsplathinspseacutedationthinspetthinspdethinsplrsquoanalgeacutesiethinsp

qui comprend entre autres la surveillance clinique de lrsquoenfantthinspresponsabiliteacutethinspthinspagravethinsplaquellethinspilsthinspdoiventthinspenthinsptoutthinsptempsthinspsethinspconsacrerthinspen prioriteacutethinsp

Dansthinspcertainsthinspcasthinsplethinspprofessionnelthinspquithinspassurethinspen prioriteacutethinsplathinspsurveillancethinspthinspcliniquethinspdethinsplrsquoenfantthinsppeutthinspecirctrethinspappeleacutethinspagravethinspassisterthinsplethinspmeacutedecinthinspdansthinsplathinspreacutealisationthinspthinspdethinspsonthinspinterventionthinspCettethinspassistancethinspquithinspdoitthinspsrsquoeffectuerthinspdansthinsplathinspmecircmethinsppiegravecethinspdoitthinspecirctrethinspdethinsptregravesthinspcourtethinspdureacuteethinspDethinspplusthinspellethinspdoitthinsppouvoirthinspecirctrethinspinterrompuethinspagravethinsptoutthinspmomentthinsppourthinspintervenirthinspimmeacutediatementthinspaupregravesthinspdethinsplrsquoenfantthinspenthinspcasthinspdethinspcomplicationsthinspouthinspdethinspbesoin

Parthinspailleursthinsplorsquethinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspneacutecessitentthinspunethinspassistancethinsptechniquethinspcontinuellethinspauthinspmeacutedecinthinsplrsquoajoutthinspdrsquounthinsptroisiegravemethinspprofessionnelthinspdethinsplathinspsanteacutethinsphabiliteacutethinsp(meacutedecinthinspinfirmiegraverethinspouthinspinhalotheacutera-peute)thinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspdethinsplrsquoenfantthinspestthinsprequisthinsp

CMQ - OIIQ - OPIQ 40

Tableau 5 Tableau reacutecapitulatif du nombre de professionnels habiliteacutes requis en seacutedation-analgeacutesie - Clientegravele peacutediatrique

Toutthinspauthinsplongthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinspdoitthinspecirctrethinspcontinuethinspetthinsplathinspcommunicationthinspavecthinspcelui-cithinspmaintenuethinsp

Proceacutederthinspagravethinsplathinspsurveillancethinspcliniquethinspcrsquoestthinspeacutevaluerthinspqualitativementthinspetthinspquanti-tativementthinspdethinspfaccedilonthinspsoutenuethinspetthinspenthinspcontinuthinsplrsquoensemblethinspdesthinspparamegravetresthinspsui-vantsthinsp(listethinspnonthinsplimitative)thinsp(tableauthinsp6)thinsp

thinsprsaquo mesurethinspdethinsplathinsppressionthinsparteacuteriellethinspduthinsppouls95etthinspdethinsplathinsprespiration106

thinsprsaquo lecturethinspdethinsplathinspsaturationthinspcapillairethinspenthinspoxygegraveneLathinsptonaliteacutethinspdethinsppoulsthinspdoitthinspecirctrethinspactiveacuteethinspenthinsptoutthinsptempsthinspetthinspsonthinspniveauthinspdoitthinspecirctrethinspajusteacutethinspdethinspfaccedilonthinspagravethinspecirctrethinspentenduthinspclairement

thinsprsaquo eacutevaluationthinspdethinsplrsquoeacutetatthinspdethinsplathinspcolorationthinspetthinspdethinsplathinsptempeacuteraturethinspdethinsplathinsppeauthinsprsaquo niveauthinspdrsquoO

2thinspdethinspCO

2thinspetthinspmonitoragethinspcardiaquethinspselonthinsplethinspcasthinsp

Enthinspplusthinspdesthinspparamegravetresthinspdethinspmonitoragethinspcliniquethinsp(mentionneacutesthinsppreacuteceacutedemment)thinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsppeacutediatriquethinspdoitthinspcomprendrethinspthinsp

thinsprsaquo lrsquoeacutevaluationthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsp(pthinspexthinspthinspbradycardiethinsphypoxiquethinsppreacutecocethinspsithinspobstruction)

thinsprsaquo lrsquoapportthinspliquidienthinsprsaquo lathinsppertethinspdethinspchaleurthinsp(selonthinsplathinspdureacuteethinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesie)

9thinspthinspthinspthinspthinspLethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp10thinspthinspthinspthinspLathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinspetthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

Nombrethinspdethinspprofessionnelsthinsphabiliteacutesthinsprequis

2 Nombrethinspmimimalthinsprequis

3 Sithinsputilisationthinspdethinsppropofolthinspkeacutetaminethinspouthinspdethinspdexmeacutedeacutetomidine

3 SithinsputilisationthinspconcomitantethinspdethinspN2Othinspetthinspdrsquounthinspagentthinspseacutedatifthinspouthinspthinsp

dunthinspopioiumldethinspouthinspsithinspconcentrationthinspdethinspN2Othinspmodifiable

3 Sithinsplassistancethinsptechniquethinspauthinspmeacutedecinthinspestthinspcontinuelle

CMQ - OIIQ - OPIQ 41

thinsprsaquo lrsquoeacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplrsquoanalgeacutesiethinspetthinspdethinsplathinspseacutedationthinspagravethinsplrsquoaidethinspdrsquooutilsthinspadapteacutesthinspagravethinsplathinspconditionthinspetthinspagravethinsplrsquoacircgethinspdethinsplrsquoenfantthinsp(annexesthinspIXthinspetthinspX)

thinsprsaquo lathinsppositionthinspduthinsppatientthinspetthinsplesthinsppointsthinspdrsquoappuithinsp(compression)

Tableau 6 Surveillance des paramegravetres cliniques en seacutedation-analgeacutesie - Clientegravele peacutediatrique

Paramegravetrethinspdethinspthinspsurveillancethinspclinique

PatientNiveauthinspdethinspthinspseacutedation

MeacutedicationInterventionthinspdiagnostiquethinspouthinsptheacuterapeutique

TAthinspRC11thinspthinspRR12thinspthinspetthinspsaturationthinspdrsquoO

2thinspthinsp

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

Niveauthinspdethinspthinsp-thinspseacutedationagitationthinspthinspthinspthinspconscience-thinspdouleur

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

NiveauthinspdethinspCO2

SelonthinsplesthinspcaracteacuteristiquesthinspAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)thinsp

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspmeacutedication Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire rsaquothinspAccegravesthinspindirectthinspouthinspthinspthinspthinspthinsprestreintthinspauthinsppatientthinspthinspthinsp(pthinspexthinspthinspIRM)

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetaminethinsp

rsaquothinspRecommandeacute rsaquothinspASAthinspgethinsp3thinsprsaquothinspApneacuteethinspobstructivethinspthinspthinspduthinspsommeilthinsprsaquothinspMaladiethinspthinspthinsprespiratoirethinsprsaquothinspObeacutesiteacutethinspmorbide

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

Monitoragethinspcardiaque

SelonthinsplesthinspcaracteacuteristiquesAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspmeacutedication Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire rsaquothinspASAthinspgethinsp3thinsprsaquothinspMaladiethinspcardiaque

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

Interventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspprolongeacuteethinsp(effetthinspcumulatifthinspdethinsplathinspmeacutedication)

rsaquothinspRecommandeacute Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

thinspthinsp IlthinspnethinspsrsquoagitthinsppasthinspdrsquounethinsplistethinsplimiteacuteethinspdesthinspsituationsthinspcliniquesthinspDrsquoautresthinspsituationsthinspcliniquesthinsppeuventthinspneacutecessiterthinspthinsplethinspmonitoragethinspcardiaquethinspouthinspduthinspCO

2thinspIlthinsprevientthinspauxthinspprofessionnelsthinspdethinspjugerthinspdethinsplathinspsituationthinspenthinspfonctionthinspdethinspthinsp

chaquethinsppatient

11thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp12thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

CMQ - OIIQ - OPIQ 42

ILthinspFAUTthinspSAVOIRthinspQUE

LathinspSocieacuteteacutethinspcanadiennethinspdesthinspanestheacutesiologistesthinsp(SCA)thinspindiquethinspquethinsplesthinspthinspdirectivesthinspgeacuteneacuteralesthinspdethinspsoinsthinsp(ythinspcompristhinsplethinspmonitorage)thinsppourthinsplathinspseacutedationthinspthinspconscientethinspsontthinsplesthinspmecircmesthinspquethinsppourthinsplesthinspautresthinspformesthinspdrsquoanestheacutesiethinsp[]thinspthinsp(Merchantthinspetthinspcollabthinsp2014bthinspopthinspcit)thinspDethinspplusthinspellethinspindiquethinspquethinsplethinspthinspcapnographethinspestthinsprequisthinsplorsthinspdethinspseacutedation-analgeacutesiethinspdethinspniveauthinspplusthinspeacuteleveacutethinspthinsp(pthinspexthinspthinspRamsaythinsp4-6)thinsp(Merchantthinspetthinspcollabthinsp2014athinspop cit)

LethinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspimpliqueacutesthinspestthinspprimordialthinspetthinspcethinspmecircmethinspsithinsplrsquoappareillagethinspenthinspplacethinspestthinspcompletthinspetthinspfonctionnelthinspUnethinspbonnethinspcommunica-tionthinspentrethinspcesthinspderniersthinspestthinspdoncthinspessentiellethinspafinthinspdethinspbienthinspcoordonnerthinsplathinspseacutedationthinspetthinsplrsquoanalgeacutesiethinspavecthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspLes alarmes (audibles et visuelles) de chaque appareil doivent ecirctre en fonction et les paramegravetres ajusteacutes agrave lrsquoacircge et agrave la condition clinique de chaque enfant

IlthinspfautthinspsrsquoassurerthinspdethinsplathinsptraccedilabiliteacutethinspdethinsplrsquoeacutevaluationthinspetthinspdethinsplathinspsurveillancethinspcliniquethinspthinspeffectueacuteesthinspparthinspunethinsptenuethinspdethinspdossiersthinspconformethinspauxthinspnormesthinspenthinspvigueurthinspthinspLesthinspoutilsthinspdrsquoeacutevaluationthinsputiliseacutesthinspdoiventthinspecirctrethinspsimplesthinspstandardiseacutesthinspvalideacutesthinspdethinsppreacutefeacuterencethinspetthinspadapteacutesthinspauthinspcontextethinspetthinspauxthinspcaracteacuteristiquesthinspduthinsppatientthinspnotam-mentthinsppourthinsplrsquoeacutevaluationthinspduthinspniveauthinspdethinspseacutedationagitationthinspdethinspconsciencethinspetthinspdethinspdouleurthinsp(annexesthinspIXthinspetthinspX)

Lathinspfreacutequencethinspdethinsplathinspmesurethinspdethinspcesthinspparamegravetresthinspetthinspleurthinspenregistrementthinspdoiventthinspecirctrethinspdeacutetermineacutesthinspentrethinspautresthinspenthinspfonctionthinspdethinsplathinspmeacutedicationthinspetthinspdethinsplathinspconditionthinsp

cliniquethinspduthinsppatientthinsp

Ideacutealementthinsplethinspprofessionnelthinspdoitthinsplesthinspdocumenterthinsp

thinsprsaquo avantthinsplethinspdeacutebutthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsprsaquo apregravesthinsplrsquoadministrationthinspdrsquounthinspagentthinspdethinspseacutedation-analgeacutesiethinspouthinspdrsquounthinspantagonistethinsprsaquo authinsppicthinspdrsquoactionthinspdethinspchacunthinspdesthinspagentsthinspadministreacutesthinspthinsprsaquo agravethinspintervallesthinspreacuteguliersthinsp(pthinspexthinspthinsp5thinspminutes)thinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-

analgeacutesiethinsprsaquo agravethinspintervallesthinspplusthinsprapprocheacutesthinsplorsquethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsplrsquoexigethinsprsaquo durantthinsplathinsppeacuteriodethinspdethinspreacutecupeacuterationthinspetthinspjusqursquoauthinspretourthinspduthinspniveauthinspdethinspconsciencethinsp

initialthinspselonthinsplathinspconditionthinspcliniquethinspduthinsppatientthinsprsaquo authinspmomentthinspduthinspcongeacutethinsp

CMQ - OIIQ - OPIQ 43

thinsp26thinspPOSTSEacuteDATION-ANALGEacuteSIEthinsp

Commethinsppourthinsplethinsppatientthinspadultethinsp(pthinsp29)thinsplathinspsurveillancethinspcliniquethinspdoitthinspecirctrethinspcons-tantethinspetthinsprigoureusethinsptoutthinspauthinsplongthinspdethinsplathinsppeacuteriodethinsppostseacutedation-analgeacutesiethinspetthinspcethinspjusqursquoauthinspretourthinspdethinsplrsquoeacutetatthinspinitialthinspdethinsplrsquoenfantthinspenthinspfonctionthinspdethinspsonthinspstadethinspdethinspdeacutevelop-pement

Rappelonsthinspquethinsplesthinspappareilsthinspdethinspmonitoragethinspdoiventthinspecirctrethinspenthinspfonctionthinspthinspmaisthinspenthinspaucunthinsptempsthinspilsthinspnethinspremplacentthinsplathinspsurveillancethinspdirectethinspduthinsppatientthinspthinspparthinsplethinspprofessionnelthinsp

LathinsppeacuteriodethinspdrsquoobservationthinspenthinspeacutetablissementthinspdoitthinspecirctrethinspsuffisammentthinspprolongeacuteethinsppourthinsppreacutevenirthinsplesthinspproblegravemesthinsppendantthinspetthinspauthinspretourthinspagravethinsplathinspmaisonthinspComptethinsptenuthinspdethinspsonthinspacircgethinspetthinspdethinspsathinspconditionthinsplrsquoenfantthinspdoitthinspecirctrethinspcapablethinspdethinspsrsquoasseoirthinspdethinspboirethinspdethinspparlerthinspetthinspdethinspmarcherthinspavecthinspunethinspaidethinspminimalethinsp

Selonthinsplathinspdistancethinspagravethinspparcourirthinspauthinspretourthinspilthinsppeutthinspecirctrethinspjudicieuxthinspdethinspprolongerthinsplathinsppeacuteriodethinspdrsquoobservation

Unthinspdocumentthinsprelatifthinspauthinspcongeacutethinspcomprenantthinspdesthinspconsignesthinspclairesthinsppourthinsplathinspthinsp

surveillancethinspagravethinspdomicilethinspdoitthinspecirctrethinspremisthinspetthinspexpliqueacutethinspauxthinspparentsthinsp(annexethinspXII)

thinsp27thinspDOCUMENTATIONthinspDESthinspSOINSthinspETthinspTENUEthinspDEthinspDOSSIERSthinsp

Lathinsptenuethinspdethinspdossiersthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinsprigueurthinspetthinsplathinspmecircmethinsppreacutecisionthinspquethinspchezthinsplrsquoadultethinsp(pthinsp30)thinspCertainesthinspinformationsthinsppropresthinspagravethinsplrsquoenfantthinspdoiventthinspecirctrethinspajouteacuteesthinspnotammentthinsp

thinsprsaquo sithinsppreacutesencethinspdrsquounthinspparentthinsprsaquo lethinsppoidsthinspetthinsplrsquoacircgethinspdethinsplrsquoenfantthinsprsaquo lathinsptaillethinspouthinsplrsquoIMCthinspsrsquoilthinspythinspathinsplieu

CMQ - OIIQ - OPIQ 44

CONCLUSION

Lathinspseacutedation-analgeacutesiethinspvisethinspagravethinspalteacutererthinsplethinspniveauthinspdethinspconsciencethinspainsithinspqursquoagravethinspsoulagerthinsplrsquoanxieacuteteacutethinspetthinsplathinspdouleurthinspdrsquounthinsppatientthinspauthinspcoursthinspdrsquounethinspinterventionthinsptheacuterapeutiquethinspouthinspdiagnostiquethinspCettethinspproceacutedurethinspbienthinspquethinspfreacutequemmentthinsputiliseacuteethinspcomportethinspcependantthinspcertainsthinsprisques

On doit y recourir de faccedilon seacutecuritaire pour le patient et en tout temps preacutevenir et reconnaicirctre les complica-tions lieacutees agrave la seacutedation-analgeacutesie afin drsquoeffectuer rapidement et efficace-ment les manœuvres neacutecessaires

LethinsprespectthinspdesthinsplignesthinspdirectricesthinspeacutenonceacuteesthinspdansthinspcethinspdocumentthinspaiderathinsplesthinspprofessionnelsthinspagravethinspmenerthinspadeacutequatementthinspcettethinspproceacutedurethinspCeux-cithinspdemeurentthinsptoutefoisthinspresponsablesthinspdethinsplathinspmisethinspagravethinspjourthinspdethinspleursthinspconnaissancesthinspetthinspduthinspdeacuteveloppementthinspdethinspleursthinspcompeacutetencesthinsprespectivesthinsp

Parthinspailleursthinsplesthinspeacutetablissementsthinspdethinspsanteacutethinspetthinsplesthinspcliniquesthinspouthinspcabinetsthinsppriveacutesthinspdevraientthinspsrsquoinspirerthinspdethinspcesthinsplignesthinspdirectricesthinsppourthinspeacutelaborerthinspthinspdesthinspproceacuteduresthinsprelativesthinspagravethinsplathinspthinspseacutedation-analgeacutesiethinspetthinspenthinspassurerthinsplrsquoeacutevaluationthinsppeacuteriodiquethinspdethinsplathinspqualiteacutethinsp

CMQ - OIIQ - OPIQ 45

mdash Annexe

thinspANNEXEthinspIthinspndashthinspDEacuteFINITIONthinspDEthinspLrsquoANESTHEacuteSIEthinspGEacuteNEacuteRALEthinspETthinspthinsp

DESthinspNIVEAUXthinspDEthinspSEacuteDATION-ANALGEacuteSIEthinspSELONthinspLrsquoAMERICANthinspSOCIETYthinspOFthinsp

ANESTHESIOLOGISTSthinsp(ASA)thinsp(AMERICANthinspSOCIETYthinspOFthinspANESTHESIOLOGISTSthinsp

ASAthinspHOUSEthinspOFthinspDELEGATEthinsp2014AthinspOP CIT)thinsp(NOTREthinspTRADUCTION)

Seacutedationthinspminimalethinspthinspanxiolyse

Seacutedation-thinspthinspanalgeacutesiethinspthinspmodeacutereacutee(consciente)

Seacutedation-thinspanalgeacutesiethinspthinspprofonde

Anestheacutesiethinspthinspgeacuteneacuterale

Reacuteponse Reacuteponsethinspnormalethinspagravethinsplathinspstimulationthinspverbale

Reacuteponsethinspvolontairethinspagravethinsplathinspstimulationthinspverbalethinspouthinsptactile

Reacuteponsethinspvolontairethinspsuivantthinspunethinspstimulationthinspreacutepeacuteteacuteethinspouthinspdouloureuse

Nonthinspeacuteveillablethinspmecircmethinspavecthinspstimulusthinspdouloureux

Voiesthinspthinspaeacuteriennes

Nonthinspaffecteacutees Pasthinspdrsquointerventionthinsprequise

Interventionthinsppeutthinspecirctrethinsprequise

Interventionthinspthinspsouventthinsprequise

Ventilationspontaneacutee

Nonthinspaffecteacuteethinsp Adeacutequate Peutthinspecirctrethinspinadeacutequate

Freacutequemmentthinspinadeacutequate

Fonctionthinspcardio-thinspvasculaire

Nonthinspaffecteacutee Geacuteneacuteralementthinspthinspmaintenue

Geacuteneacuteralementthinspthinspmaintenue

Peutthinspecirctrethinspthinspcompromise

thinspthinspLethinspreacuteflexethinspdethinspretraitthinspagravethinsplathinspsuitethinspdrsquounethinspstimulationthinspdouloureusethinspnrsquoestthinsppasthinspconsideacutereacutethinspcommethinspunethinspreacuteponsethinspvolontaire

Rappelonsthinspquethinsplathinspseacutedation-analgeacutesiethinspprofondethinspchezthinsplrsquoadultethinspetthinsplrsquoanestheacutesiethinspgeacuteneacuteralethinsp(adultethinspetthinsppeacutediatrique)thinspthinspnethinspfontthinsppasthinsplrsquoobjetthinspdethinspcettethinsppublication

CMQ - OIIQ - OPIQ 46

mdash Annexe

thinspANNEXEthinspIIthinspndashthinspINFORMATIONthinspCOMPLEacuteMENTAIREthinsp-thinspLECTURESthinspDrsquoINTEacuteREcircT

COLLEgraveGEthinspDESthinspMEacuteDECINSthinspDUthinspQUEacuteBECthinsp(CMQ)

thinsprsaquo Proceacutedures et interventions en milieu extrahospitalier (2011)thinsprsaquo Code de deacuteontologie des meacutedecinsthinsp(2015)

ORDREthinspDESthinspINFIRMIEgraveRESthinspETthinspINFIRMIERSthinspDUthinspQUEacuteBECthinsp(OIIQ)thinsp

thinsprsaquo EacutediteurthinspofficielthinspduthinspQueacutebec Code de deacuteontologie des infirmiegraveres et infirmiers (2014)

thinsprsaquo Le champ drsquoexercice et les activiteacutes reacuteserveacutees des infirmiegraveresthinsp(2013)thinsp2ethinspeacutedthinspthinsprsaquo Mosaiumlque des compeacutetences cliniques de lrsquoinfirmiegravere Compeacutetences initiales

(2009)thinsp2ethinspeacutedthinspthinsprsaquo Les obligations deacuteontologiques de lrsquoinfirmiegravere et le consentement aux soins

(2005)

ORDREthinspPROFESSIONNELthinspDESthinspINHALOTHEacuteRAPEUTESthinspDUthinspQUEacuteBECthinsp(OPIQ)

thinsprsaquo Profil national des compeacutetencesthinspLrsquoalliancethinspdesthinsporganismesthinspdethinspregraveglementationthinspenthinsptheacuterapiethinsprespiratoirethinsp(2011)

thinsprsaquo Les notes au dossier dans le secteur de lrsquoassistance anestheacutesique et de la seacutedation analgeacutesiethinsp-thinspGuidethinspdethinsppratiquethinsp(2008)

thinsprsaquo Compeacutetences relatives agrave lrsquoentreacutee dans la pratique (2003)thinsprsaquo Regraveglement sur les dossiers les autres effets les cabinets et la cessation

drsquoexercice des membres de lrsquoOrdre professionnel des inhalotheacuterapeutes du Queacutebecthinsp(2002)thinsp

thinsprsaquo Code de deacuteontologie des inhalotheacuterapeutes du Queacutebec

CMQ - OIIQ - OPIQ 47

thinspANNEXEthinspIIIthinspndashthinspPROCEacuteDURESthinspPROTOCOLESthinspOUthinspALGORITHMESthinsp

Dansthinsptousthinsplesthinsplieuxthinspougravethinspsethinsppratiquethinsplathinspseacutedation-analgeacutesiethinspagravethinspdesthinspfinsthinspdiagnos-tiquesthinspouthinsptheacuterapeutiquesthinsplethinspmeacutedecinthinspresponsablethinspdoitthinspeacutelaborerthinspenthinspcollabora-tionthinspavecthinsplesthinspmembresthinspdethinspsonthinspeacutequipethinspsoignantethinsplesthinspproceacuteduresthinspprotocolesthinspouthinsp

algorithmesthinspconcernantthinspnotammentthinsplesthinspsujetsthinspsuivantsthinsp

PARMIthinspLESthinspPROCEacuteDURESthinspOUthinspPROTOCOLESthinsp(ADULTEthinspETthinspPEacuteDIATRIQUE)thinsp

thinsprsaquo allergiethinspauthinsplatexchocthinspanaphylactiquethinsprsaquo antagonistethinsprsaquo bradycardiethinsprsaquo critegraveresthinspcliniquesthinspdethinspcongeacutethinsprsaquo hypertensionthinspmalignethinsprsaquo seacutedation-analgeacutesiethinsprsaquo transfertthinspdrsquourgence

PARMIthinspLESthinspALGORITHMESthinsp(ADULTEthinspETthinspPEacuteDIATRIQUE)thinsp

thinsprsaquo gestionthinspdesthinspvoiesthinspaeacuteriennesthinspdifficilesthinsp(ventilationintubation)thinsprsaquo reacuteanimationthinspcardiorespiratoirethinsp

thinspthinspthinspILthinspFAUTthinspPENSERthinspAgravethinsp

thinsprsaquo Lrsquoaffichagethinspdesthinspproceacuteduresthinspprotocolesthinspouthinspalgorithmesthinspdrsquourgencethinspquithinsppermettrathinspdrsquoythinspavoirthinspaccegravesthinsprapidementthinspenthinspcasthinspdrsquourgencethinspetthinspdethinsplesthinspconsulterthinspreacuteguliegraverementthinspparthinsplathinspmecircmethinspoccasionthinsp

thinsprsaquo Lrsquoeacutelaborationthinspdrsquounthinspprogrammethinsppeacuteriodiquethinspdrsquoexercicethinsp(pthinspexthinspthinspsimulation)thinspquithinsppermettrathinspdethinsprevoirthinsplesthinspdiffeacuterentesthinspproceacuteduresthinspenthinspplacethinspavecthinsptousthinsplesthinspmembresthinspdethinsplrsquoeacutequipethinspsoignantethinspetthinspdrsquoinitierthinsplethinspnouveauthinsppersonnelthinspassurantthinspainsithinspunethinspmeilleurethinsprelegravevethinspDethinspmecircmethinspmettrethinsplethinspplanthinspenthinsppratiquethinsppermetthinspdrsquooptimiserthinsplathinsprapiditeacutethinspetthinsplathinsppreacutecisionthinspdesthinspgestesthinspposeacuteesthinspetthinspdrsquoidentifierthinspdesthinspproblegravemesthinsppotentielsthinsp(avecthinspdethinsplrsquoeacutequipementthinspparthinspexemple)thinspetthinspcethinspavantthinspqursquoilthinspythinspaitthinspurgencethinspdrsquoagirthinsp

mdash Annexe

CMQ - OIIQ - OPIQ 48

thinspANNEXEthinspIVthinspndashthinspEacuteVALUATIONthinspDESthinspVOIESthinspAEacuteRIENNESthinspSUPEacuteRIEURESthinspAUthinsp

thinspMOYENthinspDUthinspSCOREthinspDEthinspMALLAMPATIthinsp(DIEMUNSCHthinspETthinspCOLLABthinsp2008)thinsp

(Agravethinsptitrethinspinformatifthinspseulement)

Objectifthinspthinspthinsp Eacutevaluerthinsplathinspvisibiliteacutethinspdesthinspstructuresthinsporopharyngeacuteesthinspetthinsplathinsptaillethinspthinsp

dethinsplathinsplangue

Lesthinsp4thinspclassesthinspdethinspMallampatithinspmodifieacuteesthinsp(SamsoonthinspandthinspYoung)thinspsontthinsp

thinsprsaquo ClassethinspIthinspthinspluettethinsppiliersthinspduthinspvoilethinspduthinsppalaisthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIIthinspthinsppiliersthinspduthinspvoilethinspduthinsppalaisthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIIIthinspthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIVthinspthinsppalaisthinspdurthinspseulthinsp

LesthinspclassesthinspIthinspetthinspIIthinsppreacutesagentthinspdrsquounethinspintubationthinspathinsppriorithinspfacilethinsplesthinspclassesthinspIIIthinspetthinspIVthinspdrsquounethinspintubationthinspdifficile

ClassesthinspdethinspMallampatithinspmodifieacuteesthinsp(Jmarchnthinsp[Enthinspligne])

LrsquoinsuffisancethinspdethinsplathinspclassificationthinspdethinspMallampatithinspathinspeacuteteacutethinspspeacutecifiquementthinspmon-treacuteethinspchezthinsplrsquoobegravesethinspEllethinspnethinsppeutthinspecirctrethinspconsideacutereacuteethinspcommethinspunthinsppreacutedicteurthinspisoleacute-mentthinspsuffisantthinspdethinsplathinspdifficulteacutethinspdethinsplathinsplaryngoscopiethinspouthinspathinspfortiorithinspdethinsplrsquointuba-tionthinspdifficilethinsp

mdash Annexe

CMQ - OIIQ - OPIQ 49

ANNEXEthinspVthinspndashthinspOUTILthinspDrsquoEacuteVALUATIONthinspDEthinspLrsquoAPNEacuteEthinspOBSTRUCTIVEthinspDUthinspSOMMEILthinsp

(AOS)thinspADAPTEacutethinspAgravethinspLAthinspCONSULTATIONthinspPREacuteANESTHESIQUESEacuteDATION-thinsp

ANALGEacuteSIEthinspthinsp(ADAPTEacutethinspDEthinspCHUNGthinspETthinspSEETthinsp2010)thinsp(NOTREthinspTRADUCTION)

(Agravethinsptitrethinspinformatifthinspseulement)

mdash Annexe

Exemplethinspdethinspquestionnairethinspstop-bang

Question Reacuteponse

Sthinspnore PreacutesencethinspdethinspronflementVosthinspronflementsthinspsont-ilsthinspbruyants(suffisammentthinsppourthinspecirctrethinspentendusthinspagravethinsptraversthinspunethinspportethinspfermeacutee)

OuithinspouthinspNon

Tthinspiredthinspfatiguethinsporthinspsleepy PreacutesencethinspdethinspsomnolencethinspouthinspfatigueVousthinspsentez-vousthinspsouventthinspfatigueacutethinspeacutepuiseacutethinspouthinspsomnolentthinsppendantthinsplathinspjourneacutee

OuithinspouthinspNon

Othinspbservedthinspapnea ApneacuteethinspobserveacuteethinspQuelqursquounthinspa-t-ilthinspdeacutejagravethinspobserveacutethinspquethinspvousthinspthinsparrecirctiezthinspdethinsprespirerthinspenthinspdormant

OuithinspouthinspNon

Pthinspressure PreacutesencethinspdrsquoHTAAvez-vousthinspouthinspecirctes-vousthinsptraiteacutepourthinspunethinsptensionthinsparteacuteriellethinspeacuteleveacutee

OuithinspouthinspNon

BthinspMI IMCthinspgtthinsp35thinspkgm2 OuithinspouthinspNon

Athinspge Acircgethinspgtthinsp50thinspans OuithinspouthinspNon

Nthinspeck Circonfeacuterencethinspduthinspcouthinspgtthinsp40thinspcm OuithinspouthinspNon

Gthinspender Sexethinspmasculin OuithinspouthinspNon

INTERPREacuteTATIONthinspCLINIQUE

ltthinsp3thinspreacuteponsesthinsppositivesthinsp=thinspfaiblethinsprisquethinspdrsquoAOS

ge 3 reacuteponses positives = risque eacuteleveacute drsquoAOS

CMQ - OIIQ - OPIQ 50

thinspANNEXEthinspVIthinspndashthinspANAMNEgraveSEthinspthinspAIDEthinspMNEacuteMOTECHNIQUEthinsp

(Agravethinsptitrethinspinformatifthinspseulement)

ObjectifthinspthinspthinspthinspCetthinspoutilthinspdrsquoaidethinspmneacutemotechniquethinspsertthinspagravethinspstructurerthinsplathinspfaccedilonthinspdontthinspthinsponthinspprocegravedethinspagravethinsplathinspcollectethinspsommairethinspdesthinspdonneacuteesthinspdansthinsplethinspcadrethinspdethinsplrsquoeacutevaluationthinspcliniquethinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinspfacilitethinsplathinspcompreacutehensionthinspetthinsplathinspreacutealisationthinspdethinsplrsquoanamnegravesethinspchezthinsplrsquoadultethinspetthinsplrsquoenfant

SAMPLEthinsp(AdapteacutethinspdethinspAltonthinspetthinspcollabthinsp2007thinsp[Notrethinsptraduction])thinsp(outhinspvariante)

SthinspthinspSignesthinspetthinspsymptocircmes

AthinspthinspAllergiesthinspetthinspreacuteactionthinsp

MthinspthinspMeacutedicamentsthinspetthinspautresthinspsubstancesthinsp(prescritsthinspouthinspnon)thinspetthinsptraitement

PthinspthinspPasseacutethinspmeacutedicalfamilialthinsp

LthinspthinspLastthinspmeallunchthinsp(dernierthinsprepas)

EthinspthinspEnvironnementeacuteveacutenement

thinsp

mdash Annexe

CMQ - OIIQ - OPIQ 51

thinspANNEXEthinspVIIthinsp-thinspEXAMENthinspPHYSIQUEthinspthinspAIDEthinspMNEacuteMOTECHNIQUE

(Agravethinsptitrethinspinformatifthinspseulement)

Objectifthinspthinspthinsp Lrsquoexamenthinspphysiquethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinspcherchethinspagravethinspmettrethinspenthinspeacutevidencethinspcertainsthinspcritegraveresthinspreconnusthinsppourthinspecirctrethinspassocieacutesthinspagravethinspunethinspassis-tancethinspventilatoirethinspdifficilethinspquithinsppeutthinspsurvenirthinspdansthinsplethinspcasthinspdrsquounthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquethinspceluithinspviseacutethinspparthinspexemple

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinspfacilitethinsplathinspcompreacutehensionthinspetthinsplathinspreacutealisationthinspdethinsplrsquoexamenthinspphysiquethinsprelativementthinspauxthinspvoiesthinspaeacuteriennesthinspdethinsplrsquoadulte

1thinspIndicateursthinspdrsquounethinsppossiblethinspventilationthinspdifficilethinsp(MOANSthinsp[AdapteacutethinspdethinspWallsthinspetthinspthinspthinspthinspthinspMurphythinsp2012]thinsp[Notrethinsptraduction]thinspouthinspvariante)

Mthinspthinspmask sealthinsp(eacutetancheacuteiteacutethinspduthinspmasque)thinspthinspeacutetancheacuteiteacutethinspcompromisethinspenthinspraisonthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspdrsquounethinspbarriegraverethinspmeacutecaniquethinsp(barbethinspfourniethinsptraumatismethinspfacialthinspetc)

OthinspthinspobeacutesiteacuteobstructionthinspthinsppatientthinspdontthinsplrsquoIMCthinspestthinspgtthinsp25thinsp(kgm2)thinspfemmethinspenceintethinspthinspthinspthinspthinspthinspthinspthinspgtthinsp6thinspmoisthinsp(2ethinsptrimestre)thinspangio-œdegravemethinspabcegravesthinspetc

Athinspthinspacircgethinspthinsppatientthinspgethinsp55thinspansthinsp(variablethinspselonthinsplesthinspauteurs)thinspenthinspraisonthinspnotammentthinspthinspthinspthinspthinspthinspthinspdethinsplathinsppertethinspdrsquoeacutelasticiteacutethinspdesthinsptissus

Nthinspthinspno teeththinsp(eacutedenteacute)thinspthinspdifficulteacutethinsplorsthinspdethinsplrsquoassistancethinspventilatoire

Sthinspthinspstiffthinsp(rigiditeacute)thinspthinsppathologiesthinspagravethinspconseacutequencesthinspsurthinsplathinspcompliancethinspetthinsplathinspthinspthinspthinspthinspthinspreacutesistancethinsppulmonairethinsp(asthmethinspMPOCthinsppneumoniethinspdethinspstadethinspavanceacutethinspetc)

thinspthinspVentilationthinspdifficilethinsp(masquethinspouthinspoutilthinspextraglottiquethinsptelthinspquethinspmasquethinspthinspthinspthinspthinspthinsplaryngeacute)thinsp(AdapteacutethinspdethinsplrsquoAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinsp[Notrethinspthinspthinspthinspthinspthinsptraduction])thinspImpossiblethinspdrsquoeffectuerthinspunethinspventilationthinspdethinspfaccedilonthinspadeacutequatethinspthinspthinspthinspthinspthinspenthinspraisonthinspdethinsplrsquounethinspetouthinspdethinsplrsquoautrethinspdesthinspsituationsthinspsuivantesthinsp

athinspMauvaisethinspeacutetancheacuteiteacutethinspduthinspmasquethinspouthinspdethinsplrsquooutilthinspextraglottiquebthinspFuitethinspdethinspgazthinspexcessivecthinspReacutesistancethinspexcessivethinspagravethinsplrsquoinspirationthinspouthinspagravethinsplrsquoexpiration

thinsp

mdash Annexe

CMQ - OIIQ - OPIQ 52

2thinspIndicateursthinspdrsquounethinsppossiblethinsplaryngoscopiethinspouthinspintubationthinspdifficilethinsp(thinspLEMONthinspthinspthinspthinspthinspthinsp[WallsthinspetthinspMurphythinsp2012thinspopthinspcit]thinsp[Notrethinsptraduction]thinspouthinspvariante)

Lthinspthinspthinsplook externallythinsp(apparencethinspphysique)thinspthinspmicrognathiethinspmacroglossiethinspdenti-tionthinspirreacuteguliegraverethinspcirconfeacuterencethinspduthinspcouthinspgethinspgrossessethinspetc

thinspEthinspthinspthinspeacutevaluationthinspthinspregraveglethinspduthinsp3-3-2thinsp(variantethinsppossiblethinspselonthinsplesthinspauteurs)thinsp-thinspthinsp

consideacuterationsthinspgeacuteomeacutetriquesthinsp(agravethinsplrsquoaidethinspdesthinspdoigtsthinspduthinsppatient)3thinspthinsp ouverturethinspdethinspbouchethinspthinspinsertionthinspdethinsp3thinspdethinspsesthinspdoigts3thinspthinsp taillethinspduthinsplarynxthinsp(longueurthinspmandibulaire)thinspthinsp3thinspdoigtsthinspsousthinsplethinspmentonthinsp

(boutthinspdethinspsonthinspmentonthinspjusqursquoagravethinsplathinspjonctionthinspduthinspcouthinspauthinspniveauthinspdethinspthinsplrsquoosthinsphyoiumlde)

2thinspthinsp positionthinspduthinsplarynxthinspthinsp2thinspdethinspsesthinspdoigtsthinspentrethinsplathinspjonctionthinspcou-mentonthinsp(osthinspthinsphyoiumlde)thinspetthinsplethinspcartilagethinspthyroiumlde

thinspMthinspthinspthinspMallampatithinsp(annexethinspIV)thinspOthinspthinspthinspobeacutesiteacuteobstructionthinspthinspIMCthinspthinspœdegravemethinspduthinsplarynxthinspneacuteoplasiethinspdethinsplathinspsphegraverethinsp

ORLthinspcompressionthinspextrinsegravequethinspparthinspheacutematomethinspcervicalthinspdifficulteacutethinspagravethinspavalerthinspdyspneacutee

thinspNthinspthinspthinspneck mobilitythinsp(mobiliteacutethinspcervicale)thinspthinspimmobilisationthinspauthinspmoyenthinspdrsquounthinspcol-

lierthinspcervicalthinsppreacutesencethinspdrsquounethinsppathologiethinspouthinspdrsquounethinspsituationthinspcliniquethinspagravethinspconseacutequencethinspsurthinsplrsquoassistancethinspventilatoirethinspouthinspdethinsplrsquointubationthinsp(pthinspexthinspthinspthinsparthrosethinspouthinsparthritethinspimportantethinsptrisomiethinsp21thinspetc)

thinspthinsp Lanryngoscopiethinspdifficilethinspthinspimpossibiliteacutethinspdethinspvisualiserthinspnrsquoimportethinspquellethinsppartiethinspdesthinspcordesthinspvocalesthinspapregravesthinspdethinspmultiplesthinsptentativesthinspavecthinspunthinsplaryngoscopethinspconventionnelthinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinspop citthinsp[Notrethinsptraduction])thinsp

thinspthinspIntubationthinspendotracheacutealethinspdifficilethinspthinspintubationthinspquithinsprequiertthinspdethinspmultiplesthinspthinsptentativesthinspenthinsppreacutesencethinspouthinspenthinsplrsquoabsencethinspdrsquounethinsppathologiethinsptracheacutealethinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinspop citthinspthinsp[Notrethinsptraduction])

IlthinspfautthinspnoterthinspquethinsplrsquoinsuffisancethinspdethinsplathinspclassificationthinspdethinspMallampatithinspathinspeacuteteacutethinspspeacutecifiquementthinspmontreacuteethinspchezthinsplrsquoobegravesethinspellethinspnethinsppeutthinspecirctrethinspconsideacutereacuteethinspcommethinspunthinsppreacutedicteurthinspisoleacutementthinspsuffisantthinspdethinsplathinspdifficulteacutethinspdethinsplathinsplaryngoscopiethinspouthinspathinspfortiorithinspdethinsplrsquointubationthinspdifficile

mdash Annexe

ge

ge

CMQ - OIIQ - OPIQ 53

thinspANNEXEthinspVIIIthinsp-thinspLEthinspCONSENTEMENT

SelonthinsplethinspdroitthinspenthinspvigueurthinspilthinspestthinspobligatoirethinspauthinspQueacutebecthinspdrsquoobtenirthinsplethinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspintervention

LethinspCode civil du Queacutebec eacutetablitthinspdesthinspregraveglesthinspgeacuteneacuteralesthinspconcernantthinsplethinspconsente-mentthinspauxthinspsoinsthinspquithinspsrsquoappliquentthinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspOnthinspythinspfaitthinspcependantthinspcertainesthinspdistinctionsthinspselonthinspquethinsplesthinspsoinsthinspsontthinsprequisthinspouthinspnonthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspetthinspselonthinspquethinsplethinsppatientthinspestthinspaptethinspagravethinspconsentirthinspouthinspnon

Sithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsp(traitementsthinspdethinspmeacutedecinethinspetthinspdethinspchirurgiethinspestheacutetiquethinspexpeacuterimentationthinspetthinspdonsthinspdrsquoorganes)thinsplethinsppatientthinspdoitthinspecirctrethinspinformeacutethinspdethinsptousthinsplesthinsprisquesthinsppossiblesthinspmecircmethinspsrsquoilsthinspsontthinspraresthinspetthinsplethinspconsentementthinspdoitthinspecirctrethinspdonneacutethinspparthinspeacutecritthinspHabituellementthinspilthinspnethinsppeutthinspecirctrethinspdonneacutethinspquethinspparthinspunthinsppatientthinspaptethinspetthinspacircgeacutethinspdethinsp14thinspansthinspetthinspplusthinspparthinsplethinspmandatairethinsplethinsptuteurthinspouthinsplethinspcurateurthinspdrsquounethinsppersonnethinspinaptethinspouthinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinspdrsquounethinsppersonnethinspdethinspmoinsthinspdethinsp14thinspansthinspLrsquoautorisationthinspdethinsplathinspcourthinspestthinspenthinspoutrethinspneacutecessairethinspsithinsplesthinspsoinsthinsppreacutesententthinspunthinsprisquethinspseacuterieuxthinsppourthinsplathinspsanteacutethinspdethinspcesthinsppersonnesthinspouthinspsrsquoilsthinsppeuventthinspcauserthinspdesthinspeffetsthinspgravesthinspetthinsppermanentsthinspUnethinsppersonnethinspmineurethinspdethinspthinsp14thinspansthinspetthinspplusthinsppeutthinspconsentirthinspseulethinspagravethinspmoinsthinspqursquoilthinspsrsquoagissethinspdethinspsoinsthinspnonthinsprequisthinspetthinspthinspcomportantthinspdesthinsprisques

SrsquoilthinspsrsquoagitthinspdethinspsoinsthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsplrsquoobligationthinspdrsquoinformerthinspcroicirctthinspenthinspfonctionthinspdethinsplathinsppreacutevalencethinspetthinspdethinsplathinspgraviteacutethinspdesthinspcomplicationsthinspSithinsplethinsppatientthinspestthinspinaptethinspetthinspqursquoilthinspnrsquoestthinsppasthinsprepreacutesenteacutethinspparthinspunthinspmandatairethinspunthinsptuteurthinspouthinspunthinspcura-teurthinsplethinspconsentementthinsppeutthinspecirctrethinspdonneacutethinspparthinspunthinspconjointthinspouthinspagravethinspdeacutefautthinspduthinspconjointthinspparthinspunthinspprochethinspouthinspunethinsppersonnethinspquithinspdeacutemontrethinspunthinspinteacuterecirctthinspparticulierthinsppourthinsplathinspper-sonnethinspinaptethinspIlthinspnrsquoythinspathinsppasthinspdrsquoobligationthinspagravethinspcethinspquethinspcethinspconsentementthinspsoitthinspdonneacutethinspparthinspeacutecritthinspLethinspconsentementthinspauxthinspsoinsthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspdrsquounethinsppersonnethinspmi-neurethinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinspouthinsplethinsptuteurthinspUnethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsppeutthinspconsentirthinspmaisthinspnethinsppeutthinsppasthinsprefuserthinspseulethinspdesthinspsoinsthinspquithinspseraientthinspjugeacutesthinsprequisthinspEnthinspcasthinspdrsquourgencethinsplethinspconsentementthinspauxthinspsoinsthinspmeacutedicauxthinspnrsquoestthinsppasthinspneacutecessairethinsplorsquethinsplathinsppersonnethinspouthinspsonthinspinteacutegriteacutethinspestthinspmenaceacuteethinspetthinspquethinsplethinspconsentementthinspnethinsppeutthinspecirctrethinspobtenuthinspagravethinsptemps

LathinspLoi sur les servicesthinspdethinspsanteacutethinspetthinsplesthinspservicesthinspsociauxthinsp(LSSS)thinspeacutetablitthinspquantthinspagravethinspellethinspcertainesthinspregraveglesthinspenthinspmatiegraverethinspdethinspconsentementthinspauxthinspinterventionsthinspchirurgicalesthinspetthinspagravethinsplrsquoanestheacutesiethinsp

mdash Annexe

CMQ - OIIQ - OPIQ 54

Selonthinspcettethinsploithinsplethinspconsentementthinspagravethinspunethinspanestheacutesiethinspouthinspagravethinspunethinspinterventionthinspchirurgi-calethinspdoitthinspecirctrethinspattesteacutethinspparthinspunthinspdocumentthinspeacutecritthinspsigneacutethinspparthinsplethinsppatientthinspouthinspsonthinsprepreacutesen-tantthinspetthinspcethinspdocumentthinspdoitthinspfairethinspeacutetatthinspdesthinspinformationsthinspapproprieacuteesthinspconcernantthinspnotammentthinsplesthinsprisquesthinspouthinsplesthinspeffetsthinsppossiblesthinspCetthinspeacutecritthinspdoitthinspecirctrethinspcontresigneacutethinspparthinsplethinspmeacutedecinthinspouthinsplethinspdentistethinsptraitantthinspetthinspconserveacutethinspdansthinsplethinspdossierthinspduthinsppatientthinspLethinspdossierthinspdoitthinspcontenirthinspunthinspdocumentthinspattestantthinsplethinspconsentementthinsppourthinsplesthinspsoinsthinspetthinsplesthinspservicesthinspdispenseacutesthinspdansthinspunthinspcentrethinsphospitalierthinsp(CH)thinspunthinspcentrethinspdrsquoheacutebergementthinspetthinspdethinspsoinsthinspdethinsplonguethinspdureacuteethinsp(CHSLD)thinspetthinspunthinspcentrethinsplocalthinspdethinspservicesthinspcommunau-tairesthinsp(CLSC)

CesthinspdispositionsthinspnethinspsrsquoappliquentthinspqursquoauxthinspsoinsthinspdispenseacutesthinspenthinspeacutetablissementthinspthinspMaintenantthinspquethinspplusieursthinspinterventionsthinspautrefoisthinspreacuteserveacuteesthinspauxthinspeacutetablissementsthinsppeuventthinspecirctrethinspeffectueacuteesthinspenthinspdehorsthinspdethinspceux-cithinsplathinspquestionthinspsethinspposethinsptoutefoisthinspdethinspsavoirthinspsithinsplesthinspmecircmesthinspexigencesthinspdevraientthinspsrsquoappliquerthinsppartoutthinsp

Qursquoenthinspest-ilthinspparthinspexemplethinspdethinsplathinspsignaturethinspdrsquounthinspformulairethinspdethinspconsentementthinspEnthinsppratiquethinspetthinspagravethinsplrsquousagethinspilthinspsrsquoestthinspaveacutereacutethinspqursquounthinspformulairethinspdethinspconsentementthinspducircmentthinspsigneacutethinspnethinsppeutthinspagravethinspluithinspseulthinspprouverthinspquethinsplethinspconsentementthinspathinspeacuteteacutethinsplibrethinspetthinspeacuteclaireacutethinspUnethinspcourtethinspnotethinspverseacuteethinspauthinspdossierthinspreacutesumantthinsplesthinspinformationsthinsptransmisesthinspetthinsplesthinspeacutechangesthinspauxquelsthinspellesthinspontthinspdonneacutethinsplieuthinspestthinsppreacutesentementthinspjugeacuteethinspbeaucoupthinspplusthinsppertinentethinspagravethinspcetthinspeacutegardthinspLethinspformulairethinspdethinspconsentementthinspcomplegravetethinsplesthinsprenseigne-mentsthinspfournisthinspverbalementthinspIlthinspsrsquoagitthinspdrsquounthinspajoutthinspagravethinsplrsquoinformationthinspverbalethinsptransmisethinspthinsp

etthinspnonthinspdrsquounethinspmesurethinspvisantthinspagravethinsplathinspremplacer

LethinspCode de deacuteontologiethinspdes meacutedecinsthinsppreacutecisethinsplesthinspobligationsthinspdesthinspmeacutedecinsthinsp

quantthinspauthinspconsentementthinsp

Article 28Le meacutedecin doit sauf urgence avant drsquoentreprendre un examen une investiga-tion un traitement ou une recherche obtenir du patient ou de son repreacutesentant leacutegal un consentement libre et eacuteclaireacute

Article 29Le meacutedecin doit srsquoassurer que le patient ou son repreacutesentant leacutegal a reccedilu les explications pertinentes agrave leur compreacutehension de la nature du but et des conseacutequences possibles de lrsquoexamen de lrsquoinvestigation du traitement ou de la recherche qursquoil srsquoapprecircte agrave effectuer Il doit faciliter la prise de deacutecision du patient et la respecter

mdash Annexe

CMQ - OIIQ - OPIQ 55

DansthinspsesthinspguidesthinspdrsquoexercicethinspportantthinspsurthinsplathinsptenuethinspdesthinspdossiersthinsplethinspCollegravegethinspestimethinspdrsquoailleursthinspquethinsplethinspdossierthinspdrsquounthinsppatientthinspdoitthinspcontenirthinspunethinspnotethinspattestantthinspquethinsplesthinspin-formationsthinspneacutecessairesthinspagravethinspunethinspprisethinspdethinspdeacutecisionthinspeacuteclaireacuteethinspontthinspeacuteteacutethinsptransmisesthinspparthinsplethinspmeacutedecinthinspetthinspcomprisesthinspparthinsplethinsppatientthinspouthinspsonthinsprepreacutesentantthinsplorsquethinsplathinspchosethinspestthinspjugeacuteethinsppertinentethinspathinspfortiorithinsplorsqursquoilthinspsrsquoagitthinspdrsquounethinspinterventionthinspchirurgicalethinspdrsquounethinspinterventionthinspchirurgicalethinspsousthinspseacutedation-analgeacutesiethinspdrsquoanestheacutesiethinspreacutegionalethinspouthinspgeacuteneacuteralethinsp

DansthinsplethinspCode de deacuteontologie des infirmiegraveres et infirmiersthinsponthinsppreacutevoitthinspquethinsp

thinspArticle 40 Lrsquoinfirmiegravere ou lrsquoinfirmier doit fournir agrave son client toutes les explications neacuteces-saires agrave la compreacutehension des soins et des services qursquoil lui prodigue

Article 41Lorsque lrsquoobligation drsquoobtenir un consentement libre et eacuteclaireacute incombe agrave lrsquoin-firmiegravere ou agrave lrsquoinfirmier ce dernier doit fournir au client toutes les informations

requises

LethinspCode de deacuteontologie des inhalotheacuterapeutes du Queacutebecthinspnethinspcontientthinsppasthinspdethinsp

dispositionthinsptouchantthinsppreacuteciseacutementthinsplethinspconsentementthinspOnthinsppreacutecisethinspcependantthinspquethinsp

Article 13En plus des avis et des conseils lrsquoinhalotheacuterapeute doit fournir agrave son client les explications neacutecessaires agrave la compreacutehension et agrave lrsquoappreacuteciation des services qursquoil

lui rend

EnthinspcompleacutementthinspdansthinspsesthinspnormesthinspdethinsppratiquethinspportantthinspsurthinsplathinsptenuethinspdesthinspdossiersthinsplrsquoOrdrethinspprofessionnelthinspdesthinspinhalotheacuterapeutesthinspduthinspQueacutebecthinspdemandethinspquethinsplethinspdos-sierthinspdrsquounthinsppatientthinspcomportethinspunethinspmentionthinspdesthinspsoinsthinspetthinspdesthinspservicesthinspprodigueacutesthinspagravethinspsonthinspeacutegardthinspAgravethinspcetthinspeffetthinsptoutethinspactiviteacutethinspexerceacuteethinspparthinsplrsquoinhalotheacuterapeutethinsptellethinspquethinsplrsquoinformationthinsptransmisethinspauthinsppatientthinspeuthinspeacutegardthinspagravethinsplathinspseacutedation-analgeacutesiethinspdoitthinspecirctrethinspinscritethinspauthinspdossierthinspduthinsppatientthinspetthinspcethinspauthinspfurthinspetthinspagravethinspmesurethinspquethinsplesthinspactiviteacutesthinspsontthinspexerceacutees

EnthinspsommethinsplathinsploithinspexigethinspunthinspconsentementthinspeacutecritthinspsithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspainsithinspquethinsppourthinsplesthinspanestheacutesiesthinsplesthinspinterventionsthinspchirurgicalesthinspetthinsplesthinspsoinsthinspdispenseacutesthinspenthinspeacutetablissementthinspDansthinspsesthinspguidesthinspportantthinspsurthinsplesthinspproceacuteduresthinspetthinspinterventionsthinspenthinspmilieuthinspextrahospitalierthinspnotammentthinsplethinspCollegravegethinsprecommandethinsptoutefoisthinspquethinsplethinspmeacutedecinthinspversethinspunethinspnotethinspexplicativethinspauthinspdossierthinspetthinspobtiennethinspunthinspconsentementthinspeacutecritthinsppourthinsptoutethinspinterventionthinspmeacutedicalethinspouthinsp

mdash Annexe

CMQ - OIIQ - OPIQ 56

chirurgicalethinspeffractivethinspqursquoellethinspsoitthinspeffectueacuteethinspdansthinspunthinspbutthinspdiagnosticthinsptheacuterapeu-tiquethinspouthinspestheacutetiquethinspLorsquethinsplethinspconsentementthinspportethinspagravethinsplathinspfoisthinspsurthinsplathinspseacutedation-thinspthinspanalgeacutesiethinspetthinspsurthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsplrsquoinformationthinsptrans-misethinspdoitthinspinclurethinsplesthinsprisquesthinspdethinsplrsquointerventionthinspetthinspceuxthinspdethinsplathinspseacutedation-analgeacutesiethinspcelle-cithinsppouvantthinspcomporterthinspdesthinsprisquesthinspimportantsthinspmecircmethinspsithinsplrsquointerventionthinspestthinspmineure

Lrsquoobtentionthinspdrsquounthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspdemeurethinspunethinspobligationthinspthinspinheacuterentethinspagravethinsplrsquointerventionthinspmeacutedicalethinspelle-mecircmethinspIlthinsprelegravevethinspdoncthinspdethinsplathinspresponsabiliteacutethinspduthinspmeacutedecinthinspdethinspsrsquoassurerthinspdethinsplathinsptransmissionthinspdethinsplrsquoinformationthinsppertinentethinspauthinsppatientthinspetthinspdethinspsathinspcompreacutehensionthinspdethinsplathinspnaturethinspduthinspbutthinspetthinspdesthinsprisquesthinsprelatifsthinspagravethinsplrsquointerventionthinspToutefoisthinsplathinsptacircchethinspdethinsptransmettrethinspdethinsplrsquoinfor-mationthinspcompleacutementairethinspouthinspdethinspfairethinsplrsquoenseignementthinspauxthinsppatientsthinsppeutthinspecirctrethinspconfieacuteethinspagravethinspdrsquoautresthinspprofessionnelsthinspetthinspcellethinspdethinsprecueillirthinsplathinspsignaturethinspdrsquounthinspthinspformulairethinspdethinspconsentementthinspagravethinspdrsquoautresthinspmembresthinspdethinsplrsquoeacutequipethinspdethinspsoins

mdash Annexe

CMQ - OIIQ - OPIQ 57

mdash Annexe

thinspANNEXEthinspIXthinsp-thinspEacuteVALUATIONthinspDEthinspLrsquoEFFICACITEacutethinspDEthinspLAthinspSEacuteDATIONthinsp(EXEMPLES)thinsp

(Listethinspnonthinsplimitative)thinsp

1 Eacutechelle de seacutedation de Ramsay modifieacuteethinsp(Adapteacute de Merchant et collab 2014b op cit)

Instruction Descriptiondeacutefinition Valeur

thinspObserverthinsplethinsppatientEacuteveilleacutethinspthinsplethinsppatientthinspestthinspanxieuxthinspetthinspagiteacutethinspouthinspnerveuxthinspouthinsplesthinspdeux 1

ObserverthinsplethinsppatientLethinsppatientthinspeacutetablit-ilthinspunthinspcontactthinspvisuelthinspetthinspreacutepond-ilthinspauxthinspordres

Eacuteveilleacutethinspthinsplethinsppatientthinspestthinspcoopeacuteratifthinspthinsporienteacutethinspetthinspcalme 2

ParlerthinspauthinsppatientthinspLethinsppatientthinspeacutetablit-ilthinspunthinspcontactthinspvisuelthinspetthinspreacutepond-t-ilthinspauxthinspordres

Eacuteveilleacutethinspthinsplethinsppatientthinspreacutepondthinspseulementthinspauxthinspordres 3

StimulerthinspphysiquementthinsplethinsppatientthinspenthinspagitantthinspsonthinspeacutepaulethinsptoutthinspenthinspparlantthinspfortthinspLethinsppatientthinspreacuteagit-ilthinspdansthinsplesthinsp10thinspsecon-des

Endormithinspthinsplethinsppatientthinspreacuteagitthinspparthinspunethinspreacuteponsethinspvivethinspagravethinsplathinspstimulationthinspdethinsplathinspgla-bellethinspouthinspagravethinspunthinspstimulusthinspauditifthinspintense 4

StimulerthinspphysiquementthinsplethinsppatientthinspenthinspagitantthinspsonthinspeacutepaulethinsptoutthinspenthinspparlantthinspfortthinspLethinsppatientthinspreacuteagit-ilthinspapregravesthinsp10thinspsecondes

Endormithinspthinsplethinsppatientthinspreacuteagitthinspparthinspunethinspreacuteponsethinspfaiblethinspagravethinsplathinspstimulationthinspdethinsplathinspglabellethinspouthinspagravethinspunthinspstimulusthinspauditifthinspintense

5

UtiliserthinspdesthinspstimulithinspdouloureuxAucunethinspreacuteaction

Endormithinspthinsplethinsppatientthinspnethinspreacuteagitthinsppasthinspagravethinsplathinspdouleur 6

thinsp Peuthinspimportethinsplrsquoeacutechellethinsputiliseacuteethinspcelle-cithinspdoitthinspecirctrethinspchoisiethinspselonthinsplathinspclientegravelethinspetthinsplethinspcontextethinspdonneacutethinspDethinspmecircmethinspsonthinsputilisationthinspdoitthinspecirctrethinspuniformethinspetthinspstandardiseacuteethinspauthinspseinthinspdrsquounethinspmecircmethinspeacutequipethinsp

CettethinspeacutechellethinsppeutthinspecirctrethinsputiliseacuteethinspchezthinsplrsquoenfantthinspToutefoisthinspellethinspserathinspdavantagethinsputilethinspdansthinsplethinspcadrethinspdrsquounethinspeacutevaluationthinsppostseacutedationthinsp(soinsthinsppostproceacutedures)thinspcarthinspilthinsppeutthinspecirctrethinspcliniquementthinspinapproprieacutethinspdethinspstimulerthinspphysiquementthinspunthinspenfantthinspsousthinspseacutedationthinspprofondethinsp

CMQ - OIIQ - OPIQ 58

2 Eacutechelle de vigilance-agitation de Richmond (Richmond Agitation Sedation Scale - RASS) (Tireacute et adapteacute de Chanques et collab 2006)

Lathinsptraductionthinspfranccedilaisethinspdethinspcettethinspeacutechellethinspathinspfaitthinsplrsquoobjetthinspdrsquounethinspvalidationthinspdethinspsathinspthinspreproductibiliteacutethinspinterobservateurthinsp

mdash Annexe

Instruction DescriptionDeacutefinition Niveau

Observerthinsplethinsppatientthinspsansthinspfairethinspdethinspbruit

Srsquoilthinspmanifestethinspunethinspactiviteacutethinspmotricethinspspon-taneacuteethinspquantifierthinsplethinspniveauthinspdrsquoagitationthinsp

Combatifthinspthinspdangerthinspimmeacutediatthinspenversthinsplrsquoeacutequipe + 4Tregraves agiteacutethinspthinsptirethinsparrachethinsptuyauxthinspouthinspcatheacutetersthinspetouthinspagressifthinspenversthinsplrsquoeacutequipe + 3Agiteacutethinspthinspmouvementsthinspfreacutequentsthinspsansthinspbutthinsppreacutecisthinspetouthinspdeacutesadaptationthinspauthinsprespirateur + 2Ne tient pas en placethinspthinspanxieuxthinspouthinspcraintifthinspmaisthinspmouvementsthinsporienteacutesthinsppeuthinspfreacutequentsthinspnonthinspvigoureuxthinspnonthinspagressifs

+ 1

Srsquoilthinspestthinspcalmethinspetthinspreacutepondthinspouthinspnonthinspauxthinspordresthinspsimplesthinsp

Eacuteveilleacute et calmethinspthinspcalmethinspetthinsplesthinspyeuxthinspouvertsConscientthinspthinspRASSthinsp0thinsp+thinspreacutepondthinspauxthinspordresthinspsimples

0

Srsquoilthinspestthinspcalmethinsplesthinspyeuxthinspfermeacutesthinspthinspquan-tifierthinsplethinspniveauthinspdrsquohypovigilancethinsp(outhinspdrsquoendormissement)thinspenthinspsrsquoadressantthinspauthinsppatientthinspparthinspsonthinspnomthinspsansthinsplethinsptoucherthinspenthinsputilisantthinspunethinspvoixthinspdethinspplusthinspenthinspplusthinspfortethinspetthinspdrsquoautantthinspplusthinspfortethinspquethinsplethinsppatientthinspestthinspsusceptiblethinspdrsquoecirctrethinspsourdthinsp(sujetthinspacircgeacutethinspseacutejourthinspprolongeacutethinspenthinspreacuteanimationthinspthinspbouchonthinspdethinspceacuterumenthinsptoxiciteacutethinspdesthinspantibiotiquesthinspetthinspduthinspfuroseacutemide)thinsp

Somnolentthinspthinsppasthinspcomplegravetementthinspeacuteveilleacutethinspmaisthinsprestethinspeacuteveilleacutethinspauthinspcontactthinspvisuelthinspagravethinsplrsquoappelthinspthinsp(gtthinsp10thinsps)

- 1

Diminution leacutegegravere de la vigilancethinspthinsprestethinspeacuteveilleacutethinspbriegravevementthinspavecthinspcontactthinspvisuelthinspagravethinsplrsquoappelthinsp(ltthinsp10thinsps)

- 2

Diminution modeacutereacutee de la vigilancethinspthinspnrsquoimportethinspquelthinspmouvementthinspagravethinsplrsquoappelthinsp(ouverturethinspdesthinspyeux)thinspmaisthinsppasthinspdethinspcon-tactthinspvisuel

- 3

Sithinsplethinsppatientthinspnethinspfaitthinspaucunthinspmouvementthinspythinspcompristhinspenthinsplrsquoappelantthinspdrsquounethinspvoixthinspfortethinspthinspfrictionnerthinspdrsquoabordthinsplrsquoeacutepaulethinsppuisthinsplethinspster-numthinspsansthinspecirctrethinspnociceptifthinsp

Diminution profonde de la vigilancethinspthinspau-cunthinspmouvementthinspagravethinsplrsquoappelthinspnrsquoimportethinspquelthinspmouvementthinspagravethinsplathinspstimulationthinspphysiquethinsp(frictionthinspnonthinspnociceptivethinspdethinsplrsquoeacutepaulethinspouthinspduthinspsternum)

- 4

Non reacuteveillablethinspthinspaucunethinspmouvementthinspnithinspagravethinsplrsquoappelthinspnithinspagravethinsplathinspstimulationthinspphysiquethinsp(frictionthinspnonthinspnociceptivethinspdethinsplrsquoeacutepaulethinspouthinspduthinspsternum)

- 5

CMQ - OIIQ - OPIQ 59

thinspANNEXEthinspXthinsp-thinspEacuteVALUATIONthinspDEthinspLrsquoEFFICACITEacutethinspDEthinspLrsquoANALGEacuteSIEthinsp(EXEMPLES)

(Listethinspnonthinsplimitative)thinsp

Selonthinsplrsquoacircgethinspduthinsppatientthinspsathinspconditionthinspetthinsplethinspcontextethinspcliniquethinspdeuxthinspstrateacutegiesthinspdrsquoeacuteva-luationthinsppeuventthinspecirctrethinsputiliseacuteesthinspsoitthinsplrsquoauto-eacutevaluationthinsp(parthinspdesthinspmotsthinspdesthinspchiffresthinspthinspouthinspdesthinspdessins)thinspouthinsplrsquoheacuteteacutero-eacutevaluationthinspcomportementalethinspCelathinspditthinspsithinsplrsquoauto-thinspeacutevaluationthinspestthinspagravethinspprivileacutegierthinspcrsquoestthinsptoutefoisthinsplrsquoacircgethinspduthinsppatientthinsp(patientthinsppeacutediatrique)thinspetthinspsathinspcapaciteacutethinspcognitivethinspquithinspguiderontthinsplethinspchoixthinspduthinspclinicienthinspdansthinsplathinspseacutelectionthinspduthinspmeilleurthinspoutilthinsp

Pourthinsplethinsppatientthinspnrsquoayantthinsppasthinsplathinspcapaciteacutethinsp(pthinspexthinspthinsphabiliteacutethinspverbalethinspouthinspcognitivethinsplimiteacutee)thinspdrsquoeacutevaluerthinsplui-mecircmethinsplrsquointensiteacutethinspdethinsplathinspdouleurthinspunethinspreacuteponsethinspverbalethinsp(ouinon)thinspouthinspgestuellethinspsignifiantthinsplathinsppreacutesencethinspouthinsplrsquoabsencethinspdethinspdouleurthinspconstituethinspunethinspformethinspdrsquoauto-eacutevaluationthinspacceptablethinspenthinsppratiquethinspcliniquethinspaupregravesthinspdethinspcertainesthinsppopulationsthinsptellesthinspquethinsplethinspjeunethinspenfantthinsplethinsppatientthinspdeacutementthinspouthinspceluithinspvivantthinspavecthinspunethinspdeacuteficiencethinspintellectuellethinsp(McCafferythinspciteacutethinspdansthinspHerrthinspetthinspcollabthinsp2011thinsp[Notrethinsptraduc-

tion])

thinspthinsp Peuthinspimportethinsplrsquoeacutechellethinsputiliseacuteethinspcelle-cithinspdoitthinspecirctrethinspchoisiethinspselonthinsplathinspclientegravelethinspetthinsplethinspcontextethinspdonneacutethinspDethinspmecircmethinspsonthinsputilisationthinspdoitthinspecirctrethinspuniformethinspetthinspstandardiseacuteethinspauthinspseinthinspdrsquounethinspmecircmethinspeacutequipethinspsoignantethinsp

ADULTE-AIcircNEacutethinsp

AUTO-EacuteVALUATIONthinsp(DOULEURthinspAIGUEuml)

thinsprsaquo Eacutechellethinspnumeacuteriquethinsp(0thinspagravethinsp10)thinsp(EN)thinsprsaquo Eacutechellethinspverbalethinspsimplethinsp(EVS)thinsprsaquo Eacutechellethinspvisuellethinspanalogiquethinsp(EVA)

HEacuteTEacuteRO-EacuteVALUATIONthinspCOMPORTEMENTALEthinsp(DOULEURthinspAIGUEuml)

thinsprsaquo ALGOPLUSthinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspdesthinsptroublesthinspdethinsplathinspcommunicationthinspverbale)

thinsprsaquo PACSLACthinspouthinspPACSLAC-Fthinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspunethinspcapaciteacutethinsplimiteacuteethinspagravethinspcommuniquer

thinsprsaquo PAINADthinsp(anglais)thinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspunethinspdeacutemencethinspouthinspautrethinsptroublethinspcognitifthinspetthinspquithinspnethinsppeutthinspcommuniquerthinspdethinspmaniegraverethinspfiable

Les hyperliens concernant ces eacutechelles sont fournis agrave titre informatif seulement

mdash Annexe

mdash Table des matiegraveres

06Introduction

08Chapitre 1 Patient adulte

08

11thinspthinspDeacutefinitionthinspobjectifsthinspetthinsp

clientegravelethinspcible

11Volet organisationnel

11

12thinspCompeacutetencesthinsp

professionnelles

11

13thinspRessourcesthinspmateacuterielles

15Volet professionnel

15

14thinspPreacuteseacutedation-analgeacutesie

15

Seacutelectionthinspdesthinsppatients

15

Eacutevaluationthinspdesthinsppatients

17

Consentementthinsp(reacutesumeacute)

19

Directivesthinspetthinspconseils

20

15thinspPerseacutedation-analgeacutesie

20

Approchethinsppharmacologique

25

Surveillancethinspclinique

29

16thinspPostseacutedation-analgeacutesie

30

17thinspDocumentationthinspdesthinspsoinsthinsp

etthinsptenuethinspdethinspdossiers

32Chapitre 2 Patient

peacutediatrique

32

Preacuteambule

32

21thinspObjectifsthinspetthinspclientegravelethinsp

ciblethinsp

35Volet organisationnel

35

22thinspCompeacutetencesthinsp

professionnelles

35

23thinspRessourcesthinspmateacuteriellesthinsp

36Volet professionnel

36

24thinspPreacuteseacutedation-analgeacutesiethinsp

36

Seacutelectionthinspdesthinsppatientsthinsp

37

Eacutevaluationthinspdesthinsppatientsthinsp thinsp

thinsp

thinsp

37

Consentementthinsp(reacutesumeacute)

37

Directivesthinspetthinspconseils

38

25thinspPerseacutedation-analgeacutesie

38

Approchethinsppharmacologique

38

Approchethinspnonthinsp

pharmacologique

39

Surveillancethinspclinique

43

26thinspPostseacutedation-analgeacutesie

43

27thinspDocumentationthinspdesthinsp

soinsthinspetthinsptenuethinspdethinspdossiers

44Conclusion

45Annexe I ndash Deacutefinition

de lrsquoanestheacutesie geacuteneacuterale

et des niveaux de

seacutedation-analgeacutesie selon

lrsquoAmerican Society of

Anesthesiologists (ASA)

46Annexe II ndash Information

compleacutementaire - lectures

drsquointeacuterecirct

mdash Table des matiegraveres

47Annexe III ndash Proceacutedures

protocoles ou algorithmes

48Annexe IV ndash Eacutevaluation des

voies aeacuteriennes supeacuterieures

au moyen du score de

Mallampati

49

Annexe V ndash Outil

drsquoeacutevaluation de

lrsquoapneacutee obstructive

du sommeil (AOS)

adapteacute agrave la consultation

preacuteanestheacutesiqueseacutedation-

analgeacutesie

50Annexe VI ndash Anamnegravese

aide mneacutemotechnique

51Annexe VII ndash Examen

physique aide

mneacutemotechnique

53Annexe VIII ndash Le

consentement

57Annexe IX- Eacutevaluation de

lrsquoefficaciteacute de la seacutedation

(exemples)

59Annexe X ndash Eacutevaluation de

lrsquoefficaciteacute de lrsquoanalgeacutesie

(exemples)

61

Annexe XI ndash Fiche

informative sur lrsquoutilisation

de la naloxone et du

flumazeacutenil

63Annexe XII ndash Consignes

pour la surveillance agrave

domicile au moment du

deacutepart

66Reacutefeacuterences

CMQ - OIIQ - OPIQ 06

INTRODUCTIONLesthinsppreacutesentesthinsplignesthinspdirectricesthinspremplacentthinspcellesthinspduthinspCollegravegethinspdesthinspmeacutedecinsthinspduthinspQueacutebecthinsp(Utilisation de la seacutedation-analgeacutesiethinspndashthinsp2009)thinspetthinsplethinspguidethinspdethinsppratiquethinspcliniquethinspdethinsplrsquoOrdrethinspprofessionnelthinspdesthinspinhalotheacuterapeutesthinspduthinspQueacutebecthinsp(La seacutedation-analgeacutesiethinspndashthinsp2009)thinspEllesthinspontthinspeacuteteacutethinspeacutelaboreacuteesthinspconjointementthinspparthinsplethinspCollegravegethinspdesthinspmeacutedecinsthinspduthinspQueacutebecthinsp(CMQ)thinsplrsquoOrdrethinspdesthinspinfirmiegraveresthinspetthinspinfirmiersthinspduthinspQueacutebecthinsp(OIIQ)thinspetthinsplrsquoOrdrethinspprofessionnelthinspdesthinspinhalotheacuterapeutesthinspduthinspQueacutebecthinsp(OPIQ)thinspetthinspellesthinspontthinsppourthinspobjectifthinspdrsquoharmoniserthinsplathinsppratiquethinspcliniquethinspdethinsplathinspseacutedation-analgeacutesiethinsp

Ellesthinspconcernentthinspsurtoutthinsplesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspeffectueacuteesthinspsousthinspseacutedation-analgeacutesiethinspdethinspniveauthinspminimalthinspagravethinspmodeacutereacutethinspchezthinspdesthinsppatientsthinspclasseacutesthinspprincipalementthinspdansthinsplesthinspcateacutegoriesthinspASAthinspPhysicalthinspStatusthinsp1thinspetthinsp2thinspetthinspsousthinspcertainesthinspconditionsthinspdethinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp3thinspetthinsp4thinspLathinspseacutedation-analgeacutesiethinspdethinspniveauthinspprofondthinspetthinsplrsquoanestheacutesiethinspgeacuteneacuteralethinspnethinspfontthinsppasthinsplrsquoobjetthinspdethinspcettethinsppublicationthinspetthinspdoiventthinspecirctrethinspplutocirctthinspreacutealiseacuteesthinspdansthinspdesthinspeacutetablissementsthinspposseacutedantthinsptoutesthinsplesthinspinstallationsthinspetthinsplesthinspressourcesthinspprofessionnellesthinspayantthinsplrsquoexpertisethinspthinsprequisethinsppourthinspassurerthinspunethinspprisethinspthinspenthinspchargethinspoptimalethinspetthinspseacutecuritaire

Ellesthinspdeacutecriventthinsplrsquoensemblethinspdesthinspconditionsthinspexigeacuteesthinsplorsquethinsplrsquoonthinspprocegravedethinspagravethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspsousthinspseacutedation-analgeacutesiethinspquethinspcethinspsoitthinsppourthinspunthinspadultethinspouthinspunthinspenfantthinspEllesthinspsontthinspconccediluesthinspdansthinsplethinspbutthinspdrsquooffrirthinspdesthinsprecommandationsthinspvisantthinspunthinspdegreacutethinspoptimalthinspdethinspseacutecuriteacutethinspnotammentthinspenthinspcethinspquithinspconcernethinsplrsquoeacutevaluationthinsplathinspsurveillancethinspcliniquethinspythinspcompristhinsplethinspmonitoragethinspetthinsplathinspmeacutedicationthinsppeu importethinsplrsquoendroitthinspougravethinsplathinspseacutedation-analgeacutesiethinspestthinspeffectueacuteethinspEllesthinspdeacutecriventthinspeacutegalementthinsplesthinspcompeacutetencesthinspprofessionnellesthinspneacutecessairesthinsppourthinsplathinspreacutealisationthinspdrsquounethinspseacutedation-analgeacutesiethinspoptimalethinspetthinspseacutecuritairethinsplesthinspressourcesthinsphumainesthinspetthinspmateacuteriellesthinsprequisesthinsplathinspmarchethinspagravethinspsuivrethinsplesthinsppreacutecautionsthinsprelativesthinspauthinspbien-ecirctrethinspetthinspagravethinsplathinspseacutecuriteacutethinspduthinsppatientthinspainsithinspquethinsplesthinspeacuteleacutementsthinspquithinspdoiventthinspecirctrethinspinscritsthinspauthinspdossierthinsp

Ellesthinspontthinspeacuteteacutethinspconccediluesthinsppourthinspquethinsplesthinspmembresthinspdethinspchacunthinspdesthinspordresthinsppuissentthinspfacilementthinspsrsquoythinspreconnaicirctrethinspselonthinsplesthinspmodaliteacutesthinspquithinspencadrentthinsplrsquoexercicethinspdethinspleurthinspprofessionthinsprespectivethinspdansthinspunthinspcontextethinspdethinsppratiquethinspinterprofessionnellethinsp

thinspthinspthinsp

CMQ - OIIQ - OPIQ 07

Puisquethinsplrsquoenfantthinsppossegravedethinspdesthinspcaracteacuteristiquesthinspquithinspluithinspsontthinsppropresthinspunethinspsectionthinspparticuliegraverethinspluithinspestthinspconsacreacuteethinsp

Enthinsptoutthinsptempsthinspnousthinspdevonsthinsprecourirthinspagravethinsplathinspseacutedation-analgeacutesiethinspavecthinspthinspcirconspectionthinspetthinspprudencethinspLrsquoeacutevaluationthinspduthinsppatientthinsplrsquoadministrationthinspthinspdethinsplathinspmeacutedicationthinspetthinsplathinspsurveillancethinspcliniquethinspdoiventthinspecirctrethinspeffectueacuteesthinspthinspavecthinsplathinspmecircmethinsprigueurthinspquethinsppourthinsplrsquoanestheacutesiethinspgeacuteneacuteralethinsp

CMQ - OIIQ - OPIQ 08

Chapitre 1 Patient adulte

thinsp11thinspDEacuteFINITIONthinspOBJECTIFSthinspETthinspCLIENTEgraveLEthinspCIBLEthinsp

Lathinspseacutedation-analgeacutesiethinspestthinspunethinspproceacutedurethinspquithinspsethinspdeacutefinitthinspcommethinspeacutetantthinsplrsquoadmi-nistrationthinspdethinspmeacutedicamentsthinspouthinspdethinspsubstancesthinspservantthinspagravethinspalteacutererthinsplethinspniveauthinspdethinspconsciencethinspdrsquounethinsppersonnethinspsathinspperceptionthinspdethinsplathinspdouleurthinspetthinspsathinsptoleacuterancethinspagravethinsplrsquoen-vironnementthinsptoutthinspenthinspluithinsppermettantthinspunethinspreacuteponsethinspagravethinsplathinspstimulationthinspverbalethinspouthinsptactilethinspetthinsplethinspmaintienthinspdrsquounethinspfonctionthinspcardiaquethinspetthinspventilatoirethinspadeacutequatethinspenthinsptousthinsppointsthinsp(OPIQthinsp2009)

Ellethinsppermetthinspdoncthinspdethinspmieuxthinsptoleacutererthinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspdethinspfaccedilonthinspseacutecuritairethinspCertainsthinsppatientsthinsprequerrontthinspsurtoutthinspunethinspseacutedationthinspdrsquoautresthinspunethinspanalgeacutesiethinspetthinsplathinspplupartthinsplesthinspdeuxthinspagravethinsplathinspfoisthinspLesthinspmeacutedicamentsthinspetthinsplathinspproceacutedurethinsputiliseacutesthinspdeacutependrontthinspprincipalementthinspduthinspniveauthinspdethinspseacutedationthinspetthinspdrsquoanal-geacutesiethinspdeacutesireacutethinspselonthinsplathinspnaturethinspetthinsplathinspdureacuteethinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacutera-peutiquethinspetthinspselonthinsplesthinspcaracteacuteristiquesthinspduthinsppatientthinspDrsquoailleursthinsplesthinspbesoinsthinspparticu-liersthinspduthinsppatientthinspdoiventthinspecirctrethinsppristhinspenthinspconsideacuteration

Lesthinspobjectifsthinspviseacutesthinspparthinsplathinspseacutedation-analgeacutesiethinsplorsthinspdrsquounethinspinterventionthinspdiagnos-tiquethinspouthinsptheacuterapeutiquethinspsontthinspdrsquoassurerthinsplathinspseacutecuriteacutethinspetthinsplethinspbien-ecirctrethinspduthinsppatientthinspetthinspdethinsppermettrethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspdethinspqualiteacutethinspenthinsp

a fournissantthinspunethinspanalgeacutesiethinspunethinspseacutedationthinspetthinspunethinspamneacutesiethinspadapteacutees

b controcirclantthinsplesthinspcomportementsthinspmoteursthinspnuisiblesthinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

c minimisantthinsplesthinspreacuteponsesthinsppsychologiquesthinspdeacutefavorablesthinspassocieacuteesthinspauxthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspdouloureusesthinspouthinspanxiogegravenesthinsp

Lathinspseacutelectionthinspdesthinsppatientsthinsppourthinsplathinspseacutedation-analgeacutesiethinspestthinspfondeacuteethinspsurthinsplrsquoeacutevaluationthinspcliniquethinspdethinspleurthinspeacutetatthinspdethinspsanteacutethinspAgravethinspcettethinspfinthinspilthinspestthinsprecommandeacutethinspdrsquoutiliserthinsplathinspclassi-ficationthinspdethinsplrsquoeacutetatthinspphysiquethinspduthinsppatientthinspquethinsplrsquoonthinsptrouvethinspdansthinsplethinsptableauthinspdethinsplathinsppagethinspsuivante

CMQ - OIIQ - OPIQ 09

Classification Eacutetatthinspdethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp1 Patientthinspenthinspbonnethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp2Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspleacutegegravere

ASAthinspPhysicalthinspStatusthinsp3Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgrave

ASAthinspPhysicalthinspStatusthinsp4Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgravethinspquithinsprepreacutesentethinspthinspunethinspmenacethinspconstantethinsppourthinspsathinspvie

ASAthinspPhysicalthinspStatusthinsp5Patientthinspmoribondthinspquithinspnethinspsurvivrathinsppasthinspthinspagravethinspmoinsthinspdrsquounethinspinterventionthinsp

ASAthinspPhysicalthinspStatusthinsp6Patientthinspdeacuteclareacutethinspenthinspeacutetatthinspdethinspmortthinspceacutereacutebralethinspdontthinsplesthinsporganesthinspontthinspeacuteteacutethinsppreacuteleveacutesthinspagravethinspdesthinspfinsthinspdethinspdon

Tableau 1Classification de lrsquoeacutetat physique du patient selon lrsquoAmerican Society of Anesthesiologists (ASA) (ASA Physical Status Classification System) [En ligne] (Notre traduction)

Ainsithinsplorsquethinsplathinspseacutedation-analgeacutesiethinspestthinspreacutealiseacuteethinspparthinspunthinspmeacutedecinthinspsansthinsplathinspcolla-borationthinspdirectethinspdrsquounthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesio-logiethinspouthinspenthinspreacuteanimationthinspcardiorespiratoirethinspavanceacuteethinsplesthinspinterventionsthinspdiagnos-tiquesthinspouthinsptheacuterapeutiquesthinspdoiventthinspecirctrethinspreacuteserveacuteesthinspprincipalementthinspauxthinsppatientsthinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp1thinspouthinspauxthinsppatientsthinspatteintsthinspdrsquounethinspaffectionthinspsysteacutemiquethinspleacutegegraverethinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp2thinsp

CMQ - OIIQ - OPIQ 10

Notonsthinspquethinspdansthinspdesthinspsituationsthinspparticuliegraveresthinspetthinspjustifieacuteesthinspauthinspdossierthinspmeacutedi-calthinsplathinspseacutedation-analgeacutesiethinsppeutthinspecirctrethinspeffectueacuteethinspchezthinsplesthinsppatientsthinspstablesthinspdethinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp3thinspetthinspexceptionnellementthinspdethinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp4thinspToutefoisthinspellethinspdoitthinsplrsquoecirctrethinspdansthinspdesthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspopti-malethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespira-toirethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspDethinspplusthinspcesthinsppatientsthinspdoiventthinspfairethinsplrsquoobjetthinspdrsquounethinspeacutevaluationthinspindividualiseacuteethinspetthinspplusthinspapprofondiethinsp

Lathinspprofondeurthinspdethinsplathinspseacutedationthinspetthinsplethinspniveauthinspdrsquoanalgeacutesiethinsprechercheacutethinspenthinspseacutedation-analgeacutesiethinspdoiventthinspcorrespondrethinspauxthinspniveauxthinsppermettantthinsplrsquoatteintethinspdesthinspobjectifsthinspviseacutesthinspetthinspecirctrethinspmesureacutesthinspagravethinsplrsquoaidethinspdrsquoeacutechellesthinspstandardiseacuteesthinspvalideacuteesthinspdethinsppreacutefeacuterencethinspetthinspadapteacuteesthinspauthinspcontextethinspetthinspagravethinsplathinspconditionthinspduthinsppatientthinspLesthinspniveauxthinspdethinspseacutedation-analgeacutesiethinspviseacutesthinsptelsthinspquethinspdeacutefinisthinspdansthinsplathinspclassificationthinspdethinsplrsquoASAthinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinspASAthinspHousethinspofthinspDelegatethinsp2014a)thinsp(annexethinspI)thinspdoiventthinspcorrespondentthinspagravethinsplrsquounthinspouthinsplrsquoautrethinspdesthinspdeuxthinspniveauxthinspsuivantsthinsp(CMQthinsp2009)thinsp

thinsprsaquo seacutedationthinspminimalethinspouthinsplaquothinspanxiolysethinspraquothinspougravethinsplrsquoappreacutehensionthinspduthinsppatientthinspestthinspdiminueacuteethinspsansthinspchangementthinspdethinspsonthinspniveauthinspdethinspconsciencethinspetthinspsansthinspalteacutererthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsplathinspventilationthinspetthinsplathinspfonctionthinspcardiovasculaire

thinsprsaquo seacutedationthinspmodeacutereacuteethinspougravethinsplathinspreacuteponsethinspauxthinspstimulithinspverbauxthinspouthinsptactilesthinspleacutegersthinspestthinspvolontairethinspsansthinspaffecterthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsplathinspventilationthinspspontaneacuteethinspetthinsplathinspfonctionthinspcardiovasculaire

Notonsthinsptoutefoisthinspquethinsplrsquoeacutequipethinspsoignantethinspparticipantthinspagravethinsplathinspproceacutedurethinspdoitthinspconnaicirctrethinsplethinspniveauthinspdethinspseacutedation-analgeacutesiethinspgeacuteneacuteralementthinspneacutecessairethinsppourthinspunethinspinterventionthinspdonneacuteethinspDethinspmecircmethinspellethinspdoitthinspecirctrethinsppreacutepareacuteethinspagravethinspgeacutererthinsplethinsppassagethinspmomentaneacutethinspagravethinspunthinspniveauthinspdethinspseacutedationthinspsupeacuterieurthinspagravethinspceluithinspquithinspathinspeacuteteacutethinspplanifieacutethinsp(crsquoest-agrave-direthinspplusthinspprofondthinspquethinsppreacutevu)thinspcethinspquithinsppeutthinspsurvenirthinspenthinsptoutthinsptempsthinsplorsthinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsp

CMQ - OIIQ - OPIQ 11

Volet organisationnel

thinsp12thinspCOMPEacuteTENCESthinspPROFESSIONNELLESthinsp

Consideacuterantthinspquethinsplathinspseacutedation-analgeacutesiethinspsrsquoinscritthinspdansthinspunethinsppratiquethinspdethinspcollabo-rationthinspentrethinsplethinspmeacutedecinthinspetthinspdrsquoautresthinspprofessionnelsthinspdethinsplathinspsanteacutethinsp(infirmiegraveresthinspetthinspinhalotheacuterapeutes)thinspilthinspimportethinspdethinsppreacuteciserthinspqursquounethinsputilisationthinspjudicieusethinspdethinspleursthinspcompeacutetencesthinspestthinspdethinspmisethinsppourthinspassurerthinsplathinspqualiteacutethinspetthinsplrsquoefficiencethinspdesthinspsoinsthinspAinsithinsptousthinspdoiventthinspavoirthinsplesthinspqualificationsthinsprequisesthinspdansthinsplethinspdomainethinspdethinsplathinspseacutedation-thinspanalgeacutesie

Dethinspplusthinsplrsquoeacutequipethinspsoignantethinspquithinspreacutealisethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacutera-peutiquethinspsousthinspseacutedation-analgeacutesiethinspdoitthinsp

a ecirctrethinspenthinspmesurethinspdrsquoeacutevaluerthinspadeacutequatementthinsplathinspconditionthinspdethinspsanteacutethinspduthinsppatientthinspetthinspdrsquoenthinspassurerthinsplathinspsurveillancethinspclinique

b connaicirctrethinspetthinsputiliserthinspjudicieusementthinsplathinspmeacutedicationthinspainsithinspquethinspsesthinspantagonistes

c posseacutederthinsplesthinspconnaissancesthinspetthinsplesthinspcompeacutetences1thinspneacutecessairesthinsppourthinspintervenirthinspenthinspsituationthinspdrsquourgencethinsptellethinspquethinsplathinspreacuteanimationthinspcardiorespiratoire2thinsp(dethinsppreacutefeacuterencethinspenthinspsoinsthinspavanceacutes)thinspcrsquoest-agrave-direthinspmaicirctriserthinspenthinspprioriteacutethinsplesthinsptechniquesthinspdethinsplathinspprisethinspenthinspchargethinspdethinsplathinspventilationthinspduthinspmassagethinspcardiaquethinspetthinspdethinsplathinspmeacutedicationthinspassocieacutee

d avoirthinsplrsquoexpertisethinsprequisethinspselonthinsplathinspclientegravelethinspviseacuteethinspetthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspagravethinspreacutealiserthinsp

thinsp13thinspRESSOURCESthinspMATEacuteRIELLESthinsp

1thinspLOCAUX

LrsquoameacutenagementthinspdesthinsplocauxthinspdoitthinsppermettrethinspdethinspreacutealiserthinspdethinspfaccedilonthinspadeacutequatethinspetthinspenthinsptoutthinsptempsthinspunethinspreacuteanimationthinspcardiorespiratoirethinspainsithinspqursquounethinspeacutevacuationthinspdrsquourgencethinsplethinspcasthinspeacutecheacuteantthinspEntrethinspautresthinsplathinspsuperficiethinspdoitthinsppermettrethinspauthinsppersonnelthinspdethinspcircu-lerthinsplibrementthinsplrsquoeacuteclairagethinspdoitthinspecirctrethinspsuffisantthinsplethinspmateacuterielthinspdrsquourgencethinsp(pthinspexthinspthinspdethinspreacuteani-mation)thinspdoitthinspecirctrethinspfacilementthinspaccessiblethinspetthinspentreposeacutethinspdansthinspunthinsplieuthinspconnuthinspdethinsptousthinsp

Selonthinsplesthinspmodaliteacutesthinspdethinspfonctionnementthinspetthinsplethinsptypethinspdrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsppratiqueacutethinspilthinspestthinspdrsquousagethinspdethinspdisposerthinspdrsquounethinspsallethinspdethinspreacutecupeacutera-tionthinspouthinspdrsquoobservation

1thinspthinspthinspthinspOnthinspentendthinspparthinspconnaissancesthinspetthinspcompeacutetencesthinspqursquoellesthinspsoientthinspmisesthinspagravethinspjourthinspselonthinsplesthinsprecommandationsthinspenthinspvigueur2thinspthinspthinspOnthinspentendthinspparthinspcertificationthinspenthinspreacuteanimationthinspcardiorespiratoirethinsplesthinspformationsthinspsuivantesthinspthinsp thinsprsaquothinspReacuteanimationthinspcardiorespiratoirethinspdethinspbasethinspthinspSoinsthinspimmeacutediatsthinspenthinspreacuteanimationthinsp(SIR)thinsppourthinspprofessionnelsthinspdethinsplathinspsanteacutethinspthinspthinspthinspthinspthinspthinspthinspthinspouthinsplrsquoeacutequivalentthinsp thinsprsaquothinspReacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspSoinsthinspavanceacutesthinspenthinspreacuteanimationthinspcardiovasculairethinsp(SARC)thinspouthinsplrsquoeacutequivalent

CMQ - OIIQ - OPIQ 12

Pourthinspinformationthinspcompleacutementairethinsp(annexethinspII)thinspProceacutedures et interventions en milieu extrahospitalierthinsp(CMQthinsp2011)

2thinspEacuteQUIPEMENTthinsp(INTRAthinspETthinspEXTRAHOSPITALIER)

OBLIGATOIRE

Enthinspplusthinspduthinspmateacuterielthinspdirectementthinsplieacutethinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspjustifiantthinsplathinspseacutedation-analgeacutesiethinsponthinspdoitthinsptrouverthinspminimalementthinsplrsquoeacutequipe-

mentthinspsuivant

Dansthinsplathinspsallethinsp

thinsprsaquo tablethinspdrsquoexamenthinspciviegraverethinspouthinsptablethinspdethinspchirurgiethinsprsaquo tablethinsppourthinsplesthinspinstrumentsthinsprsaquo soluteacutesthinspetthinspmateacuterielthinspneacutecessairethinsppourthinsplrsquoinstallationthinspetthinsplethinspmaintienthinspdrsquounethinspvoiethinsp

endoveineusethinsprsaquo saturomegravetrethinsp(oxymegravetrethinspdethinsppouls)thinsp

Lethinspmonitoragethinspdethinsplathinspsaturationthinspenthinspoxygegravenethinsppermetthinsplrsquoeacutevaluationthinspdethinsplrsquooxy-geacutenationthinsp(deacutetectionthinsppreacutecocethinspdrsquounethinsphypoxeacutemie)thinspmaisthinspilthinspnethinsppeutthinsppasthinspdeacutetecterthinsppreacutecocementthinspunethinspobstructionthinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(AmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2012)thinspthinsp

thinsprsaquo steacutethoscopethinspthinsprsaquo sphygmomanomegravetrethinspouthinspappareilthinspautomatiseacutethinspnonthinspinvasifthinsppourthinsplathinspprisethinspdethinsplathinsp

pressionthinsparteacuteriellethinsprsaquo sourcethinspdrsquooxygegravenethinspcomprimeacutethinspenthinspquantiteacutethinspsuffisantethinsppourthinspenthinsppermettrethinsp

llsquoadministrationthinspagravethinspunthinspdeacutebitthinspdethinsp15thinsplitresthinspparthinspminutethinsppendantthinsp60thinspminutesthinspetthinspthinsplethinspmateacuterielthinspneacutecessairethinspagravethinsplrsquooxygeacutenotheacuterapie

thinsprsaquo appareilthinspagravethinspaspirationthinsppouvantthinspgeacuteneacutererthinspunethinsppressionthinspneacutegativethinspdethinsp40ndash60thinspmmthinspHgthinspouthinspunethinspcapaciteacutethinspdethinspflotthinspdethinsp100thinsplitresthinspparthinspminutethinspetthinsplethinspmateacuterielthinspneacutecessairethinspthinspagravethinsplrsquoaspiration

thinsprsaquo lethinspmateacuterielthinspneacutecessairethinspagravethinsplathinspprisethinspenthinspchargethinspventilatoirethinspentrethinspautresthinspreacuteanimateurthinspmanuelthinspautogonflablethinsp(Ambuthinspbag)thinspmasquethinspcanulesthinspnasothinspthinspetthinsporopharyngeacuteesthinspdethinsptaillesthinspvarieacutees

Ce mateacuteriel doit ecirctre disponible agrave porteacutee de la main

CMQ - OIIQ - OPIQ 13

thinsprsaquo appareilthinspdrsquoalimentationthinspeacutelectriquethinspdethinspsecoursthinsppourthinsplethinspfonctionnementthinspdesthinspeacutequipementsthinspdrsquourgence

Peutthinspecirctrethinspagravethinsplrsquoexteacuterieurthinspdethinsplathinspsallethinsp(maisthinspfacilethinspdrsquoaccegravesthinspetthinsprapidementthinspdisponible)thinsp

thinsprsaquo thinsparmoirethinspfermeacuteethinsppourthinspentreposerthinspsousthinspcleacutethinspauthinspbesointhinsplethinspmateacuterielthinspetthinsplesthinspsubstancesthinspcontrocircleacuteesthinspainsithinspquethinsplesthinspbenzodiazeacutepines

thinsprsaquo mateacuterielthinspneacutecessairethinspagravethinsplrsquointubationthinspendotracheacutealethinspentrethinspautresthinspsondesthinspendotracheacutealesthinspetthinsplamesthinspdethinsplaryngoscopethinspdethinsptaillesthinspvarieacuteesthinspainsithinspquethinspdesthinspalternativesthinspagravethinsplrsquointubationthinspdifficilethinsp(pthinspexthinspthinspoutilsthinspextraglottiquesthinsptelsthinspquethinspmasquesthinsplaryngeacutes)

thinsprsaquo deacutefibrillateurthinspcardiaquethinsp(dethinsppreacutefeacuterencethinspunthinspdeacutefibrillateurthinspexternethinspautomatiseacutethinsp[DEA])

thinsprsaquo pharmaciethinsp(troussethinspouthinspchariot)thinspcontenantthinsplesthinspmeacutedicamentsthinspneacutecessairesthinspauthinsptraitementthinspdesthinspsituationsthinspdrsquourgencethinsptellesthinspquethinspthinspsurdosagethinspauxthinspopioiumldesthinspouthinspauxthinspbenzodiazeacutepinesthinspurgencethinspcardiaquethinspreacuteactionthinspallergiquethinspcrisethinspdrsquoasthmethinspcrisethinspconvulsivethinspchocthinspvagalthinsphypoglyceacutemiethinspetc

RECOMMANDEacutethinspSELONthinspLAthinspSITUATION

thinsprsaquo moniteurthinspcardiaquethinspthinspdansthinspcertainsthinspcasthinspbienthinspdeacutefinisthinsplethinspmonitoragethinspcardiaquethinsppeutthinspecirctrethinsprecommandeacutethinspouthinspobligatoirethinsp(tableauthinsp3)

thinsprsaquo capnographethinspthinspdansthinspcertainsthinspcasthinspbienthinspdeacutefinisthinsplethinspmonitoragethinspduthinspCO2thinsppeutthinspecirctrethinsp

recommandeacutethinspouthinspobligatoirethinsp(tableauthinsp3)thinspthinspLethinspmonitoragethinspduthinspCO

2thinsppermetthinspdrsquoidentifierthinsppreacutecocementthinsplesthinspcomplicationsthinsp

tellesthinsplathinspseacutedationthinspexcessivethinsplrsquohypoventilationthinspetthinsplrsquoapneacuteethinspenthinspplusthinspdethinsppermettrethinspdethinspmieuxthinspcontrocirclerthinsplethinspniveauthinspdethinspseacutedationthinspenthinspfonctionthinspdethinsplrsquointerventionthinspthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinspSonthinsputilisationthinsppermetthinspeacutegalementthinspthinspdethinspsuivrethinsplethinspmonitoragethinspventilatoirethinspCelathinspestthinspparticuliegraverementthinspapproprieacutethinspthinsplorsqursquoilthinspnrsquoexistethinsppasthinspdrsquoantagonistesthinspagravethinsplathinspmeacutedicationthinsputiliseacuteethinsp(pthinspexthinspthinsppropofol)thinsp

OPTIONNEL

thinsprsaquo moniteurthinspdethinsptempeacuteraturethinspetthinspdispositifthinspdethinspreacutechauffementthinspduthinsppatientthinspselonthinsplethinsppatientthinspetthinsplathinspdureacuteethinspdethinsplrsquointerventionthinsp

thinsprsaquo systegravemethinspdrsquoantipollutionthinsp(eacutevacuationthinspduthinspprotoxydethinspdrsquoazote)thinspsrsquoilthinspythinspathinsplieuthinsprsaquo analyseurthinspdrsquooxygegravenethinsplorsqursquounthinspmeacutelangethinspestthinsputiliseacutethinsp(pthinspexthinspthinspO

2thinspetthinspprotoxydethinsp

drsquoazote)thinsprsaquo steacutethoscopethinsppreacutecordialthinspouthinsppreacutetracheacutealthinsppourthinspeacutecoutethinspenthinspcontinu

CMQ - OIIQ - OPIQ 14

LrsquoensemblethinspdethinspcesthinspeacutequipementsthinspdoitthinspecirctrethinspadapteacutethinspauthinsppatientthinspIlsthinspdoiventthinspecirctrethinspenthinspeacutetatthinspdethinspfonctionnerthinspetthinsplesthinspattestationsthinspdesthinspveacuterificationsthinsppeacuteriodiquesthinspdoiventthinspecirctrethinspconserveacuteesthinspdansthinspunthinspregistrethinsppreacutevuthinspagravethinspcettethinspfin

Pendantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplesthinspprofessionnelsthinspdoiventthinspthinsprespecterthinsplesthinspregraveglesthinspdethinsppreacuteventionthinspetthinspdethinspcontrocirclethinspdesthinspinfections

Unethinspproceacutedurethinsprelativethinspauxthinspsituationsthinspdrsquourgencethinsp(annexethinspIII)thinspagravethinsplrsquoaccegravesthinspauxthinspser-vicesthinspdrsquourgencethinsppreacutehospitaliersthinspetthinspdethinsptransfertthinspselonthinspunethinspententethinspintereacutetablisse-mentsthinspdoitthinspecirctrethinspeacutelaboreacuteethinspmaintenuethinspagravethinspjourthinspfacilementthinspdisponiblethinspenseigneacuteethinspagravethinsptoutthinsplethinsppersonnelthinspetthinspfairethinsplrsquoobjetthinspdrsquounthinsprappelthinspaupregravesthinspdethinspcethinspdernierthinspsurthinspunethinspbasethinsp

peacuteriodiquethinsp

CMQ - OIIQ - OPIQ 15

Volet professionnel

thinsp14thinspPREacuteSEacuteDATION-ANALGEacuteSIEthinsp

SEacuteLECTIONthinspDESthinspPATIENTS

Lathinspseacutelectionthinspdesthinsppatientsthinspdoitthinsptenirthinspcomptethinspnotammentthinspdethinsplrsquoeacutevaluationthinspdesthinspvoiesthinspaeacuteriennesthinspetthinspdethinsplrsquoeacutetatthinspdethinspsanteacutethinspgeacuteneacuteralthinspduthinsppatientthinspquithinspaurontthinspmisthinspenthinspeacutevi-dencethinsplathinsppreacutesencethinspouthinsplrsquoabsencethinspdrsquoindicateursthinspdethinsppossiblesthinspcomplicationsthinsplorsthinspdethinsplathinspseacutedation-analgeacutesiethinspIlthinspexistethinspdeuxthinsptypesthinspdethinsprisquesthinspenthinspseacutedation-analgeacutesiethinspthinsplesthinsprisquesthinsppreacutevisiblesthinsp(difficulteacutethinsppotentiellethinsplieacuteethinspagravethinsplathinspgestionthinspdesthinspvoiesthinspaeacuteriennesthinspouthinspinstabiliteacutethinspduthinsppatient)thinspetthinsplesthinsprisquesthinspimpreacutevisiblesthinsp(incidentaccidentthinsperreurthinsphu-mainethinspetc)thinspUnethinspeacutevaluationthinspinitialethinsp(histoirethinspexamenthinspphysique)thinspadeacutequatethinspavantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspdiminuethinspdethinsptelsthinsprisques

Agravethinsppartirthinspdethinsplrsquoensemblethinspdesthinspeacutevaluationsthinspeffectueacuteesthinsplethinspmeacutedecinthinspseacutelectionnethinsplesthinsppatientsthinspaptesthinspagravethinsprecevoirthinspunethinspseacutedation-analgeacutesiethinspselonthinspnotammentthinsp

thinsprsaquo lesthinspfacteursthinspdethinsprisquethinspidentifieacutesthinspagravethinsplathinspsuitethinspdethinsplrsquoeacutevaluationthinsp(cardiovasculairethinsprespiratoirethinspheacutepatiquethinspneurologique)thinspdethinsplathinsppossibiliteacutethinspdethinspgrossessethinspchezthinsplathinspfemmethinspenthinspacircgethinspdethinspprocreacuteerthinspouthinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspenvisageacutee

thinsprsaquo lrsquoeacutevaluationthinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(annexethinspIV)thinspafinthinspdethinsppreacuteciserthinsplethinsprisquethinspdrsquoassistancethinspventilatoirethinspetthinspdrsquointubationthinspdifficilethinsp

thinsprsaquo lesthinspanteacuteceacutedentsthinspanestheacutesiquesthinspetthinspchirurgicauxthinspafinthinspdrsquoidentifierthinsplesthinspcomplicationsthinsppotentielles

thinsprsaquo lesthinspcomorbiditeacutesthinspdontthinsplesthinsptroublesthinsprespiratoiresthinspduthinspsommeilthinsp(annexethinspV)thinsprsaquo lathinspmeacutedicationthinspouthinspautresthinspsubstancesthinsp(prescritesthinspouthinspenthinspventethinsplibre)thinspafinthinsp

drsquoidentifierthinsplesthinsprisquesthinspdrsquointeractionsthinspavecthinsplesthinspmeacutedicamentsthinsputiliseacutesthinsplorsthinspdethinsplrsquointerventionthinspouthinspdethinsplathinspseacutedation-analgeacutesie

thinsprsaquo lrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspquithinsppourraitthinspneacutecessiterthinspunethinspseacutedation-analgeacutesiethinspdrsquounthinspniveauthinspsupeacuterieurthinspagravethinspceluithinspdontthinspilthinspestthinspquestionthinspdansthinspcesthinsplignesthinspdirectrices

thinsprsaquo lesthinspcaracteacuteristiquesthinsppropresthinspauthinsppatientthinsp(fonctionsthinspcognitivesthinspisolementthinspsocialthinspautonomiethinspetc)

EacuteVALUATIONthinspDESthinspPATIENTS

Cettethinspeacutevaluationthinspdoitthinspsethinspfairethinsppeuthinspdethinsptempsthinsp(moinsthinspdethinsp3thinspmoisthinspenthinsplrsquoabsencethinspdethinspchangementthinspnotablethinspdansthinsplathinspconditionthinspcliniquethinspduthinsppatient)thinspavantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspetthinspdoitthinspnotammentthinsppreacuteciserthinspcethinspquithinspsuit

CMQ - OIIQ - OPIQ 16

AgravethinspLrsquoANAMNEgraveSEthinspthinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsp

lrsquoeacutevaluationthinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinsp(annexethinspVI)thinsp

thinsprsaquo raison(s)thinspdethinspconsultationthinspetthinsphistoirethinspdethinsplathinspmaladiethinspactuellethinsprsaquo anteacuteceacutedentsthinsprsaquo reacuteactionthinspanteacuterieurethinspagravethinsplathinspseacutedation-analgeacutesiethinspagravethinsplrsquoanestheacutesiethinspetthinspagravethinsplathinspchirurgiethinsprsaquo allergiesthinsprsaquo momentthinspduthinspdernierthinspingestathinsp(preacuteciserthinsplethinsptypethinspetthinsplathinspquantiteacute)thinsprsaquo meacutedicationthinspetthinspautresthinspsubstancesthinsp(prescritesthinspouthinspnon)thinsprsaquo preacutemeacutedicationthinspreccediluethinsp(pthinspexthinspthinspadministrationthinspdethinspmorphinethinspchezthinspunthinsppatientthinspenthinsp

attentethinspdrsquounethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutique)thinsprsaquo habitudesthinspdethinspviethinsp(tabacthinspalcoolthinspouthinspdrogues)thinsprsaquo troublethinsprespiratoirethinspduthinspsommeilthinspetthinsplathinsptheacuterapiethinspassocieacutee

AgravethinspLrsquoEXAMENthinspPHYSIQUEthinsp

Lrsquoexamenthinspphysiquethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinspcherchethinspagravethinspmettrethinspenthinspeacutevi-dencethinspcertainsthinspcritegraveresthinspreconnusthinsppourthinspecirctrethinspassocieacutesthinspagravethinspunethinspassistancethinspventila-toirethinspdifficilethinspquithinsppeutthinspsurvenirthinspdansthinsplethinspcasthinspdrsquounthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquethinspceluithinspviseacutethinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsplrsquoeacutevaluationthinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinsp(annexethinspVII)thinsp

Lrsquoexamenthinspphysiquethinspdoitthinspecirctrethinspadapteacutethinspagravethinspchaquethinsppatientthinspetthinspporterthinspnotammentthinspsurthinspdesthinspeacuteleacutementsthinsptelsthinspquethinspceux-cithinsp

thinsprsaquo preacutesencethinspdrsquoobeacutesiteacutethinsprsaquo tecirctethinspetthinspcouthinsp

thinsprsaquo mobiliteacutethinspcervicalethinspcompromisethinsprsaquo couthinspcourtthinspouthinsplargethinsp(circonfeacuterencethinsp )thinsprsaquo pathologiethinspouthinspanomaliethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(pthinspexthinspthinspmassethinsp

cervicale)thinspthinsprsaquo bouchethinsp

thinsprsaquo petitethinspouverturethinsprsaquo dentitionthinsp(pthinspexthinspthinspbouchethinspeacutedenteacuteethinspdentsthinspinstablesthinspincisivesthinspproeacuteminentesthinsp

outhinspappareilthinspdentairethinspmalocclusionthinspimportante)thinsp

LethinspscorethinspdethinspMallampatithinspmodifieacutethinspestthinspunthinspoutilthinspagravethinspprivileacutegierthinsp(annexethinspIV)

CMQ - OIIQ - OPIQ 17

UnethinspbonnethinspeacutevaluationthinspdethinsptousthinsplesthinspaspectsthinsprelatifsthinspauthinspmaintienthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspestthinspessentiellethinspDethinspplusthinspchezthinsplethinsppatientthinspsymptomatiquethinspthinsp(pthinspexthinspthinspdyspneacutee)thinspcettethinspeacutevaluationthinspdoitthinspecirctrethinspcompleacuteteacuteethinspparthinsplrsquoauscultation cardiorespiratoirethinspFinalementthinspsithinspdrsquoautresthinspexamensthinspdoiventthinspecirctrethinspfaitsthinspleurthinspchoixthinspserathinspguideacutethinspparthinsplesthinspproblegravemesthinspmeacutedicauxthinspsous-jacents

Bienthinspquethinsplathinspseacutedation-analgeacutesiethinspnethinsppreacutevoitthinspnormalementthinsppasthinspdethinspprisethinspenthinspchargethinspcomplegravetethinspdethinsplathinspventilationthinsp(assistancethinspventilatoirethinspouthinspintubationthinspthinspendotracheacuteale)thinspilthinspestthinspimportantthinspdrsquoeffectuerthinspcettethinspeacutevaluationthinsppuisqursquoagravethinspthinsptoutthinspmomentthinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspunethinspventilationthinspthinspassisteacuteethinspavecthinspouthinspsansthinspintubationthinspendotracheacutealethinsppeutthinspsrsquoaveacutererthinspneacutecessairethinspthinspsithinsplathinsprespirationthinspestthinspcompromisethinsp

Lorsthinspdethinspsituationsthinspparticuliegraveresthinspouthinspcomplexesthinsplethinspmeacutedecinthinspdevraitthinspconsulterthinspunthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinsp

cardiorespiratoirethinspavanceacutee

CONSENTEMENTthinsp(REacuteSUMEacute)

LethinsplecteurthinspdoitthinspsethinspreacutefeacutererthinspagravethinsplrsquoannexethinspVIIIthinsppourthinsplethinsptextethinspcomplet

SelonthinsplethinspdroitthinspenthinspvigueurthinspauthinspQueacutebecthinspilthinspestthinspobligatoirethinspdrsquoobtenirthinsplethinspconsentementthinspdrsquounthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspintervention

LethinspCode civil du QueacutebecthinspeacutetablitthinspdesthinspregraveglesthinspgeacuteneacuteralesthinspconcernantthinsplethinspconsentementthinspauxthinspsoinsthinspquithinspsrsquoappliquentthinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspdispenseacutesthinspOnthinspythinspfaitthinspcependantthinspcertainesthinspdistinctionsthinspselonthinspquethinsplethinsppatientthinspestthinspaptethinspouthinspnonthinspagravethinspconsentirthinspetthinspselonthinspquethinsplesthinspsoinsthinspsontthinsprequisthinspouthinspnonthinsp

parthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspLathinspLoi sur les services de santeacute et les services sociaux (LSSSS)thinspeacutetablitthinspquantthinspagravethinspellethinsplesthinspregraveglesthinspapplicablesthinspenthinspeacutetablissementthinspenthinspmatiegraverethinspdethinspconsentementthinspauxthinspinterventionsthinspchirurgicalesthinspetthinspagravethinsplrsquoanestheacutesiethinsp

LethinspCode de deacuteontologie des meacutedecinsthinspstipulethinspquethinsplethinspmeacutedecinthinspdoitthinspobtenirthinspunthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspavantthinsptoutethinspinterventionthinspilthinspestthinsppreacuteciseacutethinspquethinsplethinspmeacutedecinthinspdoitthinspsrsquoassurerthinspquethinsplrsquoinformationthinsppertinentethinspathinspeacuteteacutethinsptransmisethinspfaciliterthinsplathinspprisethinspdethinspdeacutecisionthinspduthinsppatientthinspetthinsplathinsprespecterthinspLethinspCode de deacuteontologie

des infirmiegraveres et infirmiersthinspstipulethinspquantthinspagravethinspluithinspquethinsplrsquoinfirmiegraverethinspouthinsplrsquoinfirmierthinspdoitthinspfournirthinspauthinspclientthinsptoutesthinsplesthinspinformationsthinsprequisesthinsplorsquethinsplrsquoobligationthinspdrsquoobtenirthinspunthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspincombethinspagravethinsplrsquoinfirmiegraverethinspouthinspagravethinsplrsquoinfirmierthinspIlthinspnrsquoythinspathinsppasthinspdethinspdispositionthinsptouchantthinsppreacuteciseacutementthinsplethinspconsentementthinspdansthinsplethinspCode de

CMQ - OIIQ - OPIQ 18

deacuteontologie des inhalotheacuterapeutes du QueacutebecthinspCependantthinspilthinspestthinsppreacuteciseacutethinspqursquoenthinspplusthinspdesthinspavisthinspetthinspdesthinspconseilsthinsplrsquoinhalotheacuterapeutethinspdoitthinspfournirthinspagravethinspsonthinspclientthinsplesthinspexplicationsthinspneacutecessairesthinspagravethinsplathinspcompreacutehensionthinspetthinspagravethinsplrsquoappreacuteciationthinspdesthinspservicesthinspqursquoilthinspluithinsprend

TousthinsplesthinspprofessionnelsthinspsontthinspeacutevidemmentthinsptenusthinspdethinsprespecterthinsplesthinspdispositionsthinspleacutegalesthinspexistantesthinspndashthinspincluantthinspleurthinspcodethinspdethinspdeacuteontologiethinsprespectifthinspndashthinspetthinsplesthinspnormesthinspdethinsppratiquethinspeacutetabliesthinspparthinspleurthinspordrethinspprofessionnelthinspToutefoisthinsplathinspquestionthinspsethinspposethinspdethinspsavoirthinspcommentthinspcesthinspexigencesthinspdoiventthinspsrsquoappliquerthinspmaintenantthinspquethinspplusieursthinspinterventionsthinspreacutealiseacuteesthinspautrefoisthinspenthinspeacutetablissementthinspsontthinspeffectueacuteesthinspenthinspdehorsthinspthinspdethinspceux-cithinspetthinspquethinsplesthinspprofessionnelsthinsppartagentthinspcertainesthinspactiviteacutesthinspetthinsptravaillentthinsp

enthinspeacutetroitethinspcollaboration

Mecircmethinspsithinsplathinsploithinspnethinsplrsquoexigethinsppasthinsptoujoursthinspilthinspestthinsprecommandeacutethinsp

thinsprsaquo quethinsplethinsppatientthinspdonnethinspunthinspconsentementthinspeacutecritthinsplorsqursquoilthinspythinspathinspseacutedation-analgeacutesiethinspthinspetthinspcethinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspprodigueacutes

thinsprsaquo quethinsplethinspconsentementthinspportethinspagravethinsplathinspfoisthinspsurthinsplathinspseacutedation-analgeacutesiethinspetthinspsurthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspquethinspcettethinspderniegraverethinsppermet

thinsprsaquo quethinsplrsquoinformationthinsptransmisethinspauthinsppatientthinspverbalementthinspouthinspparthinspeacutecritthinspcomprennethinsplesthinsprisquesthinspdethinsplathinspseacutedation-analgeacutesiethinspetthinsplesthinsprisquesthinspdethinsplrsquointerventionthinspelle-mecircme

thinsprsaquo quethinsplethinspmeacutedecinthinspouthinsplethinspprofessionnelthinspagravethinspquithinspilthinspathinspconfieacutethinsplathinsptacircchethinspversethinspauthinspdossierthinspduthinsppatientthinspunethinspnotethinspexplicativethinspsurthinsplesthinspinformationsthinspfourniesthinspetthinsplethinspconsentementthinspobtenu

Lrsquoobtentionthinspdrsquounthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspdemeurethinspunethinspobligationthinspthinspinheacuterentethinspagravethinsplrsquointerventionthinspmeacutedicalethinspelle-mecircmethinspIlthinsprelegravevethinspdoncthinspdethinsplathinspresponsabiliteacutethinspduthinspmeacutedecinthinspdethinspsrsquoassurerthinspdethinsplathinsptransmissionthinspdethinsplrsquoinformationthinsppertinentethinspauthinsppatientthinspetthinspdethinspsathinspcompreacutehensionthinspdethinsplathinspnaturethinspduthinspbutthinspetthinspdesthinsprisquesthinsprelatifsthinspagravethinsplrsquointerventionthinspToutefoisthinsplathinsptacircchethinspdethinsptransmettrethinspdethinsplrsquoinformationthinspcompleacutementairethinsppeutthinspecirctrethinspconfieacuteethinspagravethinspdrsquoautresthinspprofessionnelsthinspthinspetthinspcellethinspdethinsprecueillirthinsplathinspsignaturethinspdrsquounthinspformulairethinspdethinspconsentementthinspagravethinspdrsquoautresthinspmembresthinspdethinsplrsquoeacutequipethinspdethinspsoins

CMQ - OIIQ - OPIQ 19

DIRECTIVESthinspETthinspCONSEILSthinsp

Avantthinspdethinspsubirthinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspsousthinspseacutedationthinsp-analgeacutesiethinsplethinsppatientthinspdoitthinsprecevoirthinsplesthinspdirectivesthinspneacutecessairesthinspdethinsppreacutefeacuterencethinspdansthinsp

unthinspdocumentthinspcontenantthinspentrethinspautresthinsplesthinsprecommandationsthinspsuivantesthinsp

a eacuteviterthinspdethinspconsommerthinsptoutethinspboissonthinspalcooliseacuteethinspdroguethinspouthinspsubstancethinspenthinspventethinsplibrethinsp(agravethinspmoinsthinspqursquoellethinspsoitthinspprescrite)thinsppouvantthinspalteacutererthinsplethinspniveauthinspdethinspconsciencethinspthinsp24thinspheuresthinspavantthinspetthinspapregravesthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

b observerthinspunethinsppeacuteriodethinspdethinspjeucircnethinspquithinspsrsquoappliquethinspagravethinsptoutthinspacircgethinspauxthinspcasthinspeacutelectifsthinsp(nonthinspurgents)thinspetthinspselonthinsplrsquoeacutevaluationthinspduthinsplaquothinsprapportthinsprisquebeacuteneacuteficethinspraquothinsppourthinsplesthinspcasthinspurgents

c suivrethinsplesthinsprecommandationsthinspduthinspmeacutedecinthinspquithinsppreacutecisethinspsithinsplesthinspmeacutedicamentsthinspprescritsthinspsurthinspunethinspbasethinspreacuteguliegraverethinsppeuventthinspecirctrethinspadministreacutesthinspcommethinspagravethinsplrsquoaccoutumeacuteethinspetthinspquithinspfaitthinsppartthinspdesthinspexceptionsthinsp(pthinspexthinspthinspanticoagulantthinsppsychotropethinspetc)thinspsrsquoilthinspythinspathinsplieuthinsp

Unethinspseacutedation-analgeacutesiethinspleacutegegraverethinspougravethinsplesthinspreacuteflexesthinspdethinspprotectionthinspdesthinspvoiesthinspthinspaeacuteriennesthinspsontthinsppreacuteserveacutesthinspestthinsppeuthinspsusceptiblethinspdrsquoinduirethinspunethinspaspirationthinspduthinspcon-tenuthinspgastriquethinspcontrairementthinspagravethinspunethinspseacutedationthinspplusthinspprofondethinspIlthinspestthinsptoutthinspdethinspmecircmethinspraisonnablethinspdethinsppenserthinspquethinsplethinsprisquethinspdrsquoaspirationthinspestthinspdiminueacutethinsplorsquethinsplrsquoestomacthinspestthinspvidethinspetthinspqursquounethinsppeacuteriodethinspdethinspjeucircnethinspavantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacutera-peutiquethinspestthinsppreacutefeacuterablethinspToutefoisthinspdansthinsptousthinsplesthinspcasthinsplrsquourgencethinspdethinsplrsquointerventionthinspetthinsplethinspniveauthinspdeacutesireacutethinspdethinspseacutedation-analgeacutesiethinspdoiventthinspecirctrethinspsoupeseacutesthinspauthinspregardthinspdesthinsprisquesthinspassocieacutesthinspagravethinspunthinspjeucircnethinspinadeacutequatthinspAinsithinsplethinspdeacutelaithinspentrethinsplrsquoheurethinspduthinspdernierthinsprepasthinspetthinsplethinspmomentthinspdethinsplathinspblessureaccidentthinspdoitthinspecirctrethinsppristhinspenthinspconsideacuterationthinsppourthinspestimerthinsplrsquoeacutetatthinspdethinspjeucircnethinspetthinspcethinspenthinspraisonthinspdethinsplrsquoileacuteusthinspreacuteflexethinsp

Avantthinsplathinspseacutedation-analgeacutesiethinspdrsquounethinspinterventionthinspnonthinspurgentethinsp(eacutelective)thinsplethinsppatientthinspdoitthinsprespecterthinsplesthinspdeacutelaisthinspsuivantsthinspselonthinsplathinspnaturethinspetthinsplathinspquantiteacutethinspingeacutereacuteethinspdethinspthinsp(Merchantthinspetthinspcollabthinsp2014a)thinsp

thinsprsaquo liquidethinspclairthinsp(pthinspexthinspthinspeauthinspjusthinspdethinspfruitthinsp[sansthinsppulpe]thinsptheacutethinspetthinspcafeacutethinspnoir)thinspthinspjeucircnethinspdethinsp2thinspheures

thinsprsaquo repasthinspleacutegerthinsp(pthinspexthinspthinsppainthinspgrilleacutethinsp+thinspliquidethinspclair)thinspthinspjeucircnethinspdethinsp6thinspheuresthinsprsaquo repasthinspcomposeacutethinspdethinspviandethinspouthinspdrsquoalimentsthinspfritsthinspouthinspgrasthinspthinspjeucircnethinspdethinsp8thinspheuresthinsp

CMQ - OIIQ - OPIQ 20

15thinspPERSEacuteDATION-ANALGEacuteSIEthinsp

APPROCHEthinspPHARMACOLOGIQUE

Lrsquoadministrationthinspdethinsptoutthinspmeacutedicamentthinspneacutecessitethinsplrsquoobtentionthinspdrsquounethinspordonnancethinsp

faitethinspenthinspvertuthinspdethinsplrsquoarticlethinsp393thinspduthinspCode des professions du QueacutebecthinspDrsquoailleursthinspthinsplathinspmeilleurethinspfaccedilonthinspdrsquoencadrerthinsplathinsppratiquethinspdethinsplrsquoinfirmiegraverethinspetthinspdethinsplrsquoinhalotheacuterapeutethinspestthinsplrsquoadoptionthinspdrsquounthinspprotocoleordonnancethinspcollectivethinspcomprenantthinspunthinspeacuteventailthinsptheacuterapeutiquethinspquithinsplaissethinspplacethinspauthinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspthinspUnthinsptelthinspdocumentthinspdoitthinspparthinspcontrethinspecirctrethinspenteacuterineacutethinspparthinsplesthinspresponsablesthinspmeacutedicauxthinspthinspdethinsplrsquoeacutetablissementthinspqursquoilthinspsoitthinsppublicthinspouthinsppriveacutethinsp

Soulignonsthinsplrsquoimportancethinspdrsquounthinspaccegravesthinspveineuxthinspfonctionnelthinspquithinspfaciliterathinsplrsquoadmi-nistrationthinspdesthinspagentsthinspseacutedatifsthinspetthinspanalgeacutesiquesthinspainsithinspquethinsplesthinsptraitementsthinsppharma-cologiquesthinspdesthinspcomplications

LethinspmeacutedecinthinsplrsquoinfirmiegraverethinspetthinsplrsquoinhalotheacuterapeutethinspdoiventthinsputiliserthinspunethinspmeacutedicationthinspqursquoilsthinspconnaissentthinspetthinspquithinspestthinspreconnuethinspRappelonsthinspqursquoilsthinspdoiventthinspecirctrethinspenthinspmesurethinspdethinspprendrethinspenthinspchargethinsptoutethinspcomplicationthinsppotentiellethinspythinspcompristhinsplathinspgestionthinspdrsquounthinsppassagethinspmomentaneacutethinspagravethinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspsupeacuterieurthinspagravethinspceluithinspquithinspthinspathinspeacuteteacutethinspplanifieacute

LethinspchoixthinspdethinsplathinspmeacutedicationthinsppeutthinspvarierthinspselonthinsplathinspsituationthinspcliniquethinspetthinsplesthinspfacteursthinsppropresthinspauthinsppatientthinspParthinspexemplethinspcertainsthinsppatientsthinspnethinsptolegraverentthinsppasthinsplesthinspdosagesthinsphabituelsthinspouthinsppreacutesententthinspdesthinspcontre-indications

Ilthinspestthinspimportantthinspdethinspretenirthinspquethinsplethinsptitragethinspdethinsptoutethinspmeacutedicationthinspdoitthinspecirctrethinspthinspprivileacutegieacutethinspetthinspquethinspsonthinspadministrationthinspdoitthinspsethinspfairethinspparthinsppetitesthinspdosesthinspdethinspthinspfaccedilonthinspprogressivethinspjusqursquoagravethinsplrsquoobtentionthinspduthinspniveauthinspdethinspseacutedationthinspetthinspdrsquoanalgeacutesiethinspthinspdeacutesireacutethinsptoutthinspenthinsplaissantthinspsrsquoeacutecoulerthinspsuffisammentthinspdethinsptempsthinspentrethinspdeuxthinspdosesthinsppourthinspquethinsplethinspmeacutedicamentthinspproduisethinspsesthinspeffetsthinsp

Lesthinspmeacutedicamentsthinsputiliseacutesthinspenthinspseacutedation-analgeacutesiethinspontthinspunthinspeffetthinspsynergiquethinspthinspParthinspexemplethinsplrsquoassociationthinspdrsquounethinspbenzodiazeacutepinethinspavecthinspunthinspopioiumldethinspaugmentethinspthinsplesthinsprisquesthinspdethinspdeacutepressionthinsprespiratoirethinspLeurthinspdosagethinspdoitthinspdoncthinspecirctrethinspajusteacutethinspenthinspconseacutequencethinspSithinsplrsquoobstructionthinspdesthinspvoiesthinspaeacuteriennesthinsplrsquoapneacuteethinspetthinsplrsquohypotensionthinspthinspsontthinsplesthinspcomplicationsthinsplesthinspplusthinspfreacutequentesthinspenthinspseacutedation-analgeacutesiethinspilthinspfautthinspretenirthinspquethinspcertainesthinspcomplicationsthinsppeuventthinspecirctrethinspparticuliegraveresthinspagravethinsplathinspmeacutedicationthinsputiliseacuteethinspthinspCitonsthinspagravethinsptitrethinspdrsquoexemplethinsplrsquoassociationthinsplaryngospasmethinspetthinspkeacutetaminethinsp

CMQ - OIIQ - OPIQ 21

Lorsquethinspdesthinspbenzodiazeacutepinesthinspouthinspdesthinspopioiumldesthinspsontthinspadministreacutesthinspparthinspvoiethinspthinspintraveineusethinspleursthinspantagonistesthinsprespectifsthinsp(pthinspexthinspthinspflumazeacutenilthinsp[Anexatereg]thinspthinspnaloxonethinsp[Narcanreg])thinspdoiventthinspecirctrethinsprapidementthinspdisponiblesthinspIlsthinspserontthinsputiliseacutesthinspthinspauthinspmomentthinspdrsquounethinspdeacutepressionthinsprespiratoirethinspinduitethinspparthinsplathinspmeacutedicationthinspet non en prophylaxiethinspchezthinsplethinsppatientthinspstablethinspIlthinspestthinsphabituellementthinsppreacutefeacuterablethinspdethinspthinsprenverserthinspdrsquoabordthinsplrsquoagentthinspseacutedatifthinspafinthinspdethinspmaintenirthinspintactthinsplrsquoeffetthinspanalgeacutesiquethinspthinspSithinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspdemeurethinspcompromisethinspilthinspserathinspalorsthinspthinspneacutecessairethinspdethinsprenverserthinsplrsquoeffetthinspanalgeacutesique

IlthinspfautthinspsethinsprappelerthinspquethinsplathinspdureacuteethinspdrsquoactionthinspdesthinspantagonistesthinspestthinspbienthinspinfeacuterieurethinspthinspagravethinsplathinspdureacuteethinspdrsquoactionthinspduthinspmeacutedicamentthinspdevantthinspecirctrethinspneutraliseacutethinspParthinspconseacutequentthinspthinsplathinspreacuteapparitionthinspdethinsplrsquoeffetthinspindeacutesirablethinspestthinspagravethinspsurveillerthinspchezthinsplethinsppatientthinspquithinspreccediloitthinspunthinspantagonistethinsp

VousthinsptrouverezthinspunethinspfichethinspinformativethinspsurthinsplrsquoutilisationthinspdethinsplathinspnaloxonethinspetthinspduthinspflumazeacutenilthinspagravethinsplrsquoannexethinspXI

Lesthinspdirectivesthinspeacutenonceacuteesthinspdansthinspcesthinsplignesthinspdirectricesthinspnrsquoontthinsppasthinsppourthinspobjectifthinspdethinspdeacutecrirethinspdansthinsplethinspdeacutetailthinsplathinspmeacutedicationthinsputiliseacuteethinspenthinspseacutedation-analgeacutesiethinspleursthinspagentsthinsp

antagonistesthinspetthinsplesthinspmeacutedicamentsthinspdrsquourgencethinspIlthinsprevientthinspauthinspmeacutedecinthinspdethinspbienthinsp

connaicirctrethinsplathinspmeacutedicationthinspetthinspdethinspchoisirthinspunethinspmeacutedicationthinspouthinspunethinspcombinaisonthinspdethinspmeacutedicamentsthinspreconnuethinspEtthinspilthinsprevientthinspauxthinspprofessionnelsthinspquithinsplesthinspadministrentthinsp

dethinspbienthinsplesthinspconnaicirctrethinspeacutegalementthinsp(eacuteleacutementsthinspdethinspsurveillancethinspcliniquethinsptechniquethinspdrsquoadministrationthinspeffetsthinspsecondairesthinspinteractionsthinspcontre-indicationsthinspseuilsthinspthinsptoxiquesthinspetc)thinspetthinspdethinspmaintenirthinspagravethinspjourthinspleursthinspconnaissancesthinspdansthinspcethinspdomaine

thinspPRINCIPALESthinspCLASSESthinspPHARMACOTHEacuteRAPEUTIQUESthinspUTILISEacuteESthinspthinspthinspENthinspSEacuteDATION-ANALGEacuteSIEthinsp

Lathinsplistethinspdesthinspmeacutedicamentsthinspabordeacutesthinspci-dessousthinspnrsquoestthinsppasthinsplimitativethinsp

a BenzodiazeacutepinesthinspProprieacuteteacutesthinspthinspanxiolytiquethinspamneacutesiquethinsphypnotiquethinsprelaxantthinspmusculairethinspetthinspanticonvulsivantthinspthinspIlthinspfautthinspprivileacutegierthinsplesthinspmoleacuteculesthinspagravethinspcourtethinspdemi-viethinsp(pthinspexthinspthinspmidazolamthinsp[Versedreg])thinspenthinspretenantthinspqursquoilthinspfautthinspajusterthinsplethinspdosagethinspchezthinspcertainsthinsppatientsthinsp(pthinspexthinspthinspacircgeacutesthinspouthinspaffaiblis)thinspetthinsplorsthinspdethinsplrsquoutilisationthinspconcomitantethinspdrsquoautresthinspmeacutedicamentsthinspaffectantthinsplethinspsystegravemethinspnerveuxthinspcentralthinspDethinspplusthinsplathinspdemi-viethinsp

CMQ - OIIQ - OPIQ 22

dethinspcesthinspmeacutedicamentsthinsppeutthinspecirctrethinspaugmenteacuteethinsplorsthinspdethinspleurthinspadministrationthinspenthinspperfusionthinspcontinuethinsp(context sensitive half-life)thinsp

b OpioiumldesthinspProprieacuteteacutesthinspthinspanalgeacutesiquethinspetthinspseacutedativethinspLathinspmorphinethinspconstituethinspunthinspopioiumldethinspdontthinsplrsquoefficaciteacutethinspestthinspreconnuethinspCependantthinspellethinspfavorisethinsplathinsplibeacuterationthinspdrsquohistaminethinspcethinspquithinsppeutthinspcauserthinspduthinsppruritthinspetthinspdethinsplrsquohypotensionthinspUnethinspdysfonctionthinspreacutenalethinspseacutevegraverethinspentraicircnethinsplrsquoaccumulationthinspdethinspsesthinspmeacutetabolitesthinspactifsthinsp

thinsprsaquo lethinspfentanylthinsp(Sublimazereg)thinspestthinspunthinspopioiumldethinspsyntheacutetiquethinsppuissantthinspetthinspdethinspcourtethinspdureacuteethinspdrsquoactionthinspIlthinspnethinspdeacuteclenchethinsppasthinspdethinsplibeacuterationthinspdrsquohistaminethinsp(doncthinsppeuthinspdrsquoeffetthinspheacutemodynamique)thinspIlthinspfautthinspcependantthinspsethinspmeacutefierthinspdesthinspdosesthinspeacuteleveacuteesthinspetthinspdesthinspinjectionsthinsprapidesthinspquithinsppeuventthinspprovoquerthinspunethinsprigiditeacutethinspmusculairethinspthinspetthinspunethinspdeacutepressionthinsprespiratoire

thinsprsaquo lrsquohydromorphonethinsp(Dilaudidreg)thinspestthinspunthinspopioiumldethinspsemi-syntheacutetiquethinspdontthinsplesthinspmeacutetabolitesthinspconnusthinspsontthinsprarementthinspprobleacutematiquesthinspMoinsthinsputiliseacuteethinspenthinspthinspseacutedation-analgeacutesiethinspellethinspestthinspauthinspmoinsthinsp5thinspfoisthinspplusthinsppuissantethinspquethinsplathinspmorphinethinspthinspcethinspquithinspestthinspparfoisthinspsous-estimeacute

thinsprsaquo lathinspmeacutepeacuteridinethinsp(Demerolreg)thinspestthinspunthinspopioiumldethinspsyntheacutetiquethinspposseacutedantthinspunthinspmeacuteta-bolitethinspactifthinspneurotoxiquethinspEllethinspnrsquoestthinsphabituellementthinsppasthinsprecommandeacuteethinsp

c Anestheacutesiques geacuteneacuterauxthinspLethinspmeacutedecinthinspquithinspprocegravedethinspagravethinspunethinspinterventionthinspsousthinspseacutedation-analgeacutesiethinspenthinsputilisantthinspunthinspouthinspdesthinspanestheacutesiquesthinspgeacuteneacuterauxthinspdoitthinspecirctrethinspexpeacuterimenteacutethinspenthinspseacutedation-analgeacutesiethinspetthinspenthinspreacuteanimationthinspcardiorespiratoirethinspDansthinsplethinspcasthinspcontrairethinspilthinspdoitthinspsrsquoassurerthinspdethinsplathinspcollaborationthinspdrsquounthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspParthinspailleursthinsplethinspmeacutedecinthinspdoitthinspenthinsptoutthinsptempsthinspecirctrethinspsoutenuthinspparthinspunthinspouthinspdesthinspprofessionnelsthinspqualifieacutesthinsp

thinsprsaquo propofolthinsp(Diprivanreg)thinspProprieacuteteacutesthinspseacutedativethinsphypnotiquethinspamneacutesiquethinspanxiolytiquethinspAgravethinspnoterthinspqursquoilthinspnrsquoathinspaucune proprieacuteteacute analgeacutesiquethinsp

thinspIlthinsppossegravedethinspunethinspdemi-viethinspcourtethinsppeutthinspecirctrethinspcumulatifthinspetthinspnrsquoathinsppas drsquoantago-nistethinspIlthinspnrsquoestthinsppasthinsprecommandeacutethinspchezthinsplathinspfemmethinspenceintethinspouthinspquithinspallaitethinspEnthinspregraveglethinspgeacuteneacuteralethinspetthinspselonthinsplethinsptypethinspdrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspilthinsppeutthinspecirctrethinspplusthinspjudicieuxthinspdethinsplrsquoadministrerthinspenthinspinfusionthinspIVthinspplutocirctthinspthinspqursquoenthinspbolusthinspthinspthinspIlthinsppeutthinsprapidementthinspcauserthinspunethinspdiminutionthinspmarqueacuteethinspduthinspniveauthinspdethinspcon-sciencethinspetthinspunethinspdeacutepressionthinsprespiratoirethinsppouvantthinspconduirethinspmomentaneacute-

CMQ - OIIQ - OPIQ 23

mentthinspagravethinspunethinspanestheacutesiethinspgeacuteneacuteralethinspnonthinspdeacutesireacuteethinspLesthinspprofessionnelsthinspenthinspplacethinspdoiventthinspecirctrethinspenthinspmesurethinspdethinspprendrethinspenthinspchargethinspunethinsptellethinspsituationthinspLrsquoASAthinsp(AmericanthinspSocietythinspofthinspAnesthesiologiststhinspASAthinspHousethinspofthinspDelegatesthinsp2004bthinsp[Notrethinsptraduction])thinsprecommandethinspnotammentthinspquethinsplethinsppatientthinspagravethinspquithinsplrsquoonthinspadministrethinspduthinsppropofolthinspreccediloivethinspdesthinspsoinsthinspenthinsplienthinspavecthinspunethinspseacutedationthinsppro-fondethinsp(niveauthinspnonthinspviseacutethinspdansthinspcesthinsplignesthinspdirectrices)thinspetthinspquethinsplethinspprofessionnelthinsp(nonthinspanestheacutesiologiste)thinspadministrantthinsplethinsppropofolthinsppossegravedethinsplathinspformationthinsptheacuteoriquethinspetthinsppratiquethinspneacutecessairethinspagravethinsplrsquoidentificationthinspetthinspagravethinsplathinspprisethinspenthinspchargethinspdesthinspvoiesthinspaeacuteriennesthinspetthinspdesthinspchangementsthinspcardiovasculairesthinspquithinspsurvien-nentthinspchezthinspunthinsppatientthinspeacutevoluantthinspversthinspunthinspeacutetatthinspdrsquoanestheacutesiethinspgeacuteneacuteralethinsp(niveauthinspnonthinspviseacutethinspdansthinspcesthinsplignesthinspdirectrices)thinsp

thinspthinspLorsquethinsplethinsppropofolthinspestthinspadministreacutethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspthinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspthinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspthinspobligatoirethinsp(tableauthinsp3)thinspthinspthinsp

thinsprsaquo keacutetaminethinsp(Ketalarreg)thinspProprieacuteteacutesthinspthinspseacutedativethinspetthinspanalgeacutesiquethinspthinspUtiliseacuteethinspenthinsppeacutediatriethinspetthinspchezthinsplrsquoadultethinspEllethinspproduitthinspaussithinspunethinspbroncho-thinspdilatationthinspparfoisthinspsouhaiteacuteethinsplorsthinspdrsquointerventionsthinspdiagnostiquesthinspouthinsptheacutera-peutiquesthinspchezthinsplesthinsppatientsthinspasthmatiquesthinspEllethinspsrsquoaccompagnethinspdrsquounethinsplibeacutera-tionthinspdethinspcateacutecholaminesthinspetthinspdrsquoeffetsthinspsympathomimeacutetiquesthinsp(augmentationthinspdethinsplathinspsalivation)thinspEllethinsppeutthinspprovoquerthinspdesthinspsymptocircmesthinsppsychotiquesthinspouthinspdesthinspcomportementsthinspanormauxthinspCesthinspsymptocircmesthinsppeuventthinspnuirethinspagravethinsplrsquoeacutevaluationthinspdesthinsppatientsthinspsousthinspseacutedationthinspEllethinspabaissethinsplethinspseuilthinspconvulsifthinsp

Lorsquethinsplathinspkeacutetaminethinspestthinspadministreacuteethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspobligatoirethinsp(tableauthinsp3)thinspthinsp

thinsprsaquo protoxydethinspdrsquoazotethinsp(N2O)thinsp

ProprieacuteteacutesthinspthinspgazthinspseacutedatifthinspetthinspanalgeacutesiquethinspthinspActionthinspanalgeacutesiquethinspsemblablethinspagravethinspcellethinspdethinsplathinspmorphinethinspIlthinsppotentialisethinsplesthinspanalgeacutesiquesthinspcentrauxthinspetthinsplesthinspagentsthinsphypnotiquesthinspetthinsppeutthinspaussithinspdiminuerthinsplesthinspreacuteservesthinspenthinspoxygegravenethinspduthinsppatientthinspUtiliseacutethinspenthinspcombinaisonthinspavecthinsplrsquooxygegravenethinspIlthinsppeutthinsppolluerthinsplrsquoenvironnementthinspdethinsptravailthinsp(voirthinspnormesthinspCSST)thinspIlthinsppeutthinspecirctrethinsp

CMQ - OIIQ - OPIQ 24

utiliseacutethinspenthinsppeacutediatriethinspchezthinsplrsquoadultethinspetthinspchezthinsplathinspfemmethinspenceintethinsp(saufthinspauthinspthinsppremierthinsptrimestre)thinsp

thinspDansthinsplethinspcasthinspougravethinsplethinspprotoxydethinspdrsquoazotethinspestthinsputiliseacutethinspenthinspcombinaisonthinspavecthinspunthinspagentthinspseacutedatifthinspouthinspunthinspopioiumldethinspouthinspsithinsplrsquoappareilthinsputiliseacutethinsppermetthinspdethinspmodifierthinsplathinspconcentrationthinspdrsquooxygegravenethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivement agravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspthinsp

thinsprsaquo dexmeacutedeacutetomidinethinsp(PreacuteceacutedexMC)thinsp(Agonistethinspalpha2-adreacutenergique)thinspProprieacuteteacutesthinspthinspseacutedativethinspanalgeacutesiquethinspetthinspanxiolytiquethinspthinspLathinspdexmeacutedeacutetomidinethinspenthinspperfusionthinspintraveineusethinspcontinuethinspestthinspindiqueacuteethinspnotammentthinsppourthinsplathinspseacutedationthinspdethinsppatientsthinspnonthinspintubeacutesthinspavantthinspetouthinsppendantthinspunethinspinterventionthinspchirurgicalethinspouthinspdrsquoautresthinsptypesthinspdrsquointerventionsthinspthinspNethinspcausethinspaucunethinspdeacutepressionthinsprespiratoirethinspmaisthinsppeutthinspcauserthinspunethinspbradycar-diethinspetthinspunethinsphypotensionthinspthinsp

thinspLrsquoutilisationthinspdethinspdexmeacutedeacutetomidinethinspdevraitthinspecirctrethinspreacuteserveacuteethinspauthinspmilieuthinspthinsphospitalierthinspouthinspauxthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspthinspEllethinspdevraitthinspecirctrethinspadministreacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspthinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspetthinsprapidementthinspdisponiblethinspthinspLorsquethinspdethinsplathinspdexmeacutedeacutetomidinethinspestthinspadministreacuteethinspunthinspprofessionnelthinspthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspthinspduthinsppatientthinsp(tableauthinsp2)thinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspobligatoirethinsp(tableauthinsp3)thinspthinsp

Agravethinspnoterthinspqursquoilthinspestthinspobligatoirethinspdethinsptenirthinspunthinspregistrethinspdesthinspsubstancesthinspcontrocircleacuteesthinspetthinspdesthinspbenzodiazeacutepinesthinspcomportantthinspdesthinspsignatures

thinsp

CMQ - OIIQ - OPIQ 25

SURVEILLANCEthinspCLINIQUEthinspLathinspsurveillancethinspcliniquethinspcomprendthinspplusieursthinspeacuteleacutementsthinspquithinspconcernentthinspthinspnotammentthinsplesthinspsystegravemesthinsprespiratoirethinspcardiaquethinspetthinspneurologiquethinspEllethinspdoitthinspthinsptenirthinspcomptethinspentrethinspautresthinsp

thinsprsaquo dethinsplathinspconditionthinspduthinsppatientthinspavantthinspetthinsppendantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

thinsprsaquo dethinsplathinspcomplexiteacutethinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinsprsaquo dethinsplathinspmeacutedicationthinsputiliseacuteethinsp(dosethinspdureacuteethinspetthinsppicthinspdrsquoactionthinspvoiethinspetthinspvitessethinspthinsp

drsquoadministrationthinspcombinaisonthinspetthinspantagonistes)

thinsprsaquo dethinsplrsquoassistancethinspagravethinspapporterthinspauthinspmeacutedecin

Lethinspmeacutedecinthinspquithinsppratiquethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspchezthinspunthinsppatientthinspsousthinspseacutedation-analgeacutesiethinspdoitthinspcompterthinspsurthinsplathinsppreacutesencethinspdrsquoauthinspmoinsthinspunthinspautrethinspprofessionnelthinsphabiliteacutethinspduthinspmilieuthinspdethinsplathinspsanteacutethinsp(infirmiegraverethinspinhalotheacuterapeutethinspouthinspautrethinspmeacutedecin)thinsp(annexethinspII)thinspEnthinspeacutetroitethinspcollaborationthinspavecthinsplethinspmeacutedecinthinspreacuteali-santthinsplrsquointerventionthinspceux-cithinspassurentthinspthinsplathinspgestionthinspdethinsplathinspseacutedationthinspetthinspdethinsplrsquoanalgeacutesiethinspqui comprend entre autres la surveillance clinique du patientthinspresponsabiliteacutethinspthinspagravethinsplaquellethinspilsthinspdoiventthinspenthinsptoutthinsptempsthinspsethinspconsacrerthinspenthinspprioriteacutethinsp

Dansthinspcertainsthinspcasthinsplethinspprofessionnelthinspquithinspassurethinspen prioriteacutethinsplathinspsurveillancethinspthinspcliniquethinspduthinsppatientthinsppeutthinspecirctrethinspappeleacutethinspagravethinspassisterthinsplethinspmeacutedecinthinspdansthinsplathinspreacutealisationthinspthinspdethinspsonthinspinterventionthinspCettethinspassistancethinspquithinspdoitthinspsrsquoeffectuerthinspdansthinsplathinspmecircmethinsppiegravecethinspdoitthinspecirctrethinspdethinsptregravesthinspcourtethinspdureacuteethinspDethinspplusthinspellethinspdoitthinsppouvoirthinspecirctrethinspinterrompuethinspthinspagravethinsptoutthinspmomentthinsppourthinspintervenirthinspimmeacutediatementthinspaupregravesthinspduthinsppatientthinspenthinspcasthinspdethinsp

complicationsthinspouthinspdethinspbesoin

Parthinspailleursthinsplorsquethinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspthinspneacutecessitentthinspunethinspassistancethinsptechniquethinspcontinuellethinspauthinspmeacutedecinthinsplrsquoajoutthinspdrsquounthinsptroisiegravemethinspprofessionnelthinspdethinsplathinspsanteacutethinsphabiliteacutethinsp(meacutedecinthinspinfirmiegraverethinspouthinspinhalotheacuterapeute)thinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinspestthinsprequisthinsp

CMQ - OIIQ - OPIQ 26

Tableau 2 Tableau reacutecapitulatif du nombre de professionnels habiliteacutes requis en seacutedation-analgeacutesie - Clientegravele adulte

Toutthinspauthinsplongthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplathinspsurveillancethinspcliniquethinspthinspduthinsppatientthinspdoitthinspecirctrethinspcontinuethinspetthinsplathinspcommunicationthinspavecthinspcelui-cithinspmaintenue

Proceacutederthinspagravethinsplathinspsurveillancethinspcliniquethinspcrsquoestthinspeacutevaluerthinspqualitativementthinspetthinspquantitative-mentthinspdethinspfaccedilonthinspsoutenuethinspetthinspenthinspcontinuthinsplrsquoensemblethinspdesthinspparamegravetresthinspsuivantsthinsp(listethinsp

nonthinsplimitative)thinsp(tableauthinsp3)thinsp

thinsprsaquo mesurethinspdethinsplathinsppressionthinsparteacuteriellethinspduthinsppouls3thinspetthinspdethinsplathinsprespiration4thinsprsaquo lecturethinspdethinsplathinspsaturationthinspcapillairethinspenthinspoxygegravene

Ilthinspfautthinspnoterthinspquethinsplathinsptonaliteacutethinspdethinsppoulsthinspdoitthinspecirctrethinspactiveacuteethinspenthinsptoutthinsptempsthinspetthinspsonthinspniveauthinspdoitthinspecirctrethinspajusteacutethinspdethinspfaccedilonthinspagravethinspecirctrethinspentenduthinspclairement

thinsprsaquo eacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplathinspseacutedationthinsp(eacutevaluationthinspdethinsplathinspseacutedationagitationthinspetthinspduthinspniveauthinspdethinspconscience)thinsp(annexethinspIX)thinsp

thinsprsaquo eacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplrsquoanalgeacutesiethinsp(eacutevaluationthinspdethinsplathinspdouleur)thinspdethinsplrsquoanxieacuteteacutethinspetthinspdethinsplathinspreacuteactionthinspduthinsppatientthinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsp(annexethinspX)

thinsprsaquo eacutevaluationthinspdethinsplrsquoeacutetatthinspdethinsplathinspcolorationthinspetthinspdethinsplathinsptempeacuteraturethinspdethinsplathinsppeauthinsprsaquo eacutevaluationthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsprsaquo niveauthinspdrsquoO

2thinspdethinspCO

2thinspetthinspmonitoragethinspcardiaquethinspselonthinsplethinspcas

3thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp4thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

Nombrethinspdethinspprofessionnelsthinsphabiliteacutesthinsprequis

2 Nombrethinspmimimalthinsprequis

3 Sithinsputilisationthinspdethinsppropofolthinspkeacutetaminethinspouthinspdethinspdexmeacutedeacutetomidine

3 SithinsputilisationthinspconcomitantethinspdethinspN2Othinspetthinspdrsquounthinspagentthinspseacutedatifthinspouthinspthinsp

dunthinspopioiumldethinspouthinspsithinspconcentrationthinspdethinspN2Othinspmodifiable

3 Sithinsplassistancethinsptechniquethinspauthinspmeacutedecinthinspestthinspcontinuelle

CMQ - OIIQ - OPIQ 27

Tableau 3 Surveillance des paramegravetres cliniques en seacutedation-analgeacutesie - Clientegravele adulte

Paramegravetrethinspdethinspthinspsurveillancethinspthinspclinique

PatientNiveauthinspdethinspthinspseacutedation

MeacutedicationInterventionthinspdiagnostiquethinspouthinsptheacuterapeutique

TAthinspRC5thinspthinspRR6thinspthinspetthinspsaturationthinspdrsquoO

thinsp2thinspthinsp

rsaquothinspObligatoireChezthinsptousthinsplesthinsppatients

Niveauthinspdethinspthinsp-thinspseacutedationthinspthinspthinspagitationthinspthinspthinspthinspconscience-thinspdouleur

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

NiveauthinspdethinspCO2

SelonthinsplesthinspthinspcaracteacuteristiquesthinspAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspthinspmeacutedication

Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire

rsaquothinspAccegravesthinspindirectthinspthinspthinspthinspthinspouthinsprestreintthinspthinspthinspthinspauthinsppatientthinspthinspthinspthinsp(pthinspexthinspthinspIRM)

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

rsaquothinspRecommandeacute

rsaquothinspASAthinspgethinsp3thinsprsaquothinspApneacuteethinspthinspobstructivethinspthinspthinspthinspduthinspsommeilthinsprsaquothinspMaladiethinspthinspthinspthinsprespiratoirethinsprsaquothinspObeacutesiteacutethinspmorbide

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

Monitoragethinspcardiaque

SelonthinsplesthinspcaracteacuteristiquesAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

SelonthinsplathinspmeacutedicationSelonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoirersaquothinspASAthinspgethinsp3thinsprsaquothinspMaladiethinspthinspthinspthinspcardiaque

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

Interventionthinspdiagnostiquethinspthinspouthinsptheacuterapeutiquethinspprolongeacuteethinsp(effetthinspcumulatifthinspdethinsplathinspmeacutedication)

rsaquothinspRecommandeacute

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

thinspthinspthinspthinspthinspIlthinspnethinspsrsquoagitthinsppasthinspdrsquounethinsplistethinsplimiteacuteethinspdesthinspsituationsthinspcliniquesthinspDrsquoautresthinspsituationsthinspcliniquesthinsppeuventthinspneacutecessiterthinsplethinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspmonitoragethinspcardiaquethinspouthinspduthinspCO

2thinspIlthinsprevientthinspauxthinspprofessionnelsthinspdethinspjugerthinspdethinsplathinspsituationthinspenthinspfonctionthinspdethinspchaquethinspthinspthinsp

thinspthinspthinspthinspthinspthinsppatient5thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp6thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

CMQ - OIIQ - OPIQ 28

LethinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspimpliqueacutesthinspestthinspprimordialthinspetthinspcethinspmecircmethinspsithinsplrsquoappareillagethinspenthinspplacethinspestthinspcompletthinspetthinspfonctionnelthinspUnethinspbonnethinspcommunica-tionthinspentrethinspcesthinspderniersthinspestthinspdoncthinspessentiellethinspafinthinspdethinspbienthinspcoordonnerthinsplathinspseacutedationthinsp

etthinsplrsquoanalgeacutesiethinspavecthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspLes alarmes (audibles et visuelles) de chaque appareil doivent ecirctre en fonction et les paramegravetres ajusteacutes aux caracteacuteristiques du patient et agrave sa condition clinique

IlthinspfautthinspsrsquoassurerthinspdethinsplathinsptraccedilabiliteacutethinspdethinsplrsquoeacutevaluationthinspetthinspdethinsplathinspsurveillancethinspcliniquethinspthinspeffectueacuteesthinspparthinspunethinsptenuethinspdethinspdossiersthinspconformethinspauxthinspnormesthinspenthinspvigueurthinspLesthinspoutilsthinspdrsquoeacutevaluationthinsputiliseacutesthinspdoiventthinspecirctrethinspsimplesthinspstandardiseacutesthinspvalideacutesthinspdethinsppreacutefeacuterencethinspetthinspadapteacutesthinspauthinspcontextethinspetthinspauxthinspcaracteacuteristiquesthinspduthinsppatientthinspnotam-mentthinsppourthinsplrsquoeacutevaluationthinspduthinspniveauthinspdethinspseacutedationagitationthinspdethinspconsciencethinspetthinspdethinspdouleurthinsp(annexesthinspIXthinspetthinspX)

Lathinspfreacutequencethinspdethinsplathinspmesurethinspdethinspcesthinspparamegravetresthinspetthinspleurthinspenregistrementthinspdoiventthinspecirctrethinspdeacutetermineacutesthinspentrethinspautresthinspenthinspfonctionthinspdethinsplathinspmeacutedicationthinspetthinspdethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsp

Ideacutealementthinsplethinspprofessionnelthinspdoitthinsplesthinspdocumenterthinsp

thinsprsaquo avantthinsplethinspdeacutebutthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsprsaquo apregravesthinsplrsquoadministrationthinspdrsquounthinspagentthinspdethinspseacutedation-analgeacutesiethinspouthinspdrsquounthinspantagonistethinsprsaquo authinsppicthinspdrsquoactionthinspdethinspchacunthinspdesthinspagentsthinspadministreacutesthinspthinsprsaquo agravethinspintervallesthinspreacuteguliersthinsp(pthinspexthinspthinsp5thinspminutes)thinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-thinsp

analgeacutesiethinsprsaquo agravethinspintervallesthinspplusthinsprapprocheacutesthinsplorsquethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsplrsquoexigethinsprsaquo durantthinsplathinsppeacuteriodethinspdethinspreacutecupeacuterationthinspetthinspjusqursquoauthinspretourthinspduthinspniveauthinspdethinspconsciencethinsp

initialethinspselonthinsplathinspconditionthinspcliniquethinspduthinsppatientthinsprsaquo authinspmomentthinspduthinspcongeacute

ILthinspFAUTthinspSAVOIRthinspQUE

LathinspSocieacuteteacutethinspcanadiennethinspdesthinspanestheacutesiologistesthinsp(SCA)thinspindiquethinspquethinsplesthinspthinspdirectivesthinspgeacuteneacuteralesthinspdethinspsoinsthinsp(ythinspcompristhinsplethinspmonitorage)thinsppourthinsplathinspseacutedationthinspconscientethinspsontthinsplesthinspmecircmesthinspquethinsppourthinsplesthinspautresthinspformesthinspdrsquoanestheacutesiethinsp[]thinsp(Merchantthinspetthinspcollabthinsp2014b)thinspDethinspplusthinspellethinspindiquethinspquethinsplethinspcapnographethinspthinspestthinsprequisthinsplorsthinspdethinspseacutedation-analgeacutesiethinspdethinspniveauthinspplusthinspeacuteleveacutethinsp(pthinspexthinspthinspRamsaythinspthinsp4-6)thinsp(Merchantthinspetthinspcollabthinsp2014athinspop cit)

CMQ - OIIQ - OPIQ 29

thinsp16thinspPOSTSEacuteDATION-ANALGEacuteSIEthinsp

Lethinsppatientthinspestthinspagravethinsprisquethinspdethinspdeacutevelopperthinspdesthinspcomplicationsthinspagravethinsplathinspsuitethinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspsurtoutthinspsithinspcettethinspproceacutedurethinspestthinspdethinspcourtethinspdureacuteethinsp(pthinspexthinspthinspdeacutepressionthinsprespiratoirethinsphypotension)thinspEnthinspeffetthinspcertainsthinspmeacutedicamentsthinsptelsthinspquethinsplethinspmidazolamthinspetthinsplethinspfentanylthinspnethinspserontthinsppasthinspcomplegravetementthinspeacutelimineacutesthinspsithinsplathinspdureacuteethinspdethinsplrsquointerventionthinspestthinspmoinsthinspdethinsp30thinspminutesthinspDrsquoautresthinspfacteursthinsptelsthinspquethinsplethinspmanquethinspthinspdethinspstimulationthinspouthinsplrsquoabsorptionthinspretardeacuteethinspdrsquounthinspmeacutedicamentthinsppeuventthinspcontribuerthinspthinspagravethinspunethinspseacutedationthinspprolongeacuteethinspouthinsprebond

Unethinspdeacutepressionthinsprespiratoirethinsppeutthinspsurvenirthinspjusqursquoagravethinspeacuteliminationthinspcomplegravetethinspthinspduthinspmeacutedicamentthinsp

ParthinspconseacutequentthinspjusqursquoagravethinspsonthinspdeacutepartthinsplethinsppatientthinspdoitthinspecirctrethinspsousthinsplathinspsurveillancethinspdrsquounthinspprofessionnelthinsphabiliteacutethinspagravethinspreconnaicirctrethinsplesthinspcomplicationsthinspetthinspagravethinspintervenirthinsprapidementthinspplusthinspparticuliegraverementthinsppourthinspmaintenirthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspetthinspassurerthinsplrsquoassistancethinspventilatoirethinspLethinspmeacutedecinthinspayantthinspproceacutedeacutethinspagravethinsplrsquointerventionthinspsousthinspseacutedation-analgeacutesiethinspouthinspunthinspmeacutedecinthinspdeacutesigneacutethinspdoitthinspecirctrethinspdisponiblethinspenthinsptoutthinsptempsthinspafinthinspdethinsppouvoirthinspintervenirthinspsansthinspdeacutelaithinsplethinspcasthinspeacutecheacuteant

Rappelonsthinspquethinsplesthinspappareilsthinspdethinspmonitoragethinspdoiventthinspecirctrethinspenthinspfonctionthinspmaisthinspthinspenthinspaucunthinsptempsthinspilsthinspnethinspremplacentthinsplathinspsurveillancethinspdirectethinspduthinsppatientthinspparthinspthinsplethinspprofessionnel

Lethinsppatientthinspdoitthinspresterthinspagravethinsplathinspsallethinspdethinspreacutecupeacuterationthinspouthinspdrsquoobservationthinsppendantthinspthinsp30thinspminutesthinspauthinspminimumthinspapregravesthinspavoirthinspreccediluthinsplathinspderniegraverethinspdosethinspdethinspseacutedationthinspouthinspthinspdrsquoanalgeacutesiethinspintraveineusethinsp(Merchantthinspetthinspcollabthinsp2014bthinspop cit)

Sithinspunethinspmeacutedicationthinspantagonistethinspathinspeacuteteacutethinspadministreacuteethinsplethinsppatientthinspserathinspgardeacutethinspsousthinspthinspobservationthinsplethinsptempsthinspneacutecessairethinsp(lethinsptempsthinspserathinspaugmenteacutethinspdethinspgethinsp2thinspheuresthinspthinsp[Merchantthinspetthinspcollabthinsp2014bthinspop cit]thinspenthinspfonctionthinspdethinsplrsquoeacutetatthinspcliniquethinspduthinsppatient)thinsppourthinspsrsquoassurerthinspqursquoilthinspnrsquoythinspathinsppasthinspdethinspseacutedationthinsprebond

Parmithinsplesthinspcritegraveresthinspagravethinsprespecterthinspauthinspmomentthinspduthinspcongeacutethinsp

thinsprsaquo voiesthinspaeacuteriennesthinsppermeacuteablesthinspetthinspventilationthinspadeacutequatethinsprsaquo stabiliteacutethinspcardiovasculairethinspadeacutequatethinsprsaquo niveauthinspdethinspconsciencethinspduthinsppatientthinsprevenuthinspagravethinspsonthinspeacutetatthinspinitialthinsprsaquo douleurthinspreacutesiduellethinsptoleacuterablethinspabsentethinspouthinspcommethinspagravethinspsonthinspeacutetatthinspinitial

CMQ - OIIQ - OPIQ 30

thinsprsaquo mobiliteacutethinsprevenuethinspagravethinspsonthinspeacutetatthinspinitialthinsprsaquo peuthinspouthinsppasthinspdethinspvomissementsthinsprsaquo patientthinspouthinsppersonnethinspresponsablethinspduthinsppatientthinsppeutthinspcomprendrethinsplesthinspdirectivesthinsp

dethinspdeacutepart

thinsprsaquothinsprsaquo Cesthinspcritegraveresthinspdoiventthinspecirctrethinsprespecteacutesthinspdethinspfaccedilonthinspsysteacutematiquethinsp

Lesthinspprofessionnelsthinspdoiventthinspsrsquoassurerthinspquethinspquandthinsplethinsppatientthinspquittethinsplrsquoeacutetablis-sementthinspilthinspestthinspaccompagneacutethinspdrsquounthinspadultethinspresponsablethinspetthinspqursquounthinspdocumentthinsprelatifthinspauthinspcongeacutethinspcomprenantthinspdesthinspconsignesthinspclairesthinsppourthinsplathinspsurveillancethinspagravethinspdomicilethinsp(pthinspexthinspthinspquoithinspfairethinspenthinspcasthinspdrsquourgence)thinspleurthinspsoitthinspremisthinspetthinspexpliqueacutethinsp(annexethinspXII)thinsp

thinspthinsp17thinspDOCUMENTATIONthinspDESthinspSOINSthinspETthinspTENUEthinspthinspDEthinspDOSSIERSthinsp

Commethinsppourthinsptoutethinspautrethinspinterventionthinsplesthinspmecircmesthinspnormesthinspsrsquoappliquentthinsppourthinsplathinspreacutedactionthinspdesthinspnotesthinspenthinspseacutedation-analgeacutesiethinspthinsp

Enthinspplusthinspdesthinspeacuteleacutementsthinspgeacuteneacuteralementthinspverseacutesthinspauthinspdossierthinspcelui-cithinspdoitthinspcontenirthinsptoutesthinsplesthinspinformationsthinsprelativesthinspagravethinsplathinsppeacuteriodethinsppreacutethinspperthinspetthinsppostseacutedation-analgeacutesiethinspAinsithinsplesthinspeacuteleacutementsthinspsuivantsthinspdoiventthinspecirctrethinspdocumenteacutesthinspauthinspdossierthinspduthinsppatientthinsp

(listethinspnonthinsplimitative)thinsp

1 lrsquoidentificationthinspdesthinspfacteursthinspdethinsprisquethinsplieacutesthinspagravethinsplrsquointerventionthinspdiagnostiquethinspthinspouthinsptheacuterapeutiquethinspouthinspagravethinsplathinspseacutedation-analgeacutesie

2 lrsquoheurethinspduthinspdeacutebutthinspetthinspdethinsplathinspfinthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplrsquoheurethinspdrsquoarriveacuteethinspagravethinsplathinspsallethinspdethinspreacutecupeacuterationthinspouthinspdrsquoobservationthinsp(sithinspdiffeacuterente)thinspetthinsplrsquoheurethinspduthinspdeacutepart

3 lesthinspordonnancesthinspmeacutedicalesthinspcomplegravetes4 lathinspmeacutedicationthinspthinspdosagethinspquantiteacutethinspvoiethinspvitessethinspetthinspheurethinspdrsquoadministration5 lathinspconcentrationthinspouthinsplethinspdeacutebitthinspdethinsplrsquooxygegravenethinsp(outhinspduthinspmeacutelangethinspgazeux)thinspadministreacutethinspthinsp

lethinspcasthinspeacutecheacuteant

6 lathinspsurveillancethinspeffectueacuteethinspa lesthinspsignesthinspvitauxthinspavecthinsplrsquoheurethinspdesthinsplecturesb lethinsptauxthinspdethinspsaturationthinspcapillairethinspenthinspoxygegravenethinspavecthinsplrsquoheurethinspdesthinsplecturesc lethinspniveauthinspdethinspCO

2thinspthinsplethinspcasthinspeacutecheacuteantthinspavecthinsplrsquoheurethinspdesthinsplectures

d lathinspdescriptionthinsppeacuteriodiquethinspduthinspniveauthinspdethinspseacutedationagitationthinspetthinspdethinspthinspconsciencethinsplrsquoutilisationthinspdrsquounethinspeacutechellethinspestthinsprecommandeacuteethinsp(annexethinspIX)

e lathinspdescriptionthinsppeacuteriodiquethinspduthinspniveauthinspdethinspdouleurthinsplrsquoutilisationthinspdrsquounethinspeacutechellethinspestthinsprecommandeacuteethinsp(annexethinspX)

CMQ - OIIQ - OPIQ 31

f lathinspdescriptionthinspdethinsptoutethinspreacuteactionthinspdeacutefavorablethinsplethinspcasthinspeacutecheacuteantg lathinspdescriptionthinspdethinsplrsquoeacutetatthinspduthinsppatientthinspagravethinsplathinspfinthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-thinsp

analgeacutesieh lathinspdescriptionthinspdethinsplrsquoeacutetatthinspduthinsppatientthinspauthinspmomentthinspduthinspcongeacutethinspouthinsplathinspreacutefeacuterencethinspthinsp

agravethinspunthinspprotocolethinsp(critegraveresthinspdethinspcongeacute)7 lethinspmonitoragethinspthinspappareilthinspalarmethinspemplacementthinsplethinspcasthinspeacutecheacuteant8 lethinspconsentement9 unethinspcopiethinspdesthinsprecommandationsthinspeacutecritesthinspremisethinspauthinsppatientthinspauthinspmomentthinspduthinsp

congeacutethinsp(annexethinspXII)thinspouthinspagravethinspdeacutefautthinspunethinspnotethinspattestantthinsplathinspremisethinspdethinspcethinspdocumentthinspstandardiseacutethinspdontthinspunethinspcopiethinspestthinspconserveacutee

10 thinsplethinspprotocolethinspopeacuteratoire11 thinsplathinspnotethinspdethinspdeacutepart12 thinsptoutethinspautrethinspinformationthinspjugeacuteethinsppertinentethinsp(pthinspexthinspthinspreacutesultatthinspdrsquoauscultationthinspthinsp

complication)

Enfinthinsptousthinsplesthinspprofessionnelsthinspimpliqueacutesthinspdoiventthinspsrsquoassurerthinspduthinsprespectthinspdethinspleurthinspreacuteglementationthinspouthinspnormesthinsprespectivesthinspenthinspmatiegraverethinspdethinspdocumentationthinspdesthinspsoinsthinspetthinspdethinsptenuethinspdethinspdossiers

CMQ - OIIQ - OPIQ 32

Chapitre 2Patient peacutediatrique

thinspPREacuteAMBULEthinsp

Puisquethinsplrsquoenfantthinsppossegravedethinspdesthinspcaracteacuteristiquesthinspquithinspluithinspsontthinsppropresthinspetthinspquithinspeacutevoluentthinspenthinspfonctionthinspdethinspsonthinspstadethinspdethinspdeacuteveloppementthinspilthinspestthinspdoncthinspopportunthinspdrsquoeacutetablirthinspdesthinsplignesthinspdirectricesthinspparticuliegraveresthinspagravethinspcettethinspclientegravelethinsp

Cesthinsplignesthinspdirectricesthinspvisentthinsplesthinspenfantsthinspacircgeacutesthinspdethinspplusthinspdethinsp3thinspansthinsp

Unethinspseacutedation-analgeacutesiethinspreacuteussiethinspameacuteliorethinsplathinspqualiteacutethinspdesthinspexamensthinspdemandeacutesthinspdiminuethinsplathinspneacutecessiteacutethinspdethinsprecourirthinspagravethinspdesthinspcontentionsthinspphysiquesthinspameacuteliorethinsplathinspcollaborationthinspetthinsplathinspconfiancethinspdethinsplrsquoenfantthinspetthinspdesthinspparentsthinspquantthinspauxthinspsoinsthinspprodigueacutesthinspetthinspauxthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspreacutealiseacuteesthinsp

Lathinspseacutedation-analgeacutesiethinsp(tousthinspniveaux)thinspenthinsppeacutediatriethinspdoitthinspecirctrethinspreacuteserveacuteethinspauthinspmilieuthinsphospitalierthinspouthinspauxthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacuteces-sairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspetthinspcethinspenthinspraisonthinspduthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquithinspestthinspgeacuteneacuteralementthinspneacutecessairethinspEllethinspcomportethinspdesthinsprisquesthinspseacuterieuxthinsppeuthinspimportethinsplrsquoeacutetatthinspdethinspsanteacutethinspdethinsplrsquoenfantthinspLesthinspcomplicationsthinsplesthinspplusthinspfreacutequentesthinspsontthinsplrsquoobstructionthinspdesthinspvoiesthinspaeacuteriennesthinsplrsquoapneacuteethinsplrsquoaspirationthinspdethinspseacutecreacutetionsthinspthinspetthinsplesthinspvomissements

thinsp21thinspOBJECTIFSthinspETthinspCLIENTEgraveLEthinspCIBLEthinsp

OBJECTIFS

Outrethinsplesthinspobjectifsthinspdethinspseacutedation-analgeacutesiethinspdeacutefinisthinsppourthinsplathinspclientegravelethinspadultethinsp(pthinsp8)thinspthinsp

lathinspseacutedation-analgeacutesiethinsppourthinsplathinspclientegravelethinsppeacutediatriquethinspvisethinspeacutegalementthinspagravethinspthinsp

thinsprsaquo eacuteviterthinspunthinsptraumatismethinsppsychologiquethinsprsaquo diminuerthinsplrsquoanxieacuteteacutethinspetthinsplathinsppeurthinspdethinsplrsquoenfantthinspetthinspdesthinspparentsthinsprsaquo obtenirthinsplathinspcollaborationthinspdethinsplrsquoenfant

CMQ - OIIQ - OPIQ 33

CLIENTEgraveLEthinspCIBLE

EnthinsppeacutediatriethinsplethinspniveauthinspdethinspseacutedationthinsprequisthinspestthinsptributairethinspdethinsplrsquoacircgethinspduthinspstadethinspdethinspdeacuteveloppementthinspdethinsplathinspcapaciteacutethinspcognitivethinspetthinspdethinsplathinspcollaborationthinspdethinsplrsquoenfantthinspAinsithinspchezthinsplrsquoenfantthinspdethinsp

thinsprsaquo 3thinspagravethinsp6thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspmodeacutereacutethinspsrsquoavegraverethinsprarementthinspsuffisantethinspLathinspplupartthinspdesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspneacutecessitentthinspunthinspniveauthinspprofondthinsp(voirethinspunethinspanestheacutesiethinspgeacuteneacuterale)thinsp

thinsprsaquo 7thinspagravethinsp13thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspmodeacutereacutethinspsrsquoavegraverethinspgeacuteneacuteralementthinspsuffisantethinspToutefoisthinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinsppeuventthinspneacutecessiterthinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspprofondthinsp

thinsprsaquo gethinsp14thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspleacutegerthinspouthinspmodeacutereacutethinspsrsquoavegraverethinspsuffisantethinspToutefoisthinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinsppeuventthinspneacutecessiterthinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspprofond

Chezthinsplrsquoenfantthinspdethinspmoinsthinspdethinsp3thinspansthinspouthinspdansthinsplethinspcasthinspdrsquounethinspseacutedationthinspprofondethinspviseacuteethinsplethinspmeacutedecinthinspdoitthinspsrsquoassurerthinspdethinsplathinspcollaborationthinspdrsquounthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespira-toirethinsppeacutediatriquethinspavanceacutee

Dethinspplusthinspilthinspestthinsprecommandeacutethinspdrsquoutiliserthinsplathinspclassificationthinspdethinsplrsquoeacutetatthinspphysiquethinspduthinspthinsppatientthinspquethinsplrsquoonthinsptrouvethinspdansthinsplethinsptableauthinspdethinsplathinsppagethinspsuivante

CMQ - OIIQ - OPIQ 34

Tableau 4 Classification de lrsquoeacutetat physique du patient selon lrsquoAmerican Society of Anesthesiologists (ASA) (ASA Physical Status Classification System [En ligne]) (Notre traduction)

Classification Eacutetatthinspdethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp1 Patientthinspenthinspbonnethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp2Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspleacutegegravere

ASAthinspPhysicalthinspStatusthinsp3Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgrave

ASAthinspPhysicalthinspStatusthinsp4Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgravethinspquithinsprepreacutesentethinspunethinspmenacethinspconstantethinsppourthinspsathinspvie

ASAthinspPhysicalthinspStatusthinsp5Patientthinspmoribondthinspquithinspnethinspsurvivrathinsppasthinspthinspagravethinspmoinsthinspdrsquounethinspinterventionthinsp

ASAthinspPhysicalthinspStatusthinsp6Patientthinspdeacuteclareacutethinspenthinspeacutetatthinspdethinspmortthinspceacutereacutebralethinspdontthinsplesthinsporganesthinspontthinspeacuteteacutethinsppreacuteleveacutesthinspagravethinspdesthinspfinsthinspdethinspdon

CMQ - OIIQ - OPIQ 35

Volet organisationnelthinsp22thinspCOMPEacuteTENCESthinspPROFESSIONNELLESthinsp

Outrethinsplesthinspcompeacutetencesthinspprofessionnellesthinspmentionneacuteesthinsppourthinsplethinsppatientthinspadultethinspthinsp(pthinsp11)thinsptousthinsplesthinspprofessionnelsthinspdethinsplathinspsanteacutethinsp(meacutedecinthinspinfirmiegraverethinspetthinspinhalotheacutera-peute)thinspquithinspprocegravedentthinspagravethinspunethinspseacutedation-analgeacutesiethinspaupregravesthinspdethinsppatientsthinsppeacutediatriquesthinspdoiventthinspposseacutederthinsp

athinsp lesthinspconnaissancesthinspetthinsplesthinspcompeacutetences73neacutecessairesthinspagravethinsplathinspreacuteanimationthinspthinspcardiorespiratoirethinsppeacutediatrique84(dethinsppreacutefeacuterencethinspenthinspsoinsthinspavanceacutes)thinspcrsquoest-agrave-direthinspmaicirctriserthinspenthinspprioriteacutethinsplesthinsptechniquesthinspdethinsplathinspprisethinspenthinspchargethinspdethinsplathinspventilationthinspduthinspmassagethinspcardiaquethinspetthinspdethinsplathinspmeacutedicationthinspassocieacutee

bthinspunethinspexpertisethinspcliniquethinspspeacutecifiquethinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspagravethinspreacutealiserthinspthinsp

thinspthinsp23thinspRESSOURCESthinspMATEacuteRIELLESthinsp

Sithinsplesthinspressourcesthinspmateacuteriellesthinspdethinspbasethinspetthinsplrsquoemplacementthinspsontthinspessentiellementthinsplesthinspmecircmesthinspquethinspchezthinsplrsquoadultethinsp(pthinsp11)thinspcelles-cithinspdoiventthinsptoutefoisthinspecirctrethinspadapteacuteesthinspauthinsp

patientthinsppeacutediatriquethinsp(crsquoest-agrave-direthinsptaillethinsppoidsthinspetthinspparticulariteacutes)thinsp

Agravethinsptitrethinspdrsquoexemplethinsp(listethinspnonthinsplimitative)thinsp

thinsprsaquo capteurthinspduthinspsaturomegravetrethinspdethinspmodegravelethinsppeacutediatriquethinsprsaquo reacuteanimateurthinspautogonflantthinsp(Ambuthinspbag)thinspetthinspmasquesthinspdethinspdiffeacuterentesthinsptaillesthinspthinsprsaquo lamesthinspdethinsplaryngoscopethinspsondesthinspendotracheacutealesthinsp(avecthinspouthinspsansthinspballonnet)thinspdethinsp

taillesthinspdiffeacuterentesthinsprsaquo canulesthinsporonasopharyngeacuteesthinspdethinspdiffeacuterentesthinsptaillesthinsprsaquo tubulurethinspagravethinspsoluteacutethinspdethinsptypethinspmicrogouttesthinspavecthinspouthinspsansthinspburettethinsprsaquo outilsthinspsupraglottiquesthinsp(pthinspexthinspthinspmasquethinsplaryngeacute)thinspdethinspdiffeacuterentesthinsptaillesthinsprsaquo deacutefibrillateurthinspavecthinspeacutelectrodesthinsppeacutediatriquesthinsprsaquo steacutethoscopethinspdethinsptaillethinsppeacutediatriquethinsp(preacutecordialthinspouthinsppreacutetracheacutealthinsppourthinspeacutecoutethinspenthinsp

continuethinspsrsquoilthinspythinspathinsplieu)thinsprsaquo appareilthinspagravethinspaspirationthinsppouvantthinspgeacuteneacutererthinspunethinsppressionthinspneacutegativethinspdethinsp40thinspagravethinsp60thinspmmthinsp

Hgthinspouthinspunethinspcapaciteacutethinspdethinspflotthinspdethinsp100thinsplitresthinspparthinspminutethinspetthinsplethinspmateacuterielthinspneacutecessairethinspdethinsptaillethinspadapteacutee

7thinsp Onthinspentendthinspparthinspconnaissancesthinspetthinspcompeacutetencesthinspqursquoellesthinspsoientthinspmisesthinspagravethinspjourthinspselonthinsplesthinsprecommandationsthinspenthinspvigueur

8thinsp Onthinspentendthinspparthinspcertificationthinspenthinspreacuteanimationthinspcardiorespiratoirethinsplesthinspformationsthinspsuivantesthinspthinsp rsaquothinspReacuteanimationthinspcardiorespiratoirethinspdethinspbasethinspthinspSoinsthinspimmeacutediatsthinspenthinspreacuteanimationthinsp(SIR)thinsppourthinspprofessionnelsthinspdethinsplathinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspsanteacutethinspouthinsplrsquoeacutequivalentthinsp rsaquothinspReacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspSoinsthinspavanceacutesthinspenthinspreacuteanimationthinsppeacutediatriquethinsp(SARP)thinspouthinsplrsquoeacutequivalent

CMQ - OIIQ - OPIQ 36

Volet professionnelthinsp24thinspPREacuteSEacuteDATION-ANALGEacuteSIEthinsp

SEacuteLECTIONthinspDESthinspPATIENTS

Sithinspunethinspseacutelectionthinsprigoureusethinspdesthinsppatientsthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinspattentionthinspquethinspchezthinsplrsquoadultethinsp(pthinsp15)thinspcertainesthinspparticulariteacutesthinsppropresthinspagravethinsplrsquoenfantthinspdoiventthinsp

toutefoisthinspecirctrethinspprisesthinspenthinspcomptethinsp

LorsthinspdethinspsituationsthinspparticuliegraveresthinspouthinspcomplexesthinspapregravesthinsplrsquoeacutevaluationthinspduthinsppatientthinsplethinspmeacutedecinthinspdevraitthinspconsulterthinspunthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspCitonsthinspagravethinsptitrethinspdrsquoexemplethinspmaisthinspsansthinspsrsquoythinsplimiterthinsp

thinsprsaquo preacutesencethinspdethinspcertainsthinspsyndromesthinspdontthinsplathinsptrisomiethinsp21thinsprsaquo anomaliethinspdesthinspvoiesthinspaeacuteriennesthinsprsaquo anomaliethinspcranio-facialethinsprsaquo infectionthinsprespiratoirethinspasthmethinsprsaquo maladiethinspneuromusculairethinsprsaquo maladiethinspcardiaquethinsprsaquo troublethinsprespiratoirethinspduthinspsommeilthinspetthinsplathinsptheacuterapiethinspassocieacuteethinsprsaquo obeacutesiteacutethinspimportantethinsprsaquo refluxthinspgastro-œsophagienthinsprsaquo eacutetatthinspdethinspconsciencethinspalteacutereacutethinsprsaquo troublethinspenvahissantthinspduthinspdeacuteveloppementthinsp(pthinspexthinspthinspautisme)

Dethinspmecircmethinsptoutthinspcommethinspchezthinsplrsquoadultethinsplesthinspinterventionsthinspeffectueacuteesthinspsousthinspseacutedation-analgeacutesiethinspdoiventthinspecirctrethinspreacuteserveacuteesthinspprincipalementthinspauxthinsppatientsthinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp1thinspouthinspauxthinsppatientsthinspatteintsthinspdrsquounethinspaffectionthinsp

systeacutemiquethinspleacutegegraverethinspclasseacuteethinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp2thinsp

Notonsthinspquethinsplorsquethinspcestthinspjustifieacutethinspauthinspdossierthinspmeacutedicalthinsplathinspseacutedation-analgeacutesiethinsppeutthinspecirctrethinspeffectueacuteethinspchezthinsplesthinsppatientsthinspstablesthinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp3thinspetthinspexceptionnellementthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp4thinspToutefoisthinspellethinspdoitthinsplrsquoecirctrethinspdansthinspdesthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspDethinspplusthinspcesthinsppatientsthinspdoiventthinsp

fairethinsplrsquoobjetthinspdrsquounethinspeacutevaluationthinspindividualiseacuteethinspetthinspplusthinspapprofondiethinspEacuteVALUATIONthinspDESthinspPATIENTSthinsp

CMQ - OIIQ - OPIQ 37

EacuteVALUATIONthinspDESthinspPATIENTS

Sithinspunethinspeacutevaluationthinsprigoureusethinspdesthinsppatientsthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinspatten-tionthinspquethinspchezthinspladultethinsp(pthinsp15)thinspcettethinspeacutevaluationthinspdoitthinspaussithinspinclurethinspsansthinspsrsquoythinsplimiterthinsplrsquoacircgethinsplathinsptaillethinsplethinsppoidsthinsplethinspstadethinspdethinspdeacuteveloppementthinsplathinspcapaciteacutethinspcognitivethinsplesthinspallergiesthinsplesthinspproblegravemesthinspmeacutedicauxthinspouthinspfamiliauxthinsppertinentsthinsplesthinspmeacutedicamentsthinsp(outhinspautrethinspsubstancethinspnonthinspprescrite)thinsppristhinspreacuteguliegraverementthinspouthinspreacutecemmentthinspetthinsplrsquoheurethinspduthinspdernierthinspingestathinspainsithinspquethinsplethinsptypethinspetthinsplathinspquantiteacutethinspconsommeacutee

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsplrsquoeacutevaluationthinsp(anamnegravesethinspetthinspexamenthinspphysique)thinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinspthinsp

CONSENTEMENTthinsp(REacuteSUMEacute)

LethinsplecteurthinspdoitthinspsethinspreacutefeacutererthinspagravethinsplrsquoannexethinspVIIIthinsppourthinsplethinsptextethinspcomplet

ToutthinspcommethinspchezthinsplrsquoadultethinspilthinspestthinspobligatoirethinspauthinspQueacutebecthinspdrsquoobtenirthinsplethinspconsente-mentthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspinterventionthinspCelathinspditthinsppourthinsplathinspclientegravelethinsppeacutediatriquethinspilthinspfautthinspajouterthinspunethinsppreacutecisionthinspextraitethinspduthinsp

Code civil du QueacutebecthinspthinspSithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsp(traitementsthinspdethinspmeacutedecinethinspetthinspdethinspchirurgiethinspestheacutetiquethinspexpeacuterimentationthinspetthinspdonsthinspdrsquoorganes)thinsplethinsppatientthinspdoitthinspecirctrethinspinformeacutethinspdethinsptousthinsplesthinsprisquesthinsppossiblesthinspmecircmethinspsrsquoilsthinspsontthinspraresthinspthinspetthinsplethinspconsentementthinspdoitthinspecirctrethinspdonneacutethinspparthinspeacutecrit

thinsprsaquo Unethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsp(gethinsp14thinspans)thinsppeutthinspconsentirthinspseulethinspthinspagravethinspmoinsthinspqursquoilthinspsrsquoagissethinspdethinspsoinsthinspnonthinsprequisthinspetthinspcomportantthinspdesthinsprisques

thinsprsaquo Pourthinspunethinsppersonnethinspmineurethinspdethinspmoinsthinspdethinsp14thinspansthinsp(ltthinsp14thinspans)thinsplethinspconsentementthinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentale

Srsquoilthinspsrsquoagitthinspdethinspsoins requisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsplrsquoobligationthinspdrsquoinformerthinsp

croicirctthinspenthinspfonctionthinspdethinsplathinsppreacutevalencethinspetthinspdethinsplathinspgraviteacutethinspdesthinspcomplications

thinsprsaquo Lethinspconsentementthinspdrsquounethinsppersonnethinspmineurethinsp(ltthinsp18thinspans)thinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinsp

thinsprsaquo Unethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsp(gethinsp14thinspans)thinsppeutthinspconsentirthinspmaisthinspnethinsppeutthinsppasthinsprefuserthinspseulethinspdesthinspsoinsthinspquithinspseraientthinspjugeacutesthinsprequisthinsp

DIRECTIVESthinspETthinspCONSEILSthinsp

Toutthinspcommethinsppourthinsplrsquoadultethinsp(pthinsp19)thinsplrsquoenfantthinspetthinspsonthinspparentthinsp(outhinspremplaccedilant)thinspdoiventthinsprecevoirthinsplesthinspdirectivesthinspneacutecessairesthinspCelathinspditthinspauxthinspdirectivesthinsprelativesthinspauthinspjeucircnethinsp

CMQ - OIIQ - OPIQ 38

preacute-interventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspnonthinspurgentethinsp(eacutelective)thinspilthinspfautthinspajouterthinspcecithinsp(Merchantthinspetthinspcollabthinsp2014a op cit)thinsp

thinsprsaquo liquidethinspclairthinsp(pthinspexthinspthinspeauthinspjusthinspdethinspfruitthinsp[sansthinsppulpe])thinspthinspjeucircnethinspdethinsp2thinspheuresthinsprsaquo laitthinspmaternelthinspthinspjeucircnethinspdethinsp4thinspheuresthinsprsaquo formulesthinsplacteacuteesthinspnonthinsphumaniseacuteesthinspouthinsppreacuteparationsthinspcommercialesthinsppourthinsp

nourrissonsthinspthinspjeucircnethinspdethinsp6thinspheuresthinspthinspAucunthinspajoutthinspnrsquoestthinsppermisthinspauthinsplaitthinspmaternelthinsptireacutethinsp

thinsp25thinspPERSEacuteDATION-ANALGEacuteSIEthinsp

APPROCHEthinspPHARMACOLOGIQUEthinsp

Sithinsplathinspmeacutedicationthinspgeacuteneacuteralementthinsputiliseacuteethinspestthinsplathinspmecircmethinspquethinspchezthinsplrsquoadultethinsp(pthinsp20)thinsplathinspdosethinspdoitthinspecirctrethinspadapteacuteethinspnotammentthinspenthinspfonctionthinspduthinsppoidsthinspetthinspdethinsplathinspcondi-tionthinspcliniquethinspdethinsplrsquoenfantthinspParthinspailleursthinspilthinspfautthinspretenirthinspquethinsplathinsppharmacocineacutetiquethinspetthinsplathinsppharmacodynamiquethinspdesthinspagentsthinspdethinspseacutedation-analgeacutesiethinspsontthinspinfluenceacuteesthinspparthinsplrsquoacircgethinspduthinsppatientthinspAgravethinsptitrethinspdrsquoexemplethinsppourthinspunthinspenfantthinspacircgeacutethinspdethinspunthinspagravethinspsixthinspansthinsplathinspclairancethinspdesthinspagentsthinspdethinspseacutedation-analgeacutesiethinspestthinspsupeacuterieurethinspagravethinspcellethinspdethinsplrsquoadultethinspIlthinspfaudrathinspdoncthinspajusterthinsplesthinspdosesthinspchezthinspunthinspenfantthinspdrsquoacircgethinsppreacutescolairethinsp(Saunderthinspetthinsp

collabthinsp2008)thinsp

Lrsquoutilisationthinspdrsquounethinsppommadethinspanalgeacutesiquethinsp(pthinspexthinspthinsplathinspcregravemethinspEMLAreg)thinsppeutthinspecirctrethinspavantageusethinsppourthinspcontrerthinsplathinspdouleurthinspassocieacuteethinspagravethinsplathinspposethinspdrsquounthinspcatheacuteterthinspintra-veineuxthinspparthinspexemplethinsp(lethinsptempsthinspdrsquoattentethinspdethinsp60thinspagravethinsp90thinspminutesthinspdoitthinspecirctrethinsppristhinspenthinspconsideacuteration)thinsp

APPROCHEthinspNONthinspPHARMACOLOGIQUE

Pourthinsplrsquoenfantthinspquithinspnethinspbeacuteneacuteficiethinspquethinspdrsquounethinspanalgeacutesiethinsp(aucunethinspseacutedation)thinspilthinspfautthinspretenirthinspquethinsplathinspdistractionthinsp(attirerthinsplrsquoattentionthinspversthinspquelquethinspchosethinspdethinsppositif)thinsppen-dantthinspunthinspsointhinspdouloureuxthinsp(outhinspquithinspinquiegravete)thinsppeutthinspsrsquoaveacutererthinspunthinspmoyenthinspefficacethinsppourthinspdiminuerthinspsonthinspanxieacuteteacutethinspetthinsplathinspperceptionthinspdethinspsathinspdouleurthinsp(AssociationthinspSparadrapthinspthinsp[Enthinspligne])

Agravethinsptitrethinspdrsquoexemplethinspetthinspsansthinspsrsquoythinsplimiterthinsp

thinsprsaquo discuterthinspavecthinsplrsquoenfantthinspouthinsplrsquoadolescentthinspdethinspsesthinsppreacutefeacuterencesthinsprsaquo utiliserthinspunthinspjouetthinspchanterthinspunethinspchansonthinspouthinspraconterthinspunethinsphistoirethinspagravethinsplrsquoenfantthinspthinsp

plusthinspjeunethinsprsaquo lathinsppreacutesencethinspetthinsplathinspcollaborationthinspdrsquounthinspparentthinsppeuventthinspecirctrethinsppertinentes

CMQ - OIIQ - OPIQ 39

SURVEILLANCEthinspCLINIQUE

Lathinspsurveillancethinspcliniquethinspcomprendthinspplusieursthinspeacuteleacutementsthinspquithinspconcernentthinspnotam-mentthinsplesthinspsystegravemesthinsprespiratoirethinspcardiaquethinspetthinspneurologiquethinspetthinspellethinspdoitthinsptenirthinspcomptethinspentrethinspautresthinsp

thinsprsaquo dethinsplathinspconditionthinspduthinsppatientthinspavantthinspetthinsppendantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

thinsprsaquo dethinsplathinspcomplexiteacutethinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinsprsaquo dethinsplathinspmeacutedicationthinsputiliseacuteethinsp(dosethinspdureacuteethinspetthinsppicthinspdrsquoactionthinspvoiethinspetthinspvitessethinsp

drsquoadministrationthinspcombinaisonthinspetthinspantagonistes)thinsprsaquo dethinsplrsquoassistancethinspagravethinspapporterthinspauthinspmeacutedecin

Lethinspmeacutedecinthinspquithinsppratiquethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspchezthinspunthinspenfantthinspsousthinspseacutedation-analgeacutesiethinspdoitthinspcompterthinspsurthinsplathinsppreacutesencethinspdrsquoauthinspmoinsthinspunthinspautrethinspprofessionnelthinsphabiliteacutethinspduthinspmilieuthinspdethinsplathinspsanteacutethinsp(infirmiegraverethinspinhalotheacuterapeutethinspouthinspautrethinspmeacutedecin)thinsp(annexethinspII)thinspEnthinspeacutetroitethinspcollaborationthinspavecthinsplethinspmeacutedecinthinspreacuteali-santthinsplrsquointerventionthinspceux-cithinspassurentthinsplathinspgestionthinspdethinsplathinspseacutedationthinspetthinspdethinsplrsquoanalgeacutesiethinsp

qui comprend entre autres la surveillance clinique de lrsquoenfantthinspresponsabiliteacutethinspthinspagravethinsplaquellethinspilsthinspdoiventthinspenthinsptoutthinsptempsthinspsethinspconsacrerthinspen prioriteacutethinsp

Dansthinspcertainsthinspcasthinsplethinspprofessionnelthinspquithinspassurethinspen prioriteacutethinsplathinspsurveillancethinspthinspcliniquethinspdethinsplrsquoenfantthinsppeutthinspecirctrethinspappeleacutethinspagravethinspassisterthinsplethinspmeacutedecinthinspdansthinsplathinspreacutealisationthinspthinspdethinspsonthinspinterventionthinspCettethinspassistancethinspquithinspdoitthinspsrsquoeffectuerthinspdansthinsplathinspmecircmethinsppiegravecethinspdoitthinspecirctrethinspdethinsptregravesthinspcourtethinspdureacuteethinspDethinspplusthinspellethinspdoitthinsppouvoirthinspecirctrethinspinterrompuethinspagravethinsptoutthinspmomentthinsppourthinspintervenirthinspimmeacutediatementthinspaupregravesthinspdethinsplrsquoenfantthinspenthinspcasthinspdethinspcomplicationsthinspouthinspdethinspbesoin

Parthinspailleursthinsplorsquethinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspneacutecessitentthinspunethinspassistancethinsptechniquethinspcontinuellethinspauthinspmeacutedecinthinsplrsquoajoutthinspdrsquounthinsptroisiegravemethinspprofessionnelthinspdethinsplathinspsanteacutethinsphabiliteacutethinsp(meacutedecinthinspinfirmiegraverethinspouthinspinhalotheacutera-peute)thinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspdethinsplrsquoenfantthinspestthinsprequisthinsp

CMQ - OIIQ - OPIQ 40

Tableau 5 Tableau reacutecapitulatif du nombre de professionnels habiliteacutes requis en seacutedation-analgeacutesie - Clientegravele peacutediatrique

Toutthinspauthinsplongthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinspdoitthinspecirctrethinspcontinuethinspetthinsplathinspcommunicationthinspavecthinspcelui-cithinspmaintenuethinsp

Proceacutederthinspagravethinsplathinspsurveillancethinspcliniquethinspcrsquoestthinspeacutevaluerthinspqualitativementthinspetthinspquanti-tativementthinspdethinspfaccedilonthinspsoutenuethinspetthinspenthinspcontinuthinsplrsquoensemblethinspdesthinspparamegravetresthinspsui-vantsthinsp(listethinspnonthinsplimitative)thinsp(tableauthinsp6)thinsp

thinsprsaquo mesurethinspdethinsplathinsppressionthinsparteacuteriellethinspduthinsppouls95etthinspdethinsplathinsprespiration106

thinsprsaquo lecturethinspdethinsplathinspsaturationthinspcapillairethinspenthinspoxygegraveneLathinsptonaliteacutethinspdethinsppoulsthinspdoitthinspecirctrethinspactiveacuteethinspenthinsptoutthinsptempsthinspetthinspsonthinspniveauthinspdoitthinspecirctrethinspajusteacutethinspdethinspfaccedilonthinspagravethinspecirctrethinspentenduthinspclairement

thinsprsaquo eacutevaluationthinspdethinsplrsquoeacutetatthinspdethinsplathinspcolorationthinspetthinspdethinsplathinsptempeacuteraturethinspdethinsplathinsppeauthinsprsaquo niveauthinspdrsquoO

2thinspdethinspCO

2thinspetthinspmonitoragethinspcardiaquethinspselonthinsplethinspcasthinsp

Enthinspplusthinspdesthinspparamegravetresthinspdethinspmonitoragethinspcliniquethinsp(mentionneacutesthinsppreacuteceacutedemment)thinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsppeacutediatriquethinspdoitthinspcomprendrethinspthinsp

thinsprsaquo lrsquoeacutevaluationthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsp(pthinspexthinspthinspbradycardiethinsphypoxiquethinsppreacutecocethinspsithinspobstruction)

thinsprsaquo lrsquoapportthinspliquidienthinsprsaquo lathinsppertethinspdethinspchaleurthinsp(selonthinsplathinspdureacuteethinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesie)

9thinspthinspthinspthinspthinspLethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp10thinspthinspthinspthinspLathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinspetthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

Nombrethinspdethinspprofessionnelsthinsphabiliteacutesthinsprequis

2 Nombrethinspmimimalthinsprequis

3 Sithinsputilisationthinspdethinsppropofolthinspkeacutetaminethinspouthinspdethinspdexmeacutedeacutetomidine

3 SithinsputilisationthinspconcomitantethinspdethinspN2Othinspetthinspdrsquounthinspagentthinspseacutedatifthinspouthinspthinsp

dunthinspopioiumldethinspouthinspsithinspconcentrationthinspdethinspN2Othinspmodifiable

3 Sithinsplassistancethinsptechniquethinspauthinspmeacutedecinthinspestthinspcontinuelle

CMQ - OIIQ - OPIQ 41

thinsprsaquo lrsquoeacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplrsquoanalgeacutesiethinspetthinspdethinsplathinspseacutedationthinspagravethinsplrsquoaidethinspdrsquooutilsthinspadapteacutesthinspagravethinsplathinspconditionthinspetthinspagravethinsplrsquoacircgethinspdethinsplrsquoenfantthinsp(annexesthinspIXthinspetthinspX)

thinsprsaquo lathinsppositionthinspduthinsppatientthinspetthinsplesthinsppointsthinspdrsquoappuithinsp(compression)

Tableau 6 Surveillance des paramegravetres cliniques en seacutedation-analgeacutesie - Clientegravele peacutediatrique

Paramegravetrethinspdethinspthinspsurveillancethinspclinique

PatientNiveauthinspdethinspthinspseacutedation

MeacutedicationInterventionthinspdiagnostiquethinspouthinsptheacuterapeutique

TAthinspRC11thinspthinspRR12thinspthinspetthinspsaturationthinspdrsquoO

2thinspthinsp

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

Niveauthinspdethinspthinsp-thinspseacutedationagitationthinspthinspthinspthinspconscience-thinspdouleur

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

NiveauthinspdethinspCO2

SelonthinsplesthinspcaracteacuteristiquesthinspAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)thinsp

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspmeacutedication Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire rsaquothinspAccegravesthinspindirectthinspouthinspthinspthinspthinspthinsprestreintthinspauthinsppatientthinspthinspthinsp(pthinspexthinspthinspIRM)

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetaminethinsp

rsaquothinspRecommandeacute rsaquothinspASAthinspgethinsp3thinsprsaquothinspApneacuteethinspobstructivethinspthinspthinspduthinspsommeilthinsprsaquothinspMaladiethinspthinspthinsprespiratoirethinsprsaquothinspObeacutesiteacutethinspmorbide

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

Monitoragethinspcardiaque

SelonthinsplesthinspcaracteacuteristiquesAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspmeacutedication Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire rsaquothinspASAthinspgethinsp3thinsprsaquothinspMaladiethinspcardiaque

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

Interventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspprolongeacuteethinsp(effetthinspcumulatifthinspdethinsplathinspmeacutedication)

rsaquothinspRecommandeacute Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

thinspthinsp IlthinspnethinspsrsquoagitthinsppasthinspdrsquounethinsplistethinsplimiteacuteethinspdesthinspsituationsthinspcliniquesthinspDrsquoautresthinspsituationsthinspcliniquesthinsppeuventthinspneacutecessiterthinspthinsplethinspmonitoragethinspcardiaquethinspouthinspduthinspCO

2thinspIlthinsprevientthinspauxthinspprofessionnelsthinspdethinspjugerthinspdethinsplathinspsituationthinspenthinspfonctionthinspdethinspthinsp

chaquethinsppatient

11thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp12thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

CMQ - OIIQ - OPIQ 42

ILthinspFAUTthinspSAVOIRthinspQUE

LathinspSocieacuteteacutethinspcanadiennethinspdesthinspanestheacutesiologistesthinsp(SCA)thinspindiquethinspquethinsplesthinspthinspdirectivesthinspgeacuteneacuteralesthinspdethinspsoinsthinsp(ythinspcompristhinsplethinspmonitorage)thinsppourthinsplathinspseacutedationthinspthinspconscientethinspsontthinsplesthinspmecircmesthinspquethinsppourthinsplesthinspautresthinspformesthinspdrsquoanestheacutesiethinsp[]thinspthinsp(Merchantthinspetthinspcollabthinsp2014bthinspopthinspcit)thinspDethinspplusthinspellethinspindiquethinspquethinsplethinspthinspcapnographethinspestthinsprequisthinsplorsthinspdethinspseacutedation-analgeacutesiethinspdethinspniveauthinspplusthinspeacuteleveacutethinspthinsp(pthinspexthinspthinspRamsaythinsp4-6)thinsp(Merchantthinspetthinspcollabthinsp2014athinspop cit)

LethinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspimpliqueacutesthinspestthinspprimordialthinspetthinspcethinspmecircmethinspsithinsplrsquoappareillagethinspenthinspplacethinspestthinspcompletthinspetthinspfonctionnelthinspUnethinspbonnethinspcommunica-tionthinspentrethinspcesthinspderniersthinspestthinspdoncthinspessentiellethinspafinthinspdethinspbienthinspcoordonnerthinsplathinspseacutedationthinspetthinsplrsquoanalgeacutesiethinspavecthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspLes alarmes (audibles et visuelles) de chaque appareil doivent ecirctre en fonction et les paramegravetres ajusteacutes agrave lrsquoacircge et agrave la condition clinique de chaque enfant

IlthinspfautthinspsrsquoassurerthinspdethinsplathinsptraccedilabiliteacutethinspdethinsplrsquoeacutevaluationthinspetthinspdethinsplathinspsurveillancethinspcliniquethinspthinspeffectueacuteesthinspparthinspunethinsptenuethinspdethinspdossiersthinspconformethinspauxthinspnormesthinspenthinspvigueurthinspthinspLesthinspoutilsthinspdrsquoeacutevaluationthinsputiliseacutesthinspdoiventthinspecirctrethinspsimplesthinspstandardiseacutesthinspvalideacutesthinspdethinsppreacutefeacuterencethinspetthinspadapteacutesthinspauthinspcontextethinspetthinspauxthinspcaracteacuteristiquesthinspduthinsppatientthinspnotam-mentthinsppourthinsplrsquoeacutevaluationthinspduthinspniveauthinspdethinspseacutedationagitationthinspdethinspconsciencethinspetthinspdethinspdouleurthinsp(annexesthinspIXthinspetthinspX)

Lathinspfreacutequencethinspdethinsplathinspmesurethinspdethinspcesthinspparamegravetresthinspetthinspleurthinspenregistrementthinspdoiventthinspecirctrethinspdeacutetermineacutesthinspentrethinspautresthinspenthinspfonctionthinspdethinsplathinspmeacutedicationthinspetthinspdethinsplathinspconditionthinsp

cliniquethinspduthinsppatientthinsp

Ideacutealementthinsplethinspprofessionnelthinspdoitthinsplesthinspdocumenterthinsp

thinsprsaquo avantthinsplethinspdeacutebutthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsprsaquo apregravesthinsplrsquoadministrationthinspdrsquounthinspagentthinspdethinspseacutedation-analgeacutesiethinspouthinspdrsquounthinspantagonistethinsprsaquo authinsppicthinspdrsquoactionthinspdethinspchacunthinspdesthinspagentsthinspadministreacutesthinspthinsprsaquo agravethinspintervallesthinspreacuteguliersthinsp(pthinspexthinspthinsp5thinspminutes)thinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-

analgeacutesiethinsprsaquo agravethinspintervallesthinspplusthinsprapprocheacutesthinsplorsquethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsplrsquoexigethinsprsaquo durantthinsplathinsppeacuteriodethinspdethinspreacutecupeacuterationthinspetthinspjusqursquoauthinspretourthinspduthinspniveauthinspdethinspconsciencethinsp

initialthinspselonthinsplathinspconditionthinspcliniquethinspduthinsppatientthinsprsaquo authinspmomentthinspduthinspcongeacutethinsp

CMQ - OIIQ - OPIQ 43

thinsp26thinspPOSTSEacuteDATION-ANALGEacuteSIEthinsp

Commethinsppourthinsplethinsppatientthinspadultethinsp(pthinsp29)thinsplathinspsurveillancethinspcliniquethinspdoitthinspecirctrethinspcons-tantethinspetthinsprigoureusethinsptoutthinspauthinsplongthinspdethinsplathinsppeacuteriodethinsppostseacutedation-analgeacutesiethinspetthinspcethinspjusqursquoauthinspretourthinspdethinsplrsquoeacutetatthinspinitialthinspdethinsplrsquoenfantthinspenthinspfonctionthinspdethinspsonthinspstadethinspdethinspdeacutevelop-pement

Rappelonsthinspquethinsplesthinspappareilsthinspdethinspmonitoragethinspdoiventthinspecirctrethinspenthinspfonctionthinspthinspmaisthinspenthinspaucunthinsptempsthinspilsthinspnethinspremplacentthinsplathinspsurveillancethinspdirectethinspduthinsppatientthinspthinspparthinsplethinspprofessionnelthinsp

LathinsppeacuteriodethinspdrsquoobservationthinspenthinspeacutetablissementthinspdoitthinspecirctrethinspsuffisammentthinspprolongeacuteethinsppourthinsppreacutevenirthinsplesthinspproblegravemesthinsppendantthinspetthinspauthinspretourthinspagravethinsplathinspmaisonthinspComptethinsptenuthinspdethinspsonthinspacircgethinspetthinspdethinspsathinspconditionthinsplrsquoenfantthinspdoitthinspecirctrethinspcapablethinspdethinspsrsquoasseoirthinspdethinspboirethinspdethinspparlerthinspetthinspdethinspmarcherthinspavecthinspunethinspaidethinspminimalethinsp

Selonthinsplathinspdistancethinspagravethinspparcourirthinspauthinspretourthinspilthinsppeutthinspecirctrethinspjudicieuxthinspdethinspprolongerthinsplathinsppeacuteriodethinspdrsquoobservation

Unthinspdocumentthinsprelatifthinspauthinspcongeacutethinspcomprenantthinspdesthinspconsignesthinspclairesthinsppourthinsplathinspthinsp

surveillancethinspagravethinspdomicilethinspdoitthinspecirctrethinspremisthinspetthinspexpliqueacutethinspauxthinspparentsthinsp(annexethinspXII)

thinsp27thinspDOCUMENTATIONthinspDESthinspSOINSthinspETthinspTENUEthinspDEthinspDOSSIERSthinsp

Lathinsptenuethinspdethinspdossiersthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinsprigueurthinspetthinsplathinspmecircmethinsppreacutecisionthinspquethinspchezthinsplrsquoadultethinsp(pthinsp30)thinspCertainesthinspinformationsthinsppropresthinspagravethinsplrsquoenfantthinspdoiventthinspecirctrethinspajouteacuteesthinspnotammentthinsp

thinsprsaquo sithinsppreacutesencethinspdrsquounthinspparentthinsprsaquo lethinsppoidsthinspetthinsplrsquoacircgethinspdethinsplrsquoenfantthinsprsaquo lathinsptaillethinspouthinsplrsquoIMCthinspsrsquoilthinspythinspathinsplieu

CMQ - OIIQ - OPIQ 44

CONCLUSION

Lathinspseacutedation-analgeacutesiethinspvisethinspagravethinspalteacutererthinsplethinspniveauthinspdethinspconsciencethinspainsithinspqursquoagravethinspsoulagerthinsplrsquoanxieacuteteacutethinspetthinsplathinspdouleurthinspdrsquounthinsppatientthinspauthinspcoursthinspdrsquounethinspinterventionthinsptheacuterapeutiquethinspouthinspdiagnostiquethinspCettethinspproceacutedurethinspbienthinspquethinspfreacutequemmentthinsputiliseacuteethinspcomportethinspcependantthinspcertainsthinsprisques

On doit y recourir de faccedilon seacutecuritaire pour le patient et en tout temps preacutevenir et reconnaicirctre les complica-tions lieacutees agrave la seacutedation-analgeacutesie afin drsquoeffectuer rapidement et efficace-ment les manœuvres neacutecessaires

LethinsprespectthinspdesthinsplignesthinspdirectricesthinspeacutenonceacuteesthinspdansthinspcethinspdocumentthinspaiderathinsplesthinspprofessionnelsthinspagravethinspmenerthinspadeacutequatementthinspcettethinspproceacutedurethinspCeux-cithinspdemeurentthinsptoutefoisthinspresponsablesthinspdethinsplathinspmisethinspagravethinspjourthinspdethinspleursthinspconnaissancesthinspetthinspduthinspdeacuteveloppementthinspdethinspleursthinspcompeacutetencesthinsprespectivesthinsp

Parthinspailleursthinsplesthinspeacutetablissementsthinspdethinspsanteacutethinspetthinsplesthinspcliniquesthinspouthinspcabinetsthinsppriveacutesthinspdevraientthinspsrsquoinspirerthinspdethinspcesthinsplignesthinspdirectricesthinsppourthinspeacutelaborerthinspthinspdesthinspproceacuteduresthinsprelativesthinspagravethinsplathinspthinspseacutedation-analgeacutesiethinspetthinspenthinspassurerthinsplrsquoeacutevaluationthinsppeacuteriodiquethinspdethinsplathinspqualiteacutethinsp

CMQ - OIIQ - OPIQ 45

mdash Annexe

thinspANNEXEthinspIthinspndashthinspDEacuteFINITIONthinspDEthinspLrsquoANESTHEacuteSIEthinspGEacuteNEacuteRALEthinspETthinspthinsp

DESthinspNIVEAUXthinspDEthinspSEacuteDATION-ANALGEacuteSIEthinspSELONthinspLrsquoAMERICANthinspSOCIETYthinspOFthinsp

ANESTHESIOLOGISTSthinsp(ASA)thinsp(AMERICANthinspSOCIETYthinspOFthinspANESTHESIOLOGISTSthinsp

ASAthinspHOUSEthinspOFthinspDELEGATEthinsp2014AthinspOP CIT)thinsp(NOTREthinspTRADUCTION)

Seacutedationthinspminimalethinspthinspanxiolyse

Seacutedation-thinspthinspanalgeacutesiethinspthinspmodeacutereacutee(consciente)

Seacutedation-thinspanalgeacutesiethinspthinspprofonde

Anestheacutesiethinspthinspgeacuteneacuterale

Reacuteponse Reacuteponsethinspnormalethinspagravethinsplathinspstimulationthinspverbale

Reacuteponsethinspvolontairethinspagravethinsplathinspstimulationthinspverbalethinspouthinsptactile

Reacuteponsethinspvolontairethinspsuivantthinspunethinspstimulationthinspreacutepeacuteteacuteethinspouthinspdouloureuse

Nonthinspeacuteveillablethinspmecircmethinspavecthinspstimulusthinspdouloureux

Voiesthinspthinspaeacuteriennes

Nonthinspaffecteacutees Pasthinspdrsquointerventionthinsprequise

Interventionthinsppeutthinspecirctrethinsprequise

Interventionthinspthinspsouventthinsprequise

Ventilationspontaneacutee

Nonthinspaffecteacuteethinsp Adeacutequate Peutthinspecirctrethinspinadeacutequate

Freacutequemmentthinspinadeacutequate

Fonctionthinspcardio-thinspvasculaire

Nonthinspaffecteacutee Geacuteneacuteralementthinspthinspmaintenue

Geacuteneacuteralementthinspthinspmaintenue

Peutthinspecirctrethinspthinspcompromise

thinspthinspLethinspreacuteflexethinspdethinspretraitthinspagravethinsplathinspsuitethinspdrsquounethinspstimulationthinspdouloureusethinspnrsquoestthinsppasthinspconsideacutereacutethinspcommethinspunethinspreacuteponsethinspvolontaire

Rappelonsthinspquethinsplathinspseacutedation-analgeacutesiethinspprofondethinspchezthinsplrsquoadultethinspetthinsplrsquoanestheacutesiethinspgeacuteneacuteralethinsp(adultethinspetthinsppeacutediatrique)thinspthinspnethinspfontthinsppasthinsplrsquoobjetthinspdethinspcettethinsppublication

CMQ - OIIQ - OPIQ 46

mdash Annexe

thinspANNEXEthinspIIthinspndashthinspINFORMATIONthinspCOMPLEacuteMENTAIREthinsp-thinspLECTURESthinspDrsquoINTEacuteREcircT

COLLEgraveGEthinspDESthinspMEacuteDECINSthinspDUthinspQUEacuteBECthinsp(CMQ)

thinsprsaquo Proceacutedures et interventions en milieu extrahospitalier (2011)thinsprsaquo Code de deacuteontologie des meacutedecinsthinsp(2015)

ORDREthinspDESthinspINFIRMIEgraveRESthinspETthinspINFIRMIERSthinspDUthinspQUEacuteBECthinsp(OIIQ)thinsp

thinsprsaquo EacutediteurthinspofficielthinspduthinspQueacutebec Code de deacuteontologie des infirmiegraveres et infirmiers (2014)

thinsprsaquo Le champ drsquoexercice et les activiteacutes reacuteserveacutees des infirmiegraveresthinsp(2013)thinsp2ethinspeacutedthinspthinsprsaquo Mosaiumlque des compeacutetences cliniques de lrsquoinfirmiegravere Compeacutetences initiales

(2009)thinsp2ethinspeacutedthinspthinsprsaquo Les obligations deacuteontologiques de lrsquoinfirmiegravere et le consentement aux soins

(2005)

ORDREthinspPROFESSIONNELthinspDESthinspINHALOTHEacuteRAPEUTESthinspDUthinspQUEacuteBECthinsp(OPIQ)

thinsprsaquo Profil national des compeacutetencesthinspLrsquoalliancethinspdesthinsporganismesthinspdethinspregraveglementationthinspenthinsptheacuterapiethinsprespiratoirethinsp(2011)

thinsprsaquo Les notes au dossier dans le secteur de lrsquoassistance anestheacutesique et de la seacutedation analgeacutesiethinsp-thinspGuidethinspdethinsppratiquethinsp(2008)

thinsprsaquo Compeacutetences relatives agrave lrsquoentreacutee dans la pratique (2003)thinsprsaquo Regraveglement sur les dossiers les autres effets les cabinets et la cessation

drsquoexercice des membres de lrsquoOrdre professionnel des inhalotheacuterapeutes du Queacutebecthinsp(2002)thinsp

thinsprsaquo Code de deacuteontologie des inhalotheacuterapeutes du Queacutebec

CMQ - OIIQ - OPIQ 47

thinspANNEXEthinspIIIthinspndashthinspPROCEacuteDURESthinspPROTOCOLESthinspOUthinspALGORITHMESthinsp

Dansthinsptousthinsplesthinsplieuxthinspougravethinspsethinsppratiquethinsplathinspseacutedation-analgeacutesiethinspagravethinspdesthinspfinsthinspdiagnos-tiquesthinspouthinsptheacuterapeutiquesthinsplethinspmeacutedecinthinspresponsablethinspdoitthinspeacutelaborerthinspenthinspcollabora-tionthinspavecthinsplesthinspmembresthinspdethinspsonthinspeacutequipethinspsoignantethinsplesthinspproceacuteduresthinspprotocolesthinspouthinsp

algorithmesthinspconcernantthinspnotammentthinsplesthinspsujetsthinspsuivantsthinsp

PARMIthinspLESthinspPROCEacuteDURESthinspOUthinspPROTOCOLESthinsp(ADULTEthinspETthinspPEacuteDIATRIQUE)thinsp

thinsprsaquo allergiethinspauthinsplatexchocthinspanaphylactiquethinsprsaquo antagonistethinsprsaquo bradycardiethinsprsaquo critegraveresthinspcliniquesthinspdethinspcongeacutethinsprsaquo hypertensionthinspmalignethinsprsaquo seacutedation-analgeacutesiethinsprsaquo transfertthinspdrsquourgence

PARMIthinspLESthinspALGORITHMESthinsp(ADULTEthinspETthinspPEacuteDIATRIQUE)thinsp

thinsprsaquo gestionthinspdesthinspvoiesthinspaeacuteriennesthinspdifficilesthinsp(ventilationintubation)thinsprsaquo reacuteanimationthinspcardiorespiratoirethinsp

thinspthinspthinspILthinspFAUTthinspPENSERthinspAgravethinsp

thinsprsaquo Lrsquoaffichagethinspdesthinspproceacuteduresthinspprotocolesthinspouthinspalgorithmesthinspdrsquourgencethinspquithinsppermettrathinspdrsquoythinspavoirthinspaccegravesthinsprapidementthinspenthinspcasthinspdrsquourgencethinspetthinspdethinsplesthinspconsulterthinspreacuteguliegraverementthinspparthinsplathinspmecircmethinspoccasionthinsp

thinsprsaquo Lrsquoeacutelaborationthinspdrsquounthinspprogrammethinsppeacuteriodiquethinspdrsquoexercicethinsp(pthinspexthinspthinspsimulation)thinspquithinsppermettrathinspdethinsprevoirthinsplesthinspdiffeacuterentesthinspproceacuteduresthinspenthinspplacethinspavecthinsptousthinsplesthinspmembresthinspdethinsplrsquoeacutequipethinspsoignantethinspetthinspdrsquoinitierthinsplethinspnouveauthinsppersonnelthinspassurantthinspainsithinspunethinspmeilleurethinsprelegravevethinspDethinspmecircmethinspmettrethinsplethinspplanthinspenthinsppratiquethinsppermetthinspdrsquooptimiserthinsplathinsprapiditeacutethinspetthinsplathinsppreacutecisionthinspdesthinspgestesthinspposeacuteesthinspetthinspdrsquoidentifierthinspdesthinspproblegravemesthinsppotentielsthinsp(avecthinspdethinsplrsquoeacutequipementthinspparthinspexemple)thinspetthinspcethinspavantthinspqursquoilthinspythinspaitthinspurgencethinspdrsquoagirthinsp

mdash Annexe

CMQ - OIIQ - OPIQ 48

thinspANNEXEthinspIVthinspndashthinspEacuteVALUATIONthinspDESthinspVOIESthinspAEacuteRIENNESthinspSUPEacuteRIEURESthinspAUthinsp

thinspMOYENthinspDUthinspSCOREthinspDEthinspMALLAMPATIthinsp(DIEMUNSCHthinspETthinspCOLLABthinsp2008)thinsp

(Agravethinsptitrethinspinformatifthinspseulement)

Objectifthinspthinspthinsp Eacutevaluerthinsplathinspvisibiliteacutethinspdesthinspstructuresthinsporopharyngeacuteesthinspetthinsplathinsptaillethinspthinsp

dethinsplathinsplangue

Lesthinsp4thinspclassesthinspdethinspMallampatithinspmodifieacuteesthinsp(SamsoonthinspandthinspYoung)thinspsontthinsp

thinsprsaquo ClassethinspIthinspthinspluettethinsppiliersthinspduthinspvoilethinspduthinsppalaisthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIIthinspthinsppiliersthinspduthinspvoilethinspduthinsppalaisthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIIIthinspthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIVthinspthinsppalaisthinspdurthinspseulthinsp

LesthinspclassesthinspIthinspetthinspIIthinsppreacutesagentthinspdrsquounethinspintubationthinspathinsppriorithinspfacilethinsplesthinspclassesthinspIIIthinspetthinspIVthinspdrsquounethinspintubationthinspdifficile

ClassesthinspdethinspMallampatithinspmodifieacuteesthinsp(Jmarchnthinsp[Enthinspligne])

LrsquoinsuffisancethinspdethinsplathinspclassificationthinspdethinspMallampatithinspathinspeacuteteacutethinspspeacutecifiquementthinspmon-treacuteethinspchezthinsplrsquoobegravesethinspEllethinspnethinsppeutthinspecirctrethinspconsideacutereacuteethinspcommethinspunthinsppreacutedicteurthinspisoleacute-mentthinspsuffisantthinspdethinsplathinspdifficulteacutethinspdethinsplathinsplaryngoscopiethinspouthinspathinspfortiorithinspdethinsplrsquointuba-tionthinspdifficilethinsp

mdash Annexe

CMQ - OIIQ - OPIQ 49

ANNEXEthinspVthinspndashthinspOUTILthinspDrsquoEacuteVALUATIONthinspDEthinspLrsquoAPNEacuteEthinspOBSTRUCTIVEthinspDUthinspSOMMEILthinsp

(AOS)thinspADAPTEacutethinspAgravethinspLAthinspCONSULTATIONthinspPREacuteANESTHESIQUESEacuteDATION-thinsp

ANALGEacuteSIEthinspthinsp(ADAPTEacutethinspDEthinspCHUNGthinspETthinspSEETthinsp2010)thinsp(NOTREthinspTRADUCTION)

(Agravethinsptitrethinspinformatifthinspseulement)

mdash Annexe

Exemplethinspdethinspquestionnairethinspstop-bang

Question Reacuteponse

Sthinspnore PreacutesencethinspdethinspronflementVosthinspronflementsthinspsont-ilsthinspbruyants(suffisammentthinsppourthinspecirctrethinspentendusthinspagravethinsptraversthinspunethinspportethinspfermeacutee)

OuithinspouthinspNon

Tthinspiredthinspfatiguethinsporthinspsleepy PreacutesencethinspdethinspsomnolencethinspouthinspfatigueVousthinspsentez-vousthinspsouventthinspfatigueacutethinspeacutepuiseacutethinspouthinspsomnolentthinsppendantthinsplathinspjourneacutee

OuithinspouthinspNon

Othinspbservedthinspapnea ApneacuteethinspobserveacuteethinspQuelqursquounthinspa-t-ilthinspdeacutejagravethinspobserveacutethinspquethinspvousthinspthinsparrecirctiezthinspdethinsprespirerthinspenthinspdormant

OuithinspouthinspNon

Pthinspressure PreacutesencethinspdrsquoHTAAvez-vousthinspouthinspecirctes-vousthinsptraiteacutepourthinspunethinsptensionthinsparteacuteriellethinspeacuteleveacutee

OuithinspouthinspNon

BthinspMI IMCthinspgtthinsp35thinspkgm2 OuithinspouthinspNon

Athinspge Acircgethinspgtthinsp50thinspans OuithinspouthinspNon

Nthinspeck Circonfeacuterencethinspduthinspcouthinspgtthinsp40thinspcm OuithinspouthinspNon

Gthinspender Sexethinspmasculin OuithinspouthinspNon

INTERPREacuteTATIONthinspCLINIQUE

ltthinsp3thinspreacuteponsesthinsppositivesthinsp=thinspfaiblethinsprisquethinspdrsquoAOS

ge 3 reacuteponses positives = risque eacuteleveacute drsquoAOS

CMQ - OIIQ - OPIQ 50

thinspANNEXEthinspVIthinspndashthinspANAMNEgraveSEthinspthinspAIDEthinspMNEacuteMOTECHNIQUEthinsp

(Agravethinsptitrethinspinformatifthinspseulement)

ObjectifthinspthinspthinspthinspCetthinspoutilthinspdrsquoaidethinspmneacutemotechniquethinspsertthinspagravethinspstructurerthinsplathinspfaccedilonthinspdontthinspthinsponthinspprocegravedethinspagravethinsplathinspcollectethinspsommairethinspdesthinspdonneacuteesthinspdansthinsplethinspcadrethinspdethinsplrsquoeacutevaluationthinspcliniquethinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinspfacilitethinsplathinspcompreacutehensionthinspetthinsplathinspreacutealisationthinspdethinsplrsquoanamnegravesethinspchezthinsplrsquoadultethinspetthinsplrsquoenfant

SAMPLEthinsp(AdapteacutethinspdethinspAltonthinspetthinspcollabthinsp2007thinsp[Notrethinsptraduction])thinsp(outhinspvariante)

SthinspthinspSignesthinspetthinspsymptocircmes

AthinspthinspAllergiesthinspetthinspreacuteactionthinsp

MthinspthinspMeacutedicamentsthinspetthinspautresthinspsubstancesthinsp(prescritsthinspouthinspnon)thinspetthinsptraitement

PthinspthinspPasseacutethinspmeacutedicalfamilialthinsp

LthinspthinspLastthinspmeallunchthinsp(dernierthinsprepas)

EthinspthinspEnvironnementeacuteveacutenement

thinsp

mdash Annexe

CMQ - OIIQ - OPIQ 51

thinspANNEXEthinspVIIthinsp-thinspEXAMENthinspPHYSIQUEthinspthinspAIDEthinspMNEacuteMOTECHNIQUE

(Agravethinsptitrethinspinformatifthinspseulement)

Objectifthinspthinspthinsp Lrsquoexamenthinspphysiquethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinspcherchethinspagravethinspmettrethinspenthinspeacutevidencethinspcertainsthinspcritegraveresthinspreconnusthinsppourthinspecirctrethinspassocieacutesthinspagravethinspunethinspassis-tancethinspventilatoirethinspdifficilethinspquithinsppeutthinspsurvenirthinspdansthinsplethinspcasthinspdrsquounthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquethinspceluithinspviseacutethinspparthinspexemple

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinspfacilitethinsplathinspcompreacutehensionthinspetthinsplathinspreacutealisationthinspdethinsplrsquoexamenthinspphysiquethinsprelativementthinspauxthinspvoiesthinspaeacuteriennesthinspdethinsplrsquoadulte

1thinspIndicateursthinspdrsquounethinsppossiblethinspventilationthinspdifficilethinsp(MOANSthinsp[AdapteacutethinspdethinspWallsthinspetthinspthinspthinspthinspthinspMurphythinsp2012]thinsp[Notrethinsptraduction]thinspouthinspvariante)

Mthinspthinspmask sealthinsp(eacutetancheacuteiteacutethinspduthinspmasque)thinspthinspeacutetancheacuteiteacutethinspcompromisethinspenthinspraisonthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspdrsquounethinspbarriegraverethinspmeacutecaniquethinsp(barbethinspfourniethinsptraumatismethinspfacialthinspetc)

OthinspthinspobeacutesiteacuteobstructionthinspthinsppatientthinspdontthinsplrsquoIMCthinspestthinspgtthinsp25thinsp(kgm2)thinspfemmethinspenceintethinspthinspthinspthinspthinspthinspthinspthinspgtthinsp6thinspmoisthinsp(2ethinsptrimestre)thinspangio-œdegravemethinspabcegravesthinspetc

Athinspthinspacircgethinspthinsppatientthinspgethinsp55thinspansthinsp(variablethinspselonthinsplesthinspauteurs)thinspenthinspraisonthinspnotammentthinspthinspthinspthinspthinspthinspthinspdethinsplathinsppertethinspdrsquoeacutelasticiteacutethinspdesthinsptissus

Nthinspthinspno teeththinsp(eacutedenteacute)thinspthinspdifficulteacutethinsplorsthinspdethinsplrsquoassistancethinspventilatoire

Sthinspthinspstiffthinsp(rigiditeacute)thinspthinsppathologiesthinspagravethinspconseacutequencesthinspsurthinsplathinspcompliancethinspetthinsplathinspthinspthinspthinspthinspthinspreacutesistancethinsppulmonairethinsp(asthmethinspMPOCthinsppneumoniethinspdethinspstadethinspavanceacutethinspetc)

thinspthinspVentilationthinspdifficilethinsp(masquethinspouthinspoutilthinspextraglottiquethinsptelthinspquethinspmasquethinspthinspthinspthinspthinspthinsplaryngeacute)thinsp(AdapteacutethinspdethinsplrsquoAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinsp[Notrethinspthinspthinspthinspthinspthinsptraduction])thinspImpossiblethinspdrsquoeffectuerthinspunethinspventilationthinspdethinspfaccedilonthinspadeacutequatethinspthinspthinspthinspthinspthinspenthinspraisonthinspdethinsplrsquounethinspetouthinspdethinsplrsquoautrethinspdesthinspsituationsthinspsuivantesthinsp

athinspMauvaisethinspeacutetancheacuteiteacutethinspduthinspmasquethinspouthinspdethinsplrsquooutilthinspextraglottiquebthinspFuitethinspdethinspgazthinspexcessivecthinspReacutesistancethinspexcessivethinspagravethinsplrsquoinspirationthinspouthinspagravethinsplrsquoexpiration

thinsp

mdash Annexe

CMQ - OIIQ - OPIQ 52

2thinspIndicateursthinspdrsquounethinsppossiblethinsplaryngoscopiethinspouthinspintubationthinspdifficilethinsp(thinspLEMONthinspthinspthinspthinspthinspthinsp[WallsthinspetthinspMurphythinsp2012thinspopthinspcit]thinsp[Notrethinsptraduction]thinspouthinspvariante)

Lthinspthinspthinsplook externallythinsp(apparencethinspphysique)thinspthinspmicrognathiethinspmacroglossiethinspdenti-tionthinspirreacuteguliegraverethinspcirconfeacuterencethinspduthinspcouthinspgethinspgrossessethinspetc

thinspEthinspthinspthinspeacutevaluationthinspthinspregraveglethinspduthinsp3-3-2thinsp(variantethinsppossiblethinspselonthinsplesthinspauteurs)thinsp-thinspthinsp

consideacuterationsthinspgeacuteomeacutetriquesthinsp(agravethinsplrsquoaidethinspdesthinspdoigtsthinspduthinsppatient)3thinspthinsp ouverturethinspdethinspbouchethinspthinspinsertionthinspdethinsp3thinspdethinspsesthinspdoigts3thinspthinsp taillethinspduthinsplarynxthinsp(longueurthinspmandibulaire)thinspthinsp3thinspdoigtsthinspsousthinsplethinspmentonthinsp

(boutthinspdethinspsonthinspmentonthinspjusqursquoagravethinsplathinspjonctionthinspduthinspcouthinspauthinspniveauthinspdethinspthinsplrsquoosthinsphyoiumlde)

2thinspthinsp positionthinspduthinsplarynxthinspthinsp2thinspdethinspsesthinspdoigtsthinspentrethinsplathinspjonctionthinspcou-mentonthinsp(osthinspthinsphyoiumlde)thinspetthinsplethinspcartilagethinspthyroiumlde

thinspMthinspthinspthinspMallampatithinsp(annexethinspIV)thinspOthinspthinspthinspobeacutesiteacuteobstructionthinspthinspIMCthinspthinspœdegravemethinspduthinsplarynxthinspneacuteoplasiethinspdethinsplathinspsphegraverethinsp

ORLthinspcompressionthinspextrinsegravequethinspparthinspheacutematomethinspcervicalthinspdifficulteacutethinspagravethinspavalerthinspdyspneacutee

thinspNthinspthinspthinspneck mobilitythinsp(mobiliteacutethinspcervicale)thinspthinspimmobilisationthinspauthinspmoyenthinspdrsquounthinspcol-

lierthinspcervicalthinsppreacutesencethinspdrsquounethinsppathologiethinspouthinspdrsquounethinspsituationthinspcliniquethinspagravethinspconseacutequencethinspsurthinsplrsquoassistancethinspventilatoirethinspouthinspdethinsplrsquointubationthinsp(pthinspexthinspthinspthinsparthrosethinspouthinsparthritethinspimportantethinsptrisomiethinsp21thinspetc)

thinspthinsp Lanryngoscopiethinspdifficilethinspthinspimpossibiliteacutethinspdethinspvisualiserthinspnrsquoimportethinspquellethinsppartiethinspdesthinspcordesthinspvocalesthinspapregravesthinspdethinspmultiplesthinsptentativesthinspavecthinspunthinsplaryngoscopethinspconventionnelthinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinspop citthinsp[Notrethinsptraduction])thinsp

thinspthinspIntubationthinspendotracheacutealethinspdifficilethinspthinspintubationthinspquithinsprequiertthinspdethinspmultiplesthinspthinsptentativesthinspenthinsppreacutesencethinspouthinspenthinsplrsquoabsencethinspdrsquounethinsppathologiethinsptracheacutealethinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinspop citthinspthinsp[Notrethinsptraduction])

IlthinspfautthinspnoterthinspquethinsplrsquoinsuffisancethinspdethinsplathinspclassificationthinspdethinspMallampatithinspathinspeacuteteacutethinspspeacutecifiquementthinspmontreacuteethinspchezthinsplrsquoobegravesethinspellethinspnethinsppeutthinspecirctrethinspconsideacutereacuteethinspcommethinspunthinsppreacutedicteurthinspisoleacutementthinspsuffisantthinspdethinsplathinspdifficulteacutethinspdethinsplathinsplaryngoscopiethinspouthinspathinspfortiorithinspdethinsplrsquointubationthinspdifficile

mdash Annexe

ge

ge

CMQ - OIIQ - OPIQ 53

thinspANNEXEthinspVIIIthinsp-thinspLEthinspCONSENTEMENT

SelonthinsplethinspdroitthinspenthinspvigueurthinspilthinspestthinspobligatoirethinspauthinspQueacutebecthinspdrsquoobtenirthinsplethinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspintervention

LethinspCode civil du Queacutebec eacutetablitthinspdesthinspregraveglesthinspgeacuteneacuteralesthinspconcernantthinsplethinspconsente-mentthinspauxthinspsoinsthinspquithinspsrsquoappliquentthinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspOnthinspythinspfaitthinspcependantthinspcertainesthinspdistinctionsthinspselonthinspquethinsplesthinspsoinsthinspsontthinsprequisthinspouthinspnonthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspetthinspselonthinspquethinsplethinsppatientthinspestthinspaptethinspagravethinspconsentirthinspouthinspnon

Sithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsp(traitementsthinspdethinspmeacutedecinethinspetthinspdethinspchirurgiethinspestheacutetiquethinspexpeacuterimentationthinspetthinspdonsthinspdrsquoorganes)thinsplethinsppatientthinspdoitthinspecirctrethinspinformeacutethinspdethinsptousthinsplesthinsprisquesthinsppossiblesthinspmecircmethinspsrsquoilsthinspsontthinspraresthinspetthinsplethinspconsentementthinspdoitthinspecirctrethinspdonneacutethinspparthinspeacutecritthinspHabituellementthinspilthinspnethinsppeutthinspecirctrethinspdonneacutethinspquethinspparthinspunthinsppatientthinspaptethinspetthinspacircgeacutethinspdethinsp14thinspansthinspetthinspplusthinspparthinsplethinspmandatairethinsplethinsptuteurthinspouthinsplethinspcurateurthinspdrsquounethinsppersonnethinspinaptethinspouthinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinspdrsquounethinsppersonnethinspdethinspmoinsthinspdethinsp14thinspansthinspLrsquoautorisationthinspdethinsplathinspcourthinspestthinspenthinspoutrethinspneacutecessairethinspsithinsplesthinspsoinsthinsppreacutesententthinspunthinsprisquethinspseacuterieuxthinsppourthinsplathinspsanteacutethinspdethinspcesthinsppersonnesthinspouthinspsrsquoilsthinsppeuventthinspcauserthinspdesthinspeffetsthinspgravesthinspetthinsppermanentsthinspUnethinsppersonnethinspmineurethinspdethinspthinsp14thinspansthinspetthinspplusthinsppeutthinspconsentirthinspseulethinspagravethinspmoinsthinspqursquoilthinspsrsquoagissethinspdethinspsoinsthinspnonthinsprequisthinspetthinspthinspcomportantthinspdesthinsprisques

SrsquoilthinspsrsquoagitthinspdethinspsoinsthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsplrsquoobligationthinspdrsquoinformerthinspcroicirctthinspenthinspfonctionthinspdethinsplathinsppreacutevalencethinspetthinspdethinsplathinspgraviteacutethinspdesthinspcomplicationsthinspSithinsplethinsppatientthinspestthinspinaptethinspetthinspqursquoilthinspnrsquoestthinsppasthinsprepreacutesenteacutethinspparthinspunthinspmandatairethinspunthinsptuteurthinspouthinspunthinspcura-teurthinsplethinspconsentementthinsppeutthinspecirctrethinspdonneacutethinspparthinspunthinspconjointthinspouthinspagravethinspdeacutefautthinspduthinspconjointthinspparthinspunthinspprochethinspouthinspunethinsppersonnethinspquithinspdeacutemontrethinspunthinspinteacuterecirctthinspparticulierthinsppourthinsplathinspper-sonnethinspinaptethinspIlthinspnrsquoythinspathinsppasthinspdrsquoobligationthinspagravethinspcethinspquethinspcethinspconsentementthinspsoitthinspdonneacutethinspparthinspeacutecritthinspLethinspconsentementthinspauxthinspsoinsthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspdrsquounethinsppersonnethinspmi-neurethinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinspouthinsplethinsptuteurthinspUnethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsppeutthinspconsentirthinspmaisthinspnethinsppeutthinsppasthinsprefuserthinspseulethinspdesthinspsoinsthinspquithinspseraientthinspjugeacutesthinsprequisthinspEnthinspcasthinspdrsquourgencethinsplethinspconsentementthinspauxthinspsoinsthinspmeacutedicauxthinspnrsquoestthinsppasthinspneacutecessairethinsplorsquethinsplathinsppersonnethinspouthinspsonthinspinteacutegriteacutethinspestthinspmenaceacuteethinspetthinspquethinsplethinspconsentementthinspnethinsppeutthinspecirctrethinspobtenuthinspagravethinsptemps

LathinspLoi sur les servicesthinspdethinspsanteacutethinspetthinsplesthinspservicesthinspsociauxthinsp(LSSS)thinspeacutetablitthinspquantthinspagravethinspellethinspcertainesthinspregraveglesthinspenthinspmatiegraverethinspdethinspconsentementthinspauxthinspinterventionsthinspchirurgicalesthinspetthinspagravethinsplrsquoanestheacutesiethinsp

mdash Annexe

CMQ - OIIQ - OPIQ 54

Selonthinspcettethinsploithinsplethinspconsentementthinspagravethinspunethinspanestheacutesiethinspouthinspagravethinspunethinspinterventionthinspchirurgi-calethinspdoitthinspecirctrethinspattesteacutethinspparthinspunthinspdocumentthinspeacutecritthinspsigneacutethinspparthinsplethinsppatientthinspouthinspsonthinsprepreacutesen-tantthinspetthinspcethinspdocumentthinspdoitthinspfairethinspeacutetatthinspdesthinspinformationsthinspapproprieacuteesthinspconcernantthinspnotammentthinsplesthinsprisquesthinspouthinsplesthinspeffetsthinsppossiblesthinspCetthinspeacutecritthinspdoitthinspecirctrethinspcontresigneacutethinspparthinsplethinspmeacutedecinthinspouthinsplethinspdentistethinsptraitantthinspetthinspconserveacutethinspdansthinsplethinspdossierthinspduthinsppatientthinspLethinspdossierthinspdoitthinspcontenirthinspunthinspdocumentthinspattestantthinsplethinspconsentementthinsppourthinsplesthinspsoinsthinspetthinsplesthinspservicesthinspdispenseacutesthinspdansthinspunthinspcentrethinsphospitalierthinsp(CH)thinspunthinspcentrethinspdrsquoheacutebergementthinspetthinspdethinspsoinsthinspdethinsplonguethinspdureacuteethinsp(CHSLD)thinspetthinspunthinspcentrethinsplocalthinspdethinspservicesthinspcommunau-tairesthinsp(CLSC)

CesthinspdispositionsthinspnethinspsrsquoappliquentthinspqursquoauxthinspsoinsthinspdispenseacutesthinspenthinspeacutetablissementthinspthinspMaintenantthinspquethinspplusieursthinspinterventionsthinspautrefoisthinspreacuteserveacuteesthinspauxthinspeacutetablissementsthinsppeuventthinspecirctrethinspeffectueacuteesthinspenthinspdehorsthinspdethinspceux-cithinsplathinspquestionthinspsethinspposethinsptoutefoisthinspdethinspsavoirthinspsithinsplesthinspmecircmesthinspexigencesthinspdevraientthinspsrsquoappliquerthinsppartoutthinsp

Qursquoenthinspest-ilthinspparthinspexemplethinspdethinsplathinspsignaturethinspdrsquounthinspformulairethinspdethinspconsentementthinspEnthinsppratiquethinspetthinspagravethinsplrsquousagethinspilthinspsrsquoestthinspaveacutereacutethinspqursquounthinspformulairethinspdethinspconsentementthinspducircmentthinspsigneacutethinspnethinsppeutthinspagravethinspluithinspseulthinspprouverthinspquethinsplethinspconsentementthinspathinspeacuteteacutethinsplibrethinspetthinspeacuteclaireacutethinspUnethinspcourtethinspnotethinspverseacuteethinspauthinspdossierthinspreacutesumantthinsplesthinspinformationsthinsptransmisesthinspetthinsplesthinspeacutechangesthinspauxquelsthinspellesthinspontthinspdonneacutethinsplieuthinspestthinsppreacutesentementthinspjugeacuteethinspbeaucoupthinspplusthinsppertinentethinspagravethinspcetthinspeacutegardthinspLethinspformulairethinspdethinspconsentementthinspcomplegravetethinsplesthinsprenseigne-mentsthinspfournisthinspverbalementthinspIlthinspsrsquoagitthinspdrsquounthinspajoutthinspagravethinsplrsquoinformationthinspverbalethinsptransmisethinspthinsp

etthinspnonthinspdrsquounethinspmesurethinspvisantthinspagravethinsplathinspremplacer

LethinspCode de deacuteontologiethinspdes meacutedecinsthinsppreacutecisethinsplesthinspobligationsthinspdesthinspmeacutedecinsthinsp

quantthinspauthinspconsentementthinsp

Article 28Le meacutedecin doit sauf urgence avant drsquoentreprendre un examen une investiga-tion un traitement ou une recherche obtenir du patient ou de son repreacutesentant leacutegal un consentement libre et eacuteclaireacute

Article 29Le meacutedecin doit srsquoassurer que le patient ou son repreacutesentant leacutegal a reccedilu les explications pertinentes agrave leur compreacutehension de la nature du but et des conseacutequences possibles de lrsquoexamen de lrsquoinvestigation du traitement ou de la recherche qursquoil srsquoapprecircte agrave effectuer Il doit faciliter la prise de deacutecision du patient et la respecter

mdash Annexe

CMQ - OIIQ - OPIQ 55

DansthinspsesthinspguidesthinspdrsquoexercicethinspportantthinspsurthinsplathinsptenuethinspdesthinspdossiersthinsplethinspCollegravegethinspestimethinspdrsquoailleursthinspquethinsplethinspdossierthinspdrsquounthinsppatientthinspdoitthinspcontenirthinspunethinspnotethinspattestantthinspquethinsplesthinspin-formationsthinspneacutecessairesthinspagravethinspunethinspprisethinspdethinspdeacutecisionthinspeacuteclaireacuteethinspontthinspeacuteteacutethinsptransmisesthinspparthinsplethinspmeacutedecinthinspetthinspcomprisesthinspparthinsplethinsppatientthinspouthinspsonthinsprepreacutesentantthinsplorsquethinsplathinspchosethinspestthinspjugeacuteethinsppertinentethinspathinspfortiorithinsplorsqursquoilthinspsrsquoagitthinspdrsquounethinspinterventionthinspchirurgicalethinspdrsquounethinspinterventionthinspchirurgicalethinspsousthinspseacutedation-analgeacutesiethinspdrsquoanestheacutesiethinspreacutegionalethinspouthinspgeacuteneacuteralethinsp

DansthinsplethinspCode de deacuteontologie des infirmiegraveres et infirmiersthinsponthinsppreacutevoitthinspquethinsp

thinspArticle 40 Lrsquoinfirmiegravere ou lrsquoinfirmier doit fournir agrave son client toutes les explications neacuteces-saires agrave la compreacutehension des soins et des services qursquoil lui prodigue

Article 41Lorsque lrsquoobligation drsquoobtenir un consentement libre et eacuteclaireacute incombe agrave lrsquoin-firmiegravere ou agrave lrsquoinfirmier ce dernier doit fournir au client toutes les informations

requises

LethinspCode de deacuteontologie des inhalotheacuterapeutes du Queacutebecthinspnethinspcontientthinsppasthinspdethinsp

dispositionthinsptouchantthinsppreacuteciseacutementthinsplethinspconsentementthinspOnthinsppreacutecisethinspcependantthinspquethinsp

Article 13En plus des avis et des conseils lrsquoinhalotheacuterapeute doit fournir agrave son client les explications neacutecessaires agrave la compreacutehension et agrave lrsquoappreacuteciation des services qursquoil

lui rend

EnthinspcompleacutementthinspdansthinspsesthinspnormesthinspdethinsppratiquethinspportantthinspsurthinsplathinsptenuethinspdesthinspdossiersthinsplrsquoOrdrethinspprofessionnelthinspdesthinspinhalotheacuterapeutesthinspduthinspQueacutebecthinspdemandethinspquethinsplethinspdos-sierthinspdrsquounthinsppatientthinspcomportethinspunethinspmentionthinspdesthinspsoinsthinspetthinspdesthinspservicesthinspprodigueacutesthinspagravethinspsonthinspeacutegardthinspAgravethinspcetthinspeffetthinsptoutethinspactiviteacutethinspexerceacuteethinspparthinsplrsquoinhalotheacuterapeutethinsptellethinspquethinsplrsquoinformationthinsptransmisethinspauthinsppatientthinspeuthinspeacutegardthinspagravethinsplathinspseacutedation-analgeacutesiethinspdoitthinspecirctrethinspinscritethinspauthinspdossierthinspduthinsppatientthinspetthinspcethinspauthinspfurthinspetthinspagravethinspmesurethinspquethinsplesthinspactiviteacutesthinspsontthinspexerceacutees

EnthinspsommethinsplathinsploithinspexigethinspunthinspconsentementthinspeacutecritthinspsithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspainsithinspquethinsppourthinsplesthinspanestheacutesiesthinsplesthinspinterventionsthinspchirurgicalesthinspetthinsplesthinspsoinsthinspdispenseacutesthinspenthinspeacutetablissementthinspDansthinspsesthinspguidesthinspportantthinspsurthinsplesthinspproceacuteduresthinspetthinspinterventionsthinspenthinspmilieuthinspextrahospitalierthinspnotammentthinsplethinspCollegravegethinsprecommandethinsptoutefoisthinspquethinsplethinspmeacutedecinthinspversethinspunethinspnotethinspexplicativethinspauthinspdossierthinspetthinspobtiennethinspunthinspconsentementthinspeacutecritthinsppourthinsptoutethinspinterventionthinspmeacutedicalethinspouthinsp

mdash Annexe

CMQ - OIIQ - OPIQ 56

chirurgicalethinspeffractivethinspqursquoellethinspsoitthinspeffectueacuteethinspdansthinspunthinspbutthinspdiagnosticthinsptheacuterapeu-tiquethinspouthinspestheacutetiquethinspLorsquethinsplethinspconsentementthinspportethinspagravethinsplathinspfoisthinspsurthinsplathinspseacutedation-thinspthinspanalgeacutesiethinspetthinspsurthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsplrsquoinformationthinsptrans-misethinspdoitthinspinclurethinsplesthinsprisquesthinspdethinsplrsquointerventionthinspetthinspceuxthinspdethinsplathinspseacutedation-analgeacutesiethinspcelle-cithinsppouvantthinspcomporterthinspdesthinsprisquesthinspimportantsthinspmecircmethinspsithinsplrsquointerventionthinspestthinspmineure

Lrsquoobtentionthinspdrsquounthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspdemeurethinspunethinspobligationthinspthinspinheacuterentethinspagravethinsplrsquointerventionthinspmeacutedicalethinspelle-mecircmethinspIlthinsprelegravevethinspdoncthinspdethinsplathinspresponsabiliteacutethinspduthinspmeacutedecinthinspdethinspsrsquoassurerthinspdethinsplathinsptransmissionthinspdethinsplrsquoinformationthinsppertinentethinspauthinsppatientthinspetthinspdethinspsathinspcompreacutehensionthinspdethinsplathinspnaturethinspduthinspbutthinspetthinspdesthinsprisquesthinsprelatifsthinspagravethinsplrsquointerventionthinspToutefoisthinsplathinsptacircchethinspdethinsptransmettrethinspdethinsplrsquoinfor-mationthinspcompleacutementairethinspouthinspdethinspfairethinsplrsquoenseignementthinspauxthinsppatientsthinsppeutthinspecirctrethinspconfieacuteethinspagravethinspdrsquoautresthinspprofessionnelsthinspetthinspcellethinspdethinsprecueillirthinsplathinspsignaturethinspdrsquounthinspthinspformulairethinspdethinspconsentementthinspagravethinspdrsquoautresthinspmembresthinspdethinsplrsquoeacutequipethinspdethinspsoins

mdash Annexe

CMQ - OIIQ - OPIQ 57

mdash Annexe

thinspANNEXEthinspIXthinsp-thinspEacuteVALUATIONthinspDEthinspLrsquoEFFICACITEacutethinspDEthinspLAthinspSEacuteDATIONthinsp(EXEMPLES)thinsp

(Listethinspnonthinsplimitative)thinsp

1 Eacutechelle de seacutedation de Ramsay modifieacuteethinsp(Adapteacute de Merchant et collab 2014b op cit)

Instruction Descriptiondeacutefinition Valeur

thinspObserverthinsplethinsppatientEacuteveilleacutethinspthinsplethinsppatientthinspestthinspanxieuxthinspetthinspagiteacutethinspouthinspnerveuxthinspouthinsplesthinspdeux 1

ObserverthinsplethinsppatientLethinsppatientthinspeacutetablit-ilthinspunthinspcontactthinspvisuelthinspetthinspreacutepond-ilthinspauxthinspordres

Eacuteveilleacutethinspthinsplethinsppatientthinspestthinspcoopeacuteratifthinspthinsporienteacutethinspetthinspcalme 2

ParlerthinspauthinsppatientthinspLethinsppatientthinspeacutetablit-ilthinspunthinspcontactthinspvisuelthinspetthinspreacutepond-t-ilthinspauxthinspordres

Eacuteveilleacutethinspthinsplethinsppatientthinspreacutepondthinspseulementthinspauxthinspordres 3

StimulerthinspphysiquementthinsplethinsppatientthinspenthinspagitantthinspsonthinspeacutepaulethinsptoutthinspenthinspparlantthinspfortthinspLethinsppatientthinspreacuteagit-ilthinspdansthinsplesthinsp10thinspsecon-des

Endormithinspthinsplethinsppatientthinspreacuteagitthinspparthinspunethinspreacuteponsethinspvivethinspagravethinsplathinspstimulationthinspdethinsplathinspgla-bellethinspouthinspagravethinspunthinspstimulusthinspauditifthinspintense 4

StimulerthinspphysiquementthinsplethinsppatientthinspenthinspagitantthinspsonthinspeacutepaulethinsptoutthinspenthinspparlantthinspfortthinspLethinsppatientthinspreacuteagit-ilthinspapregravesthinsp10thinspsecondes

Endormithinspthinsplethinsppatientthinspreacuteagitthinspparthinspunethinspreacuteponsethinspfaiblethinspagravethinsplathinspstimulationthinspdethinsplathinspglabellethinspouthinspagravethinspunthinspstimulusthinspauditifthinspintense

5

UtiliserthinspdesthinspstimulithinspdouloureuxAucunethinspreacuteaction

Endormithinspthinsplethinsppatientthinspnethinspreacuteagitthinsppasthinspagravethinsplathinspdouleur 6

thinsp Peuthinspimportethinsplrsquoeacutechellethinsputiliseacuteethinspcelle-cithinspdoitthinspecirctrethinspchoisiethinspselonthinsplathinspclientegravelethinspetthinsplethinspcontextethinspdonneacutethinspDethinspmecircmethinspsonthinsputilisationthinspdoitthinspecirctrethinspuniformethinspetthinspstandardiseacuteethinspauthinspseinthinspdrsquounethinspmecircmethinspeacutequipethinsp

CettethinspeacutechellethinsppeutthinspecirctrethinsputiliseacuteethinspchezthinsplrsquoenfantthinspToutefoisthinspellethinspserathinspdavantagethinsputilethinspdansthinsplethinspcadrethinspdrsquounethinspeacutevaluationthinsppostseacutedationthinsp(soinsthinsppostproceacutedures)thinspcarthinspilthinsppeutthinspecirctrethinspcliniquementthinspinapproprieacutethinspdethinspstimulerthinspphysiquementthinspunthinspenfantthinspsousthinspseacutedationthinspprofondethinsp

CMQ - OIIQ - OPIQ 58

2 Eacutechelle de vigilance-agitation de Richmond (Richmond Agitation Sedation Scale - RASS) (Tireacute et adapteacute de Chanques et collab 2006)

Lathinsptraductionthinspfranccedilaisethinspdethinspcettethinspeacutechellethinspathinspfaitthinsplrsquoobjetthinspdrsquounethinspvalidationthinspdethinspsathinspthinspreproductibiliteacutethinspinterobservateurthinsp

mdash Annexe

Instruction DescriptionDeacutefinition Niveau

Observerthinsplethinsppatientthinspsansthinspfairethinspdethinspbruit

Srsquoilthinspmanifestethinspunethinspactiviteacutethinspmotricethinspspon-taneacuteethinspquantifierthinsplethinspniveauthinspdrsquoagitationthinsp

Combatifthinspthinspdangerthinspimmeacutediatthinspenversthinsplrsquoeacutequipe + 4Tregraves agiteacutethinspthinsptirethinsparrachethinsptuyauxthinspouthinspcatheacutetersthinspetouthinspagressifthinspenversthinsplrsquoeacutequipe + 3Agiteacutethinspthinspmouvementsthinspfreacutequentsthinspsansthinspbutthinsppreacutecisthinspetouthinspdeacutesadaptationthinspauthinsprespirateur + 2Ne tient pas en placethinspthinspanxieuxthinspouthinspcraintifthinspmaisthinspmouvementsthinsporienteacutesthinsppeuthinspfreacutequentsthinspnonthinspvigoureuxthinspnonthinspagressifs

+ 1

Srsquoilthinspestthinspcalmethinspetthinspreacutepondthinspouthinspnonthinspauxthinspordresthinspsimplesthinsp

Eacuteveilleacute et calmethinspthinspcalmethinspetthinsplesthinspyeuxthinspouvertsConscientthinspthinspRASSthinsp0thinsp+thinspreacutepondthinspauxthinspordresthinspsimples

0

Srsquoilthinspestthinspcalmethinsplesthinspyeuxthinspfermeacutesthinspthinspquan-tifierthinsplethinspniveauthinspdrsquohypovigilancethinsp(outhinspdrsquoendormissement)thinspenthinspsrsquoadressantthinspauthinsppatientthinspparthinspsonthinspnomthinspsansthinsplethinsptoucherthinspenthinsputilisantthinspunethinspvoixthinspdethinspplusthinspenthinspplusthinspfortethinspetthinspdrsquoautantthinspplusthinspfortethinspquethinsplethinsppatientthinspestthinspsusceptiblethinspdrsquoecirctrethinspsourdthinsp(sujetthinspacircgeacutethinspseacutejourthinspprolongeacutethinspenthinspreacuteanimationthinspthinspbouchonthinspdethinspceacuterumenthinsptoxiciteacutethinspdesthinspantibiotiquesthinspetthinspduthinspfuroseacutemide)thinsp

Somnolentthinspthinsppasthinspcomplegravetementthinspeacuteveilleacutethinspmaisthinsprestethinspeacuteveilleacutethinspauthinspcontactthinspvisuelthinspagravethinsplrsquoappelthinspthinsp(gtthinsp10thinsps)

- 1

Diminution leacutegegravere de la vigilancethinspthinsprestethinspeacuteveilleacutethinspbriegravevementthinspavecthinspcontactthinspvisuelthinspagravethinsplrsquoappelthinsp(ltthinsp10thinsps)

- 2

Diminution modeacutereacutee de la vigilancethinspthinspnrsquoimportethinspquelthinspmouvementthinspagravethinsplrsquoappelthinsp(ouverturethinspdesthinspyeux)thinspmaisthinsppasthinspdethinspcon-tactthinspvisuel

- 3

Sithinsplethinsppatientthinspnethinspfaitthinspaucunthinspmouvementthinspythinspcompristhinspenthinsplrsquoappelantthinspdrsquounethinspvoixthinspfortethinspthinspfrictionnerthinspdrsquoabordthinsplrsquoeacutepaulethinsppuisthinsplethinspster-numthinspsansthinspecirctrethinspnociceptifthinsp

Diminution profonde de la vigilancethinspthinspau-cunthinspmouvementthinspagravethinsplrsquoappelthinspnrsquoimportethinspquelthinspmouvementthinspagravethinsplathinspstimulationthinspphysiquethinsp(frictionthinspnonthinspnociceptivethinspdethinsplrsquoeacutepaulethinspouthinspduthinspsternum)

- 4

Non reacuteveillablethinspthinspaucunethinspmouvementthinspnithinspagravethinsplrsquoappelthinspnithinspagravethinsplathinspstimulationthinspphysiquethinsp(frictionthinspnonthinspnociceptivethinspdethinsplrsquoeacutepaulethinspouthinspduthinspsternum)

- 5

CMQ - OIIQ - OPIQ 59

thinspANNEXEthinspXthinsp-thinspEacuteVALUATIONthinspDEthinspLrsquoEFFICACITEacutethinspDEthinspLrsquoANALGEacuteSIEthinsp(EXEMPLES)

(Listethinspnonthinsplimitative)thinsp

Selonthinsplrsquoacircgethinspduthinsppatientthinspsathinspconditionthinspetthinsplethinspcontextethinspcliniquethinspdeuxthinspstrateacutegiesthinspdrsquoeacuteva-luationthinsppeuventthinspecirctrethinsputiliseacuteesthinspsoitthinsplrsquoauto-eacutevaluationthinsp(parthinspdesthinspmotsthinspdesthinspchiffresthinspthinspouthinspdesthinspdessins)thinspouthinsplrsquoheacuteteacutero-eacutevaluationthinspcomportementalethinspCelathinspditthinspsithinsplrsquoauto-thinspeacutevaluationthinspestthinspagravethinspprivileacutegierthinspcrsquoestthinsptoutefoisthinsplrsquoacircgethinspduthinsppatientthinsp(patientthinsppeacutediatrique)thinspetthinspsathinspcapaciteacutethinspcognitivethinspquithinspguiderontthinsplethinspchoixthinspduthinspclinicienthinspdansthinsplathinspseacutelectionthinspduthinspmeilleurthinspoutilthinsp

Pourthinsplethinsppatientthinspnrsquoayantthinsppasthinsplathinspcapaciteacutethinsp(pthinspexthinspthinsphabiliteacutethinspverbalethinspouthinspcognitivethinsplimiteacutee)thinspdrsquoeacutevaluerthinsplui-mecircmethinsplrsquointensiteacutethinspdethinsplathinspdouleurthinspunethinspreacuteponsethinspverbalethinsp(ouinon)thinspouthinspgestuellethinspsignifiantthinsplathinsppreacutesencethinspouthinsplrsquoabsencethinspdethinspdouleurthinspconstituethinspunethinspformethinspdrsquoauto-eacutevaluationthinspacceptablethinspenthinsppratiquethinspcliniquethinspaupregravesthinspdethinspcertainesthinsppopulationsthinsptellesthinspquethinsplethinspjeunethinspenfantthinsplethinsppatientthinspdeacutementthinspouthinspceluithinspvivantthinspavecthinspunethinspdeacuteficiencethinspintellectuellethinsp(McCafferythinspciteacutethinspdansthinspHerrthinspetthinspcollabthinsp2011thinsp[Notrethinsptraduc-

tion])

thinspthinsp Peuthinspimportethinsplrsquoeacutechellethinsputiliseacuteethinspcelle-cithinspdoitthinspecirctrethinspchoisiethinspselonthinsplathinspclientegravelethinspetthinsplethinspcontextethinspdonneacutethinspDethinspmecircmethinspsonthinsputilisationthinspdoitthinspecirctrethinspuniformethinspetthinspstandardiseacuteethinspauthinspseinthinspdrsquounethinspmecircmethinspeacutequipethinspsoignantethinsp

ADULTE-AIcircNEacutethinsp

AUTO-EacuteVALUATIONthinsp(DOULEURthinspAIGUEuml)

thinsprsaquo Eacutechellethinspnumeacuteriquethinsp(0thinspagravethinsp10)thinsp(EN)thinsprsaquo Eacutechellethinspverbalethinspsimplethinsp(EVS)thinsprsaquo Eacutechellethinspvisuellethinspanalogiquethinsp(EVA)

HEacuteTEacuteRO-EacuteVALUATIONthinspCOMPORTEMENTALEthinsp(DOULEURthinspAIGUEuml)

thinsprsaquo ALGOPLUSthinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspdesthinsptroublesthinspdethinsplathinspcommunicationthinspverbale)

thinsprsaquo PACSLACthinspouthinspPACSLAC-Fthinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspunethinspcapaciteacutethinsplimiteacuteethinspagravethinspcommuniquer

thinsprsaquo PAINADthinsp(anglais)thinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspunethinspdeacutemencethinspouthinspautrethinsptroublethinspcognitifthinspetthinspquithinspnethinsppeutthinspcommuniquerthinspdethinspmaniegraverethinspfiable

Les hyperliens concernant ces eacutechelles sont fournis agrave titre informatif seulement

mdash Annexe

mdash Table des matiegraveres

47Annexe III ndash Proceacutedures

protocoles ou algorithmes

48Annexe IV ndash Eacutevaluation des

voies aeacuteriennes supeacuterieures

au moyen du score de

Mallampati

49

Annexe V ndash Outil

drsquoeacutevaluation de

lrsquoapneacutee obstructive

du sommeil (AOS)

adapteacute agrave la consultation

preacuteanestheacutesiqueseacutedation-

analgeacutesie

50Annexe VI ndash Anamnegravese

aide mneacutemotechnique

51Annexe VII ndash Examen

physique aide

mneacutemotechnique

53Annexe VIII ndash Le

consentement

57Annexe IX- Eacutevaluation de

lrsquoefficaciteacute de la seacutedation

(exemples)

59Annexe X ndash Eacutevaluation de

lrsquoefficaciteacute de lrsquoanalgeacutesie

(exemples)

61

Annexe XI ndash Fiche

informative sur lrsquoutilisation

de la naloxone et du

flumazeacutenil

63Annexe XII ndash Consignes

pour la surveillance agrave

domicile au moment du

deacutepart

66Reacutefeacuterences

CMQ - OIIQ - OPIQ 06

INTRODUCTIONLesthinsppreacutesentesthinsplignesthinspdirectricesthinspremplacentthinspcellesthinspduthinspCollegravegethinspdesthinspmeacutedecinsthinspduthinspQueacutebecthinsp(Utilisation de la seacutedation-analgeacutesiethinspndashthinsp2009)thinspetthinsplethinspguidethinspdethinsppratiquethinspcliniquethinspdethinsplrsquoOrdrethinspprofessionnelthinspdesthinspinhalotheacuterapeutesthinspduthinspQueacutebecthinsp(La seacutedation-analgeacutesiethinspndashthinsp2009)thinspEllesthinspontthinspeacuteteacutethinspeacutelaboreacuteesthinspconjointementthinspparthinsplethinspCollegravegethinspdesthinspmeacutedecinsthinspduthinspQueacutebecthinsp(CMQ)thinsplrsquoOrdrethinspdesthinspinfirmiegraveresthinspetthinspinfirmiersthinspduthinspQueacutebecthinsp(OIIQ)thinspetthinsplrsquoOrdrethinspprofessionnelthinspdesthinspinhalotheacuterapeutesthinspduthinspQueacutebecthinsp(OPIQ)thinspetthinspellesthinspontthinsppourthinspobjectifthinspdrsquoharmoniserthinsplathinsppratiquethinspcliniquethinspdethinsplathinspseacutedation-analgeacutesiethinsp

Ellesthinspconcernentthinspsurtoutthinsplesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspeffectueacuteesthinspsousthinspseacutedation-analgeacutesiethinspdethinspniveauthinspminimalthinspagravethinspmodeacutereacutethinspchezthinspdesthinsppatientsthinspclasseacutesthinspprincipalementthinspdansthinsplesthinspcateacutegoriesthinspASAthinspPhysicalthinspStatusthinsp1thinspetthinsp2thinspetthinspsousthinspcertainesthinspconditionsthinspdethinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp3thinspetthinsp4thinspLathinspseacutedation-analgeacutesiethinspdethinspniveauthinspprofondthinspetthinsplrsquoanestheacutesiethinspgeacuteneacuteralethinspnethinspfontthinsppasthinsplrsquoobjetthinspdethinspcettethinsppublicationthinspetthinspdoiventthinspecirctrethinspplutocirctthinspreacutealiseacuteesthinspdansthinspdesthinspeacutetablissementsthinspposseacutedantthinsptoutesthinsplesthinspinstallationsthinspetthinsplesthinspressourcesthinspprofessionnellesthinspayantthinsplrsquoexpertisethinspthinsprequisethinsppourthinspassurerthinspunethinspprisethinspthinspenthinspchargethinspoptimalethinspetthinspseacutecuritaire

Ellesthinspdeacutecriventthinsplrsquoensemblethinspdesthinspconditionsthinspexigeacuteesthinsplorsquethinsplrsquoonthinspprocegravedethinspagravethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspsousthinspseacutedation-analgeacutesiethinspquethinspcethinspsoitthinsppourthinspunthinspadultethinspouthinspunthinspenfantthinspEllesthinspsontthinspconccediluesthinspdansthinsplethinspbutthinspdrsquooffrirthinspdesthinsprecommandationsthinspvisantthinspunthinspdegreacutethinspoptimalthinspdethinspseacutecuriteacutethinspnotammentthinspenthinspcethinspquithinspconcernethinsplrsquoeacutevaluationthinsplathinspsurveillancethinspcliniquethinspythinspcompristhinsplethinspmonitoragethinspetthinsplathinspmeacutedicationthinsppeu importethinsplrsquoendroitthinspougravethinsplathinspseacutedation-analgeacutesiethinspestthinspeffectueacuteethinspEllesthinspdeacutecriventthinspeacutegalementthinsplesthinspcompeacutetencesthinspprofessionnellesthinspneacutecessairesthinsppourthinsplathinspreacutealisationthinspdrsquounethinspseacutedation-analgeacutesiethinspoptimalethinspetthinspseacutecuritairethinsplesthinspressourcesthinsphumainesthinspetthinspmateacuteriellesthinsprequisesthinsplathinspmarchethinspagravethinspsuivrethinsplesthinsppreacutecautionsthinsprelativesthinspauthinspbien-ecirctrethinspetthinspagravethinsplathinspseacutecuriteacutethinspduthinsppatientthinspainsithinspquethinsplesthinspeacuteleacutementsthinspquithinspdoiventthinspecirctrethinspinscritsthinspauthinspdossierthinsp

Ellesthinspontthinspeacuteteacutethinspconccediluesthinsppourthinspquethinsplesthinspmembresthinspdethinspchacunthinspdesthinspordresthinsppuissentthinspfacilementthinspsrsquoythinspreconnaicirctrethinspselonthinsplesthinspmodaliteacutesthinspquithinspencadrentthinsplrsquoexercicethinspdethinspleurthinspprofessionthinsprespectivethinspdansthinspunthinspcontextethinspdethinsppratiquethinspinterprofessionnellethinsp

thinspthinspthinsp

CMQ - OIIQ - OPIQ 07

Puisquethinsplrsquoenfantthinsppossegravedethinspdesthinspcaracteacuteristiquesthinspquithinspluithinspsontthinsppropresthinspunethinspsectionthinspparticuliegraverethinspluithinspestthinspconsacreacuteethinsp

Enthinsptoutthinsptempsthinspnousthinspdevonsthinsprecourirthinspagravethinsplathinspseacutedation-analgeacutesiethinspavecthinspthinspcirconspectionthinspetthinspprudencethinspLrsquoeacutevaluationthinspduthinsppatientthinsplrsquoadministrationthinspthinspdethinsplathinspmeacutedicationthinspetthinsplathinspsurveillancethinspcliniquethinspdoiventthinspecirctrethinspeffectueacuteesthinspthinspavecthinsplathinspmecircmethinsprigueurthinspquethinsppourthinsplrsquoanestheacutesiethinspgeacuteneacuteralethinsp

CMQ - OIIQ - OPIQ 08

Chapitre 1 Patient adulte

thinsp11thinspDEacuteFINITIONthinspOBJECTIFSthinspETthinspCLIENTEgraveLEthinspCIBLEthinsp

Lathinspseacutedation-analgeacutesiethinspestthinspunethinspproceacutedurethinspquithinspsethinspdeacutefinitthinspcommethinspeacutetantthinsplrsquoadmi-nistrationthinspdethinspmeacutedicamentsthinspouthinspdethinspsubstancesthinspservantthinspagravethinspalteacutererthinsplethinspniveauthinspdethinspconsciencethinspdrsquounethinsppersonnethinspsathinspperceptionthinspdethinsplathinspdouleurthinspetthinspsathinsptoleacuterancethinspagravethinsplrsquoen-vironnementthinsptoutthinspenthinspluithinsppermettantthinspunethinspreacuteponsethinspagravethinsplathinspstimulationthinspverbalethinspouthinsptactilethinspetthinsplethinspmaintienthinspdrsquounethinspfonctionthinspcardiaquethinspetthinspventilatoirethinspadeacutequatethinspenthinsptousthinsppointsthinsp(OPIQthinsp2009)

Ellethinsppermetthinspdoncthinspdethinspmieuxthinsptoleacutererthinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspdethinspfaccedilonthinspseacutecuritairethinspCertainsthinsppatientsthinsprequerrontthinspsurtoutthinspunethinspseacutedationthinspdrsquoautresthinspunethinspanalgeacutesiethinspetthinsplathinspplupartthinsplesthinspdeuxthinspagravethinsplathinspfoisthinspLesthinspmeacutedicamentsthinspetthinsplathinspproceacutedurethinsputiliseacutesthinspdeacutependrontthinspprincipalementthinspduthinspniveauthinspdethinspseacutedationthinspetthinspdrsquoanal-geacutesiethinspdeacutesireacutethinspselonthinsplathinspnaturethinspetthinsplathinspdureacuteethinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacutera-peutiquethinspetthinspselonthinsplesthinspcaracteacuteristiquesthinspduthinsppatientthinspDrsquoailleursthinsplesthinspbesoinsthinspparticu-liersthinspduthinsppatientthinspdoiventthinspecirctrethinsppristhinspenthinspconsideacuteration

Lesthinspobjectifsthinspviseacutesthinspparthinsplathinspseacutedation-analgeacutesiethinsplorsthinspdrsquounethinspinterventionthinspdiagnos-tiquethinspouthinsptheacuterapeutiquethinspsontthinspdrsquoassurerthinsplathinspseacutecuriteacutethinspetthinsplethinspbien-ecirctrethinspduthinsppatientthinspetthinspdethinsppermettrethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspdethinspqualiteacutethinspenthinsp

a fournissantthinspunethinspanalgeacutesiethinspunethinspseacutedationthinspetthinspunethinspamneacutesiethinspadapteacutees

b controcirclantthinsplesthinspcomportementsthinspmoteursthinspnuisiblesthinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

c minimisantthinsplesthinspreacuteponsesthinsppsychologiquesthinspdeacutefavorablesthinspassocieacuteesthinspauxthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspdouloureusesthinspouthinspanxiogegravenesthinsp

Lathinspseacutelectionthinspdesthinsppatientsthinsppourthinsplathinspseacutedation-analgeacutesiethinspestthinspfondeacuteethinspsurthinsplrsquoeacutevaluationthinspcliniquethinspdethinspleurthinspeacutetatthinspdethinspsanteacutethinspAgravethinspcettethinspfinthinspilthinspestthinsprecommandeacutethinspdrsquoutiliserthinsplathinspclassi-ficationthinspdethinsplrsquoeacutetatthinspphysiquethinspduthinsppatientthinspquethinsplrsquoonthinsptrouvethinspdansthinsplethinsptableauthinspdethinsplathinsppagethinspsuivante

CMQ - OIIQ - OPIQ 09

Classification Eacutetatthinspdethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp1 Patientthinspenthinspbonnethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp2Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspleacutegegravere

ASAthinspPhysicalthinspStatusthinsp3Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgrave

ASAthinspPhysicalthinspStatusthinsp4Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgravethinspquithinsprepreacutesentethinspthinspunethinspmenacethinspconstantethinsppourthinspsathinspvie

ASAthinspPhysicalthinspStatusthinsp5Patientthinspmoribondthinspquithinspnethinspsurvivrathinsppasthinspthinspagravethinspmoinsthinspdrsquounethinspinterventionthinsp

ASAthinspPhysicalthinspStatusthinsp6Patientthinspdeacuteclareacutethinspenthinspeacutetatthinspdethinspmortthinspceacutereacutebralethinspdontthinsplesthinsporganesthinspontthinspeacuteteacutethinsppreacuteleveacutesthinspagravethinspdesthinspfinsthinspdethinspdon

Tableau 1Classification de lrsquoeacutetat physique du patient selon lrsquoAmerican Society of Anesthesiologists (ASA) (ASA Physical Status Classification System) [En ligne] (Notre traduction)

Ainsithinsplorsquethinsplathinspseacutedation-analgeacutesiethinspestthinspreacutealiseacuteethinspparthinspunthinspmeacutedecinthinspsansthinsplathinspcolla-borationthinspdirectethinspdrsquounthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesio-logiethinspouthinspenthinspreacuteanimationthinspcardiorespiratoirethinspavanceacuteethinsplesthinspinterventionsthinspdiagnos-tiquesthinspouthinsptheacuterapeutiquesthinspdoiventthinspecirctrethinspreacuteserveacuteesthinspprincipalementthinspauxthinsppatientsthinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp1thinspouthinspauxthinsppatientsthinspatteintsthinspdrsquounethinspaffectionthinspsysteacutemiquethinspleacutegegraverethinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp2thinsp

CMQ - OIIQ - OPIQ 10

Notonsthinspquethinspdansthinspdesthinspsituationsthinspparticuliegraveresthinspetthinspjustifieacuteesthinspauthinspdossierthinspmeacutedi-calthinsplathinspseacutedation-analgeacutesiethinsppeutthinspecirctrethinspeffectueacuteethinspchezthinsplesthinsppatientsthinspstablesthinspdethinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp3thinspetthinspexceptionnellementthinspdethinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp4thinspToutefoisthinspellethinspdoitthinsplrsquoecirctrethinspdansthinspdesthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspopti-malethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespira-toirethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspDethinspplusthinspcesthinsppatientsthinspdoiventthinspfairethinsplrsquoobjetthinspdrsquounethinspeacutevaluationthinspindividualiseacuteethinspetthinspplusthinspapprofondiethinsp

Lathinspprofondeurthinspdethinsplathinspseacutedationthinspetthinsplethinspniveauthinspdrsquoanalgeacutesiethinsprechercheacutethinspenthinspseacutedation-analgeacutesiethinspdoiventthinspcorrespondrethinspauxthinspniveauxthinsppermettantthinsplrsquoatteintethinspdesthinspobjectifsthinspviseacutesthinspetthinspecirctrethinspmesureacutesthinspagravethinsplrsquoaidethinspdrsquoeacutechellesthinspstandardiseacuteesthinspvalideacuteesthinspdethinsppreacutefeacuterencethinspetthinspadapteacuteesthinspauthinspcontextethinspetthinspagravethinsplathinspconditionthinspduthinsppatientthinspLesthinspniveauxthinspdethinspseacutedation-analgeacutesiethinspviseacutesthinsptelsthinspquethinspdeacutefinisthinspdansthinsplathinspclassificationthinspdethinsplrsquoASAthinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinspASAthinspHousethinspofthinspDelegatethinsp2014a)thinsp(annexethinspI)thinspdoiventthinspcorrespondentthinspagravethinsplrsquounthinspouthinsplrsquoautrethinspdesthinspdeuxthinspniveauxthinspsuivantsthinsp(CMQthinsp2009)thinsp

thinsprsaquo seacutedationthinspminimalethinspouthinsplaquothinspanxiolysethinspraquothinspougravethinsplrsquoappreacutehensionthinspduthinsppatientthinspestthinspdiminueacuteethinspsansthinspchangementthinspdethinspsonthinspniveauthinspdethinspconsciencethinspetthinspsansthinspalteacutererthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsplathinspventilationthinspetthinsplathinspfonctionthinspcardiovasculaire

thinsprsaquo seacutedationthinspmodeacutereacuteethinspougravethinsplathinspreacuteponsethinspauxthinspstimulithinspverbauxthinspouthinsptactilesthinspleacutegersthinspestthinspvolontairethinspsansthinspaffecterthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsplathinspventilationthinspspontaneacuteethinspetthinsplathinspfonctionthinspcardiovasculaire

Notonsthinsptoutefoisthinspquethinsplrsquoeacutequipethinspsoignantethinspparticipantthinspagravethinsplathinspproceacutedurethinspdoitthinspconnaicirctrethinsplethinspniveauthinspdethinspseacutedation-analgeacutesiethinspgeacuteneacuteralementthinspneacutecessairethinsppourthinspunethinspinterventionthinspdonneacuteethinspDethinspmecircmethinspellethinspdoitthinspecirctrethinsppreacutepareacuteethinspagravethinspgeacutererthinsplethinsppassagethinspmomentaneacutethinspagravethinspunthinspniveauthinspdethinspseacutedationthinspsupeacuterieurthinspagravethinspceluithinspquithinspathinspeacuteteacutethinspplanifieacutethinsp(crsquoest-agrave-direthinspplusthinspprofondthinspquethinsppreacutevu)thinspcethinspquithinsppeutthinspsurvenirthinspenthinsptoutthinsptempsthinsplorsthinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsp

CMQ - OIIQ - OPIQ 11

Volet organisationnel

thinsp12thinspCOMPEacuteTENCESthinspPROFESSIONNELLESthinsp

Consideacuterantthinspquethinsplathinspseacutedation-analgeacutesiethinspsrsquoinscritthinspdansthinspunethinsppratiquethinspdethinspcollabo-rationthinspentrethinsplethinspmeacutedecinthinspetthinspdrsquoautresthinspprofessionnelsthinspdethinsplathinspsanteacutethinsp(infirmiegraveresthinspetthinspinhalotheacuterapeutes)thinspilthinspimportethinspdethinsppreacuteciserthinspqursquounethinsputilisationthinspjudicieusethinspdethinspleursthinspcompeacutetencesthinspestthinspdethinspmisethinsppourthinspassurerthinsplathinspqualiteacutethinspetthinsplrsquoefficiencethinspdesthinspsoinsthinspAinsithinsptousthinspdoiventthinspavoirthinsplesthinspqualificationsthinsprequisesthinspdansthinsplethinspdomainethinspdethinsplathinspseacutedation-thinspanalgeacutesie

Dethinspplusthinsplrsquoeacutequipethinspsoignantethinspquithinspreacutealisethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacutera-peutiquethinspsousthinspseacutedation-analgeacutesiethinspdoitthinsp

a ecirctrethinspenthinspmesurethinspdrsquoeacutevaluerthinspadeacutequatementthinsplathinspconditionthinspdethinspsanteacutethinspduthinsppatientthinspetthinspdrsquoenthinspassurerthinsplathinspsurveillancethinspclinique

b connaicirctrethinspetthinsputiliserthinspjudicieusementthinsplathinspmeacutedicationthinspainsithinspquethinspsesthinspantagonistes

c posseacutederthinsplesthinspconnaissancesthinspetthinsplesthinspcompeacutetences1thinspneacutecessairesthinsppourthinspintervenirthinspenthinspsituationthinspdrsquourgencethinsptellethinspquethinsplathinspreacuteanimationthinspcardiorespiratoire2thinsp(dethinsppreacutefeacuterencethinspenthinspsoinsthinspavanceacutes)thinspcrsquoest-agrave-direthinspmaicirctriserthinspenthinspprioriteacutethinsplesthinsptechniquesthinspdethinsplathinspprisethinspenthinspchargethinspdethinsplathinspventilationthinspduthinspmassagethinspcardiaquethinspetthinspdethinsplathinspmeacutedicationthinspassocieacutee

d avoirthinsplrsquoexpertisethinsprequisethinspselonthinsplathinspclientegravelethinspviseacuteethinspetthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspagravethinspreacutealiserthinsp

thinsp13thinspRESSOURCESthinspMATEacuteRIELLESthinsp

1thinspLOCAUX

LrsquoameacutenagementthinspdesthinsplocauxthinspdoitthinsppermettrethinspdethinspreacutealiserthinspdethinspfaccedilonthinspadeacutequatethinspetthinspenthinsptoutthinsptempsthinspunethinspreacuteanimationthinspcardiorespiratoirethinspainsithinspqursquounethinspeacutevacuationthinspdrsquourgencethinsplethinspcasthinspeacutecheacuteantthinspEntrethinspautresthinsplathinspsuperficiethinspdoitthinsppermettrethinspauthinsppersonnelthinspdethinspcircu-lerthinsplibrementthinsplrsquoeacuteclairagethinspdoitthinspecirctrethinspsuffisantthinsplethinspmateacuterielthinspdrsquourgencethinsp(pthinspexthinspthinspdethinspreacuteani-mation)thinspdoitthinspecirctrethinspfacilementthinspaccessiblethinspetthinspentreposeacutethinspdansthinspunthinsplieuthinspconnuthinspdethinsptousthinsp

Selonthinsplesthinspmodaliteacutesthinspdethinspfonctionnementthinspetthinsplethinsptypethinspdrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsppratiqueacutethinspilthinspestthinspdrsquousagethinspdethinspdisposerthinspdrsquounethinspsallethinspdethinspreacutecupeacutera-tionthinspouthinspdrsquoobservation

1thinspthinspthinspthinspOnthinspentendthinspparthinspconnaissancesthinspetthinspcompeacutetencesthinspqursquoellesthinspsoientthinspmisesthinspagravethinspjourthinspselonthinsplesthinsprecommandationsthinspenthinspvigueur2thinspthinspthinspOnthinspentendthinspparthinspcertificationthinspenthinspreacuteanimationthinspcardiorespiratoirethinsplesthinspformationsthinspsuivantesthinspthinsp thinsprsaquothinspReacuteanimationthinspcardiorespiratoirethinspdethinspbasethinspthinspSoinsthinspimmeacutediatsthinspenthinspreacuteanimationthinsp(SIR)thinsppourthinspprofessionnelsthinspdethinsplathinspsanteacutethinspthinspthinspthinspthinspthinspthinspthinspthinspouthinsplrsquoeacutequivalentthinsp thinsprsaquothinspReacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspSoinsthinspavanceacutesthinspenthinspreacuteanimationthinspcardiovasculairethinsp(SARC)thinspouthinsplrsquoeacutequivalent

CMQ - OIIQ - OPIQ 12

Pourthinspinformationthinspcompleacutementairethinsp(annexethinspII)thinspProceacutedures et interventions en milieu extrahospitalierthinsp(CMQthinsp2011)

2thinspEacuteQUIPEMENTthinsp(INTRAthinspETthinspEXTRAHOSPITALIER)

OBLIGATOIRE

Enthinspplusthinspduthinspmateacuterielthinspdirectementthinsplieacutethinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspjustifiantthinsplathinspseacutedation-analgeacutesiethinsponthinspdoitthinsptrouverthinspminimalementthinsplrsquoeacutequipe-

mentthinspsuivant

Dansthinsplathinspsallethinsp

thinsprsaquo tablethinspdrsquoexamenthinspciviegraverethinspouthinsptablethinspdethinspchirurgiethinsprsaquo tablethinsppourthinsplesthinspinstrumentsthinsprsaquo soluteacutesthinspetthinspmateacuterielthinspneacutecessairethinsppourthinsplrsquoinstallationthinspetthinsplethinspmaintienthinspdrsquounethinspvoiethinsp

endoveineusethinsprsaquo saturomegravetrethinsp(oxymegravetrethinspdethinsppouls)thinsp

Lethinspmonitoragethinspdethinsplathinspsaturationthinspenthinspoxygegravenethinsppermetthinsplrsquoeacutevaluationthinspdethinsplrsquooxy-geacutenationthinsp(deacutetectionthinsppreacutecocethinspdrsquounethinsphypoxeacutemie)thinspmaisthinspilthinspnethinsppeutthinsppasthinspdeacutetecterthinsppreacutecocementthinspunethinspobstructionthinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(AmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2012)thinspthinsp

thinsprsaquo steacutethoscopethinspthinsprsaquo sphygmomanomegravetrethinspouthinspappareilthinspautomatiseacutethinspnonthinspinvasifthinsppourthinsplathinspprisethinspdethinsplathinsp

pressionthinsparteacuteriellethinsprsaquo sourcethinspdrsquooxygegravenethinspcomprimeacutethinspenthinspquantiteacutethinspsuffisantethinsppourthinspenthinsppermettrethinsp

llsquoadministrationthinspagravethinspunthinspdeacutebitthinspdethinsp15thinsplitresthinspparthinspminutethinsppendantthinsp60thinspminutesthinspetthinspthinsplethinspmateacuterielthinspneacutecessairethinspagravethinsplrsquooxygeacutenotheacuterapie

thinsprsaquo appareilthinspagravethinspaspirationthinsppouvantthinspgeacuteneacutererthinspunethinsppressionthinspneacutegativethinspdethinsp40ndash60thinspmmthinspHgthinspouthinspunethinspcapaciteacutethinspdethinspflotthinspdethinsp100thinsplitresthinspparthinspminutethinspetthinsplethinspmateacuterielthinspneacutecessairethinspthinspagravethinsplrsquoaspiration

thinsprsaquo lethinspmateacuterielthinspneacutecessairethinspagravethinsplathinspprisethinspenthinspchargethinspventilatoirethinspentrethinspautresthinspreacuteanimateurthinspmanuelthinspautogonflablethinsp(Ambuthinspbag)thinspmasquethinspcanulesthinspnasothinspthinspetthinsporopharyngeacuteesthinspdethinsptaillesthinspvarieacutees

Ce mateacuteriel doit ecirctre disponible agrave porteacutee de la main

CMQ - OIIQ - OPIQ 13

thinsprsaquo appareilthinspdrsquoalimentationthinspeacutelectriquethinspdethinspsecoursthinsppourthinsplethinspfonctionnementthinspdesthinspeacutequipementsthinspdrsquourgence

Peutthinspecirctrethinspagravethinsplrsquoexteacuterieurthinspdethinsplathinspsallethinsp(maisthinspfacilethinspdrsquoaccegravesthinspetthinsprapidementthinspdisponible)thinsp

thinsprsaquo thinsparmoirethinspfermeacuteethinsppourthinspentreposerthinspsousthinspcleacutethinspauthinspbesointhinsplethinspmateacuterielthinspetthinsplesthinspsubstancesthinspcontrocircleacuteesthinspainsithinspquethinsplesthinspbenzodiazeacutepines

thinsprsaquo mateacuterielthinspneacutecessairethinspagravethinsplrsquointubationthinspendotracheacutealethinspentrethinspautresthinspsondesthinspendotracheacutealesthinspetthinsplamesthinspdethinsplaryngoscopethinspdethinsptaillesthinspvarieacuteesthinspainsithinspquethinspdesthinspalternativesthinspagravethinsplrsquointubationthinspdifficilethinsp(pthinspexthinspthinspoutilsthinspextraglottiquesthinsptelsthinspquethinspmasquesthinsplaryngeacutes)

thinsprsaquo deacutefibrillateurthinspcardiaquethinsp(dethinsppreacutefeacuterencethinspunthinspdeacutefibrillateurthinspexternethinspautomatiseacutethinsp[DEA])

thinsprsaquo pharmaciethinsp(troussethinspouthinspchariot)thinspcontenantthinsplesthinspmeacutedicamentsthinspneacutecessairesthinspauthinsptraitementthinspdesthinspsituationsthinspdrsquourgencethinsptellesthinspquethinspthinspsurdosagethinspauxthinspopioiumldesthinspouthinspauxthinspbenzodiazeacutepinesthinspurgencethinspcardiaquethinspreacuteactionthinspallergiquethinspcrisethinspdrsquoasthmethinspcrisethinspconvulsivethinspchocthinspvagalthinsphypoglyceacutemiethinspetc

RECOMMANDEacutethinspSELONthinspLAthinspSITUATION

thinsprsaquo moniteurthinspcardiaquethinspthinspdansthinspcertainsthinspcasthinspbienthinspdeacutefinisthinsplethinspmonitoragethinspcardiaquethinsppeutthinspecirctrethinsprecommandeacutethinspouthinspobligatoirethinsp(tableauthinsp3)

thinsprsaquo capnographethinspthinspdansthinspcertainsthinspcasthinspbienthinspdeacutefinisthinsplethinspmonitoragethinspduthinspCO2thinsppeutthinspecirctrethinsp

recommandeacutethinspouthinspobligatoirethinsp(tableauthinsp3)thinspthinspLethinspmonitoragethinspduthinspCO

2thinsppermetthinspdrsquoidentifierthinsppreacutecocementthinsplesthinspcomplicationsthinsp

tellesthinsplathinspseacutedationthinspexcessivethinsplrsquohypoventilationthinspetthinsplrsquoapneacuteethinspenthinspplusthinspdethinsppermettrethinspdethinspmieuxthinspcontrocirclerthinsplethinspniveauthinspdethinspseacutedationthinspenthinspfonctionthinspdethinsplrsquointerventionthinspthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinspSonthinsputilisationthinsppermetthinspeacutegalementthinspthinspdethinspsuivrethinsplethinspmonitoragethinspventilatoirethinspCelathinspestthinspparticuliegraverementthinspapproprieacutethinspthinsplorsqursquoilthinspnrsquoexistethinsppasthinspdrsquoantagonistesthinspagravethinsplathinspmeacutedicationthinsputiliseacuteethinsp(pthinspexthinspthinsppropofol)thinsp

OPTIONNEL

thinsprsaquo moniteurthinspdethinsptempeacuteraturethinspetthinspdispositifthinspdethinspreacutechauffementthinspduthinsppatientthinspselonthinsplethinsppatientthinspetthinsplathinspdureacuteethinspdethinsplrsquointerventionthinsp

thinsprsaquo systegravemethinspdrsquoantipollutionthinsp(eacutevacuationthinspduthinspprotoxydethinspdrsquoazote)thinspsrsquoilthinspythinspathinsplieuthinsprsaquo analyseurthinspdrsquooxygegravenethinsplorsqursquounthinspmeacutelangethinspestthinsputiliseacutethinsp(pthinspexthinspthinspO

2thinspetthinspprotoxydethinsp

drsquoazote)thinsprsaquo steacutethoscopethinsppreacutecordialthinspouthinsppreacutetracheacutealthinsppourthinspeacutecoutethinspenthinspcontinu

CMQ - OIIQ - OPIQ 14

LrsquoensemblethinspdethinspcesthinspeacutequipementsthinspdoitthinspecirctrethinspadapteacutethinspauthinsppatientthinspIlsthinspdoiventthinspecirctrethinspenthinspeacutetatthinspdethinspfonctionnerthinspetthinsplesthinspattestationsthinspdesthinspveacuterificationsthinsppeacuteriodiquesthinspdoiventthinspecirctrethinspconserveacuteesthinspdansthinspunthinspregistrethinsppreacutevuthinspagravethinspcettethinspfin

Pendantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplesthinspprofessionnelsthinspdoiventthinspthinsprespecterthinsplesthinspregraveglesthinspdethinsppreacuteventionthinspetthinspdethinspcontrocirclethinspdesthinspinfections

Unethinspproceacutedurethinsprelativethinspauxthinspsituationsthinspdrsquourgencethinsp(annexethinspIII)thinspagravethinsplrsquoaccegravesthinspauxthinspser-vicesthinspdrsquourgencethinsppreacutehospitaliersthinspetthinspdethinsptransfertthinspselonthinspunethinspententethinspintereacutetablisse-mentsthinspdoitthinspecirctrethinspeacutelaboreacuteethinspmaintenuethinspagravethinspjourthinspfacilementthinspdisponiblethinspenseigneacuteethinspagravethinsptoutthinsplethinsppersonnelthinspetthinspfairethinsplrsquoobjetthinspdrsquounthinsprappelthinspaupregravesthinspdethinspcethinspdernierthinspsurthinspunethinspbasethinsp

peacuteriodiquethinsp

CMQ - OIIQ - OPIQ 15

Volet professionnel

thinsp14thinspPREacuteSEacuteDATION-ANALGEacuteSIEthinsp

SEacuteLECTIONthinspDESthinspPATIENTS

Lathinspseacutelectionthinspdesthinsppatientsthinspdoitthinsptenirthinspcomptethinspnotammentthinspdethinsplrsquoeacutevaluationthinspdesthinspvoiesthinspaeacuteriennesthinspetthinspdethinsplrsquoeacutetatthinspdethinspsanteacutethinspgeacuteneacuteralthinspduthinsppatientthinspquithinspaurontthinspmisthinspenthinspeacutevi-dencethinsplathinsppreacutesencethinspouthinsplrsquoabsencethinspdrsquoindicateursthinspdethinsppossiblesthinspcomplicationsthinsplorsthinspdethinsplathinspseacutedation-analgeacutesiethinspIlthinspexistethinspdeuxthinsptypesthinspdethinsprisquesthinspenthinspseacutedation-analgeacutesiethinspthinsplesthinsprisquesthinsppreacutevisiblesthinsp(difficulteacutethinsppotentiellethinsplieacuteethinspagravethinsplathinspgestionthinspdesthinspvoiesthinspaeacuteriennesthinspouthinspinstabiliteacutethinspduthinsppatient)thinspetthinsplesthinsprisquesthinspimpreacutevisiblesthinsp(incidentaccidentthinsperreurthinsphu-mainethinspetc)thinspUnethinspeacutevaluationthinspinitialethinsp(histoirethinspexamenthinspphysique)thinspadeacutequatethinspavantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspdiminuethinspdethinsptelsthinsprisques

Agravethinsppartirthinspdethinsplrsquoensemblethinspdesthinspeacutevaluationsthinspeffectueacuteesthinsplethinspmeacutedecinthinspseacutelectionnethinsplesthinsppatientsthinspaptesthinspagravethinsprecevoirthinspunethinspseacutedation-analgeacutesiethinspselonthinspnotammentthinsp

thinsprsaquo lesthinspfacteursthinspdethinsprisquethinspidentifieacutesthinspagravethinsplathinspsuitethinspdethinsplrsquoeacutevaluationthinsp(cardiovasculairethinsprespiratoirethinspheacutepatiquethinspneurologique)thinspdethinsplathinsppossibiliteacutethinspdethinspgrossessethinspchezthinsplathinspfemmethinspenthinspacircgethinspdethinspprocreacuteerthinspouthinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspenvisageacutee

thinsprsaquo lrsquoeacutevaluationthinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(annexethinspIV)thinspafinthinspdethinsppreacuteciserthinsplethinsprisquethinspdrsquoassistancethinspventilatoirethinspetthinspdrsquointubationthinspdifficilethinsp

thinsprsaquo lesthinspanteacuteceacutedentsthinspanestheacutesiquesthinspetthinspchirurgicauxthinspafinthinspdrsquoidentifierthinsplesthinspcomplicationsthinsppotentielles

thinsprsaquo lesthinspcomorbiditeacutesthinspdontthinsplesthinsptroublesthinsprespiratoiresthinspduthinspsommeilthinsp(annexethinspV)thinsprsaquo lathinspmeacutedicationthinspouthinspautresthinspsubstancesthinsp(prescritesthinspouthinspenthinspventethinsplibre)thinspafinthinsp

drsquoidentifierthinsplesthinsprisquesthinspdrsquointeractionsthinspavecthinsplesthinspmeacutedicamentsthinsputiliseacutesthinsplorsthinspdethinsplrsquointerventionthinspouthinspdethinsplathinspseacutedation-analgeacutesie

thinsprsaquo lrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspquithinsppourraitthinspneacutecessiterthinspunethinspseacutedation-analgeacutesiethinspdrsquounthinspniveauthinspsupeacuterieurthinspagravethinspceluithinspdontthinspilthinspestthinspquestionthinspdansthinspcesthinsplignesthinspdirectrices

thinsprsaquo lesthinspcaracteacuteristiquesthinsppropresthinspauthinsppatientthinsp(fonctionsthinspcognitivesthinspisolementthinspsocialthinspautonomiethinspetc)

EacuteVALUATIONthinspDESthinspPATIENTS

Cettethinspeacutevaluationthinspdoitthinspsethinspfairethinsppeuthinspdethinsptempsthinsp(moinsthinspdethinsp3thinspmoisthinspenthinsplrsquoabsencethinspdethinspchangementthinspnotablethinspdansthinsplathinspconditionthinspcliniquethinspduthinsppatient)thinspavantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspetthinspdoitthinspnotammentthinsppreacuteciserthinspcethinspquithinspsuit

CMQ - OIIQ - OPIQ 16

AgravethinspLrsquoANAMNEgraveSEthinspthinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsp

lrsquoeacutevaluationthinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinsp(annexethinspVI)thinsp

thinsprsaquo raison(s)thinspdethinspconsultationthinspetthinsphistoirethinspdethinsplathinspmaladiethinspactuellethinsprsaquo anteacuteceacutedentsthinsprsaquo reacuteactionthinspanteacuterieurethinspagravethinsplathinspseacutedation-analgeacutesiethinspagravethinsplrsquoanestheacutesiethinspetthinspagravethinsplathinspchirurgiethinsprsaquo allergiesthinsprsaquo momentthinspduthinspdernierthinspingestathinsp(preacuteciserthinsplethinsptypethinspetthinsplathinspquantiteacute)thinsprsaquo meacutedicationthinspetthinspautresthinspsubstancesthinsp(prescritesthinspouthinspnon)thinsprsaquo preacutemeacutedicationthinspreccediluethinsp(pthinspexthinspthinspadministrationthinspdethinspmorphinethinspchezthinspunthinsppatientthinspenthinsp

attentethinspdrsquounethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutique)thinsprsaquo habitudesthinspdethinspviethinsp(tabacthinspalcoolthinspouthinspdrogues)thinsprsaquo troublethinsprespiratoirethinspduthinspsommeilthinspetthinsplathinsptheacuterapiethinspassocieacutee

AgravethinspLrsquoEXAMENthinspPHYSIQUEthinsp

Lrsquoexamenthinspphysiquethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinspcherchethinspagravethinspmettrethinspenthinspeacutevi-dencethinspcertainsthinspcritegraveresthinspreconnusthinsppourthinspecirctrethinspassocieacutesthinspagravethinspunethinspassistancethinspventila-toirethinspdifficilethinspquithinsppeutthinspsurvenirthinspdansthinsplethinspcasthinspdrsquounthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquethinspceluithinspviseacutethinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsplrsquoeacutevaluationthinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinsp(annexethinspVII)thinsp

Lrsquoexamenthinspphysiquethinspdoitthinspecirctrethinspadapteacutethinspagravethinspchaquethinsppatientthinspetthinspporterthinspnotammentthinspsurthinspdesthinspeacuteleacutementsthinsptelsthinspquethinspceux-cithinsp

thinsprsaquo preacutesencethinspdrsquoobeacutesiteacutethinsprsaquo tecirctethinspetthinspcouthinsp

thinsprsaquo mobiliteacutethinspcervicalethinspcompromisethinsprsaquo couthinspcourtthinspouthinsplargethinsp(circonfeacuterencethinsp )thinsprsaquo pathologiethinspouthinspanomaliethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(pthinspexthinspthinspmassethinsp

cervicale)thinspthinsprsaquo bouchethinsp

thinsprsaquo petitethinspouverturethinsprsaquo dentitionthinsp(pthinspexthinspthinspbouchethinspeacutedenteacuteethinspdentsthinspinstablesthinspincisivesthinspproeacuteminentesthinsp

outhinspappareilthinspdentairethinspmalocclusionthinspimportante)thinsp

LethinspscorethinspdethinspMallampatithinspmodifieacutethinspestthinspunthinspoutilthinspagravethinspprivileacutegierthinsp(annexethinspIV)

CMQ - OIIQ - OPIQ 17

UnethinspbonnethinspeacutevaluationthinspdethinsptousthinsplesthinspaspectsthinsprelatifsthinspauthinspmaintienthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspestthinspessentiellethinspDethinspplusthinspchezthinsplethinsppatientthinspsymptomatiquethinspthinsp(pthinspexthinspthinspdyspneacutee)thinspcettethinspeacutevaluationthinspdoitthinspecirctrethinspcompleacuteteacuteethinspparthinsplrsquoauscultation cardiorespiratoirethinspFinalementthinspsithinspdrsquoautresthinspexamensthinspdoiventthinspecirctrethinspfaitsthinspleurthinspchoixthinspserathinspguideacutethinspparthinsplesthinspproblegravemesthinspmeacutedicauxthinspsous-jacents

Bienthinspquethinsplathinspseacutedation-analgeacutesiethinspnethinsppreacutevoitthinspnormalementthinsppasthinspdethinspprisethinspenthinspchargethinspcomplegravetethinspdethinsplathinspventilationthinsp(assistancethinspventilatoirethinspouthinspintubationthinspthinspendotracheacuteale)thinspilthinspestthinspimportantthinspdrsquoeffectuerthinspcettethinspeacutevaluationthinsppuisqursquoagravethinspthinsptoutthinspmomentthinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspunethinspventilationthinspthinspassisteacuteethinspavecthinspouthinspsansthinspintubationthinspendotracheacutealethinsppeutthinspsrsquoaveacutererthinspneacutecessairethinspthinspsithinsplathinsprespirationthinspestthinspcompromisethinsp

Lorsthinspdethinspsituationsthinspparticuliegraveresthinspouthinspcomplexesthinsplethinspmeacutedecinthinspdevraitthinspconsulterthinspunthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinsp

cardiorespiratoirethinspavanceacutee

CONSENTEMENTthinsp(REacuteSUMEacute)

LethinsplecteurthinspdoitthinspsethinspreacutefeacutererthinspagravethinsplrsquoannexethinspVIIIthinsppourthinsplethinsptextethinspcomplet

SelonthinsplethinspdroitthinspenthinspvigueurthinspauthinspQueacutebecthinspilthinspestthinspobligatoirethinspdrsquoobtenirthinsplethinspconsentementthinspdrsquounthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspintervention

LethinspCode civil du QueacutebecthinspeacutetablitthinspdesthinspregraveglesthinspgeacuteneacuteralesthinspconcernantthinsplethinspconsentementthinspauxthinspsoinsthinspquithinspsrsquoappliquentthinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspdispenseacutesthinspOnthinspythinspfaitthinspcependantthinspcertainesthinspdistinctionsthinspselonthinspquethinsplethinsppatientthinspestthinspaptethinspouthinspnonthinspagravethinspconsentirthinspetthinspselonthinspquethinsplesthinspsoinsthinspsontthinsprequisthinspouthinspnonthinsp

parthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspLathinspLoi sur les services de santeacute et les services sociaux (LSSSS)thinspeacutetablitthinspquantthinspagravethinspellethinsplesthinspregraveglesthinspapplicablesthinspenthinspeacutetablissementthinspenthinspmatiegraverethinspdethinspconsentementthinspauxthinspinterventionsthinspchirurgicalesthinspetthinspagravethinsplrsquoanestheacutesiethinsp

LethinspCode de deacuteontologie des meacutedecinsthinspstipulethinspquethinsplethinspmeacutedecinthinspdoitthinspobtenirthinspunthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspavantthinsptoutethinspinterventionthinspilthinspestthinsppreacuteciseacutethinspquethinsplethinspmeacutedecinthinspdoitthinspsrsquoassurerthinspquethinsplrsquoinformationthinsppertinentethinspathinspeacuteteacutethinsptransmisethinspfaciliterthinsplathinspprisethinspdethinspdeacutecisionthinspduthinsppatientthinspetthinsplathinsprespecterthinspLethinspCode de deacuteontologie

des infirmiegraveres et infirmiersthinspstipulethinspquantthinspagravethinspluithinspquethinsplrsquoinfirmiegraverethinspouthinsplrsquoinfirmierthinspdoitthinspfournirthinspauthinspclientthinsptoutesthinsplesthinspinformationsthinsprequisesthinsplorsquethinsplrsquoobligationthinspdrsquoobtenirthinspunthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspincombethinspagravethinsplrsquoinfirmiegraverethinspouthinspagravethinsplrsquoinfirmierthinspIlthinspnrsquoythinspathinsppasthinspdethinspdispositionthinsptouchantthinsppreacuteciseacutementthinsplethinspconsentementthinspdansthinsplethinspCode de

CMQ - OIIQ - OPIQ 18

deacuteontologie des inhalotheacuterapeutes du QueacutebecthinspCependantthinspilthinspestthinsppreacuteciseacutethinspqursquoenthinspplusthinspdesthinspavisthinspetthinspdesthinspconseilsthinsplrsquoinhalotheacuterapeutethinspdoitthinspfournirthinspagravethinspsonthinspclientthinsplesthinspexplicationsthinspneacutecessairesthinspagravethinsplathinspcompreacutehensionthinspetthinspagravethinsplrsquoappreacuteciationthinspdesthinspservicesthinspqursquoilthinspluithinsprend

TousthinsplesthinspprofessionnelsthinspsontthinspeacutevidemmentthinsptenusthinspdethinsprespecterthinsplesthinspdispositionsthinspleacutegalesthinspexistantesthinspndashthinspincluantthinspleurthinspcodethinspdethinspdeacuteontologiethinsprespectifthinspndashthinspetthinsplesthinspnormesthinspdethinsppratiquethinspeacutetabliesthinspparthinspleurthinspordrethinspprofessionnelthinspToutefoisthinsplathinspquestionthinspsethinspposethinspdethinspsavoirthinspcommentthinspcesthinspexigencesthinspdoiventthinspsrsquoappliquerthinspmaintenantthinspquethinspplusieursthinspinterventionsthinspreacutealiseacuteesthinspautrefoisthinspenthinspeacutetablissementthinspsontthinspeffectueacuteesthinspenthinspdehorsthinspthinspdethinspceux-cithinspetthinspquethinsplesthinspprofessionnelsthinsppartagentthinspcertainesthinspactiviteacutesthinspetthinsptravaillentthinsp

enthinspeacutetroitethinspcollaboration

Mecircmethinspsithinsplathinsploithinspnethinsplrsquoexigethinsppasthinsptoujoursthinspilthinspestthinsprecommandeacutethinsp

thinsprsaquo quethinsplethinsppatientthinspdonnethinspunthinspconsentementthinspeacutecritthinsplorsqursquoilthinspythinspathinspseacutedation-analgeacutesiethinspthinspetthinspcethinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspprodigueacutes

thinsprsaquo quethinsplethinspconsentementthinspportethinspagravethinsplathinspfoisthinspsurthinsplathinspseacutedation-analgeacutesiethinspetthinspsurthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspquethinspcettethinspderniegraverethinsppermet

thinsprsaquo quethinsplrsquoinformationthinsptransmisethinspauthinsppatientthinspverbalementthinspouthinspparthinspeacutecritthinspcomprennethinsplesthinsprisquesthinspdethinsplathinspseacutedation-analgeacutesiethinspetthinsplesthinsprisquesthinspdethinsplrsquointerventionthinspelle-mecircme

thinsprsaquo quethinsplethinspmeacutedecinthinspouthinsplethinspprofessionnelthinspagravethinspquithinspilthinspathinspconfieacutethinsplathinsptacircchethinspversethinspauthinspdossierthinspduthinsppatientthinspunethinspnotethinspexplicativethinspsurthinsplesthinspinformationsthinspfourniesthinspetthinsplethinspconsentementthinspobtenu

Lrsquoobtentionthinspdrsquounthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspdemeurethinspunethinspobligationthinspthinspinheacuterentethinspagravethinsplrsquointerventionthinspmeacutedicalethinspelle-mecircmethinspIlthinsprelegravevethinspdoncthinspdethinsplathinspresponsabiliteacutethinspduthinspmeacutedecinthinspdethinspsrsquoassurerthinspdethinsplathinsptransmissionthinspdethinsplrsquoinformationthinsppertinentethinspauthinsppatientthinspetthinspdethinspsathinspcompreacutehensionthinspdethinsplathinspnaturethinspduthinspbutthinspetthinspdesthinsprisquesthinsprelatifsthinspagravethinsplrsquointerventionthinspToutefoisthinsplathinsptacircchethinspdethinsptransmettrethinspdethinsplrsquoinformationthinspcompleacutementairethinsppeutthinspecirctrethinspconfieacuteethinspagravethinspdrsquoautresthinspprofessionnelsthinspthinspetthinspcellethinspdethinsprecueillirthinsplathinspsignaturethinspdrsquounthinspformulairethinspdethinspconsentementthinspagravethinspdrsquoautresthinspmembresthinspdethinsplrsquoeacutequipethinspdethinspsoins

CMQ - OIIQ - OPIQ 19

DIRECTIVESthinspETthinspCONSEILSthinsp

Avantthinspdethinspsubirthinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspsousthinspseacutedationthinsp-analgeacutesiethinsplethinsppatientthinspdoitthinsprecevoirthinsplesthinspdirectivesthinspneacutecessairesthinspdethinsppreacutefeacuterencethinspdansthinsp

unthinspdocumentthinspcontenantthinspentrethinspautresthinsplesthinsprecommandationsthinspsuivantesthinsp

a eacuteviterthinspdethinspconsommerthinsptoutethinspboissonthinspalcooliseacuteethinspdroguethinspouthinspsubstancethinspenthinspventethinsplibrethinsp(agravethinspmoinsthinspqursquoellethinspsoitthinspprescrite)thinsppouvantthinspalteacutererthinsplethinspniveauthinspdethinspconsciencethinspthinsp24thinspheuresthinspavantthinspetthinspapregravesthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

b observerthinspunethinsppeacuteriodethinspdethinspjeucircnethinspquithinspsrsquoappliquethinspagravethinsptoutthinspacircgethinspauxthinspcasthinspeacutelectifsthinsp(nonthinspurgents)thinspetthinspselonthinsplrsquoeacutevaluationthinspduthinsplaquothinsprapportthinsprisquebeacuteneacuteficethinspraquothinsppourthinsplesthinspcasthinspurgents

c suivrethinsplesthinsprecommandationsthinspduthinspmeacutedecinthinspquithinsppreacutecisethinspsithinsplesthinspmeacutedicamentsthinspprescritsthinspsurthinspunethinspbasethinspreacuteguliegraverethinsppeuventthinspecirctrethinspadministreacutesthinspcommethinspagravethinsplrsquoaccoutumeacuteethinspetthinspquithinspfaitthinsppartthinspdesthinspexceptionsthinsp(pthinspexthinspthinspanticoagulantthinsppsychotropethinspetc)thinspsrsquoilthinspythinspathinsplieuthinsp

Unethinspseacutedation-analgeacutesiethinspleacutegegraverethinspougravethinsplesthinspreacuteflexesthinspdethinspprotectionthinspdesthinspvoiesthinspthinspaeacuteriennesthinspsontthinsppreacuteserveacutesthinspestthinsppeuthinspsusceptiblethinspdrsquoinduirethinspunethinspaspirationthinspduthinspcon-tenuthinspgastriquethinspcontrairementthinspagravethinspunethinspseacutedationthinspplusthinspprofondethinspIlthinspestthinsptoutthinspdethinspmecircmethinspraisonnablethinspdethinsppenserthinspquethinsplethinsprisquethinspdrsquoaspirationthinspestthinspdiminueacutethinsplorsquethinsplrsquoestomacthinspestthinspvidethinspetthinspqursquounethinsppeacuteriodethinspdethinspjeucircnethinspavantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacutera-peutiquethinspestthinsppreacutefeacuterablethinspToutefoisthinspdansthinsptousthinsplesthinspcasthinsplrsquourgencethinspdethinsplrsquointerventionthinspetthinsplethinspniveauthinspdeacutesireacutethinspdethinspseacutedation-analgeacutesiethinspdoiventthinspecirctrethinspsoupeseacutesthinspauthinspregardthinspdesthinsprisquesthinspassocieacutesthinspagravethinspunthinspjeucircnethinspinadeacutequatthinspAinsithinsplethinspdeacutelaithinspentrethinsplrsquoheurethinspduthinspdernierthinsprepasthinspetthinsplethinspmomentthinspdethinsplathinspblessureaccidentthinspdoitthinspecirctrethinsppristhinspenthinspconsideacuterationthinsppourthinspestimerthinsplrsquoeacutetatthinspdethinspjeucircnethinspetthinspcethinspenthinspraisonthinspdethinsplrsquoileacuteusthinspreacuteflexethinsp

Avantthinsplathinspseacutedation-analgeacutesiethinspdrsquounethinspinterventionthinspnonthinspurgentethinsp(eacutelective)thinsplethinsppatientthinspdoitthinsprespecterthinsplesthinspdeacutelaisthinspsuivantsthinspselonthinsplathinspnaturethinspetthinsplathinspquantiteacutethinspingeacutereacuteethinspdethinspthinsp(Merchantthinspetthinspcollabthinsp2014a)thinsp

thinsprsaquo liquidethinspclairthinsp(pthinspexthinspthinspeauthinspjusthinspdethinspfruitthinsp[sansthinsppulpe]thinsptheacutethinspetthinspcafeacutethinspnoir)thinspthinspjeucircnethinspdethinsp2thinspheures

thinsprsaquo repasthinspleacutegerthinsp(pthinspexthinspthinsppainthinspgrilleacutethinsp+thinspliquidethinspclair)thinspthinspjeucircnethinspdethinsp6thinspheuresthinsprsaquo repasthinspcomposeacutethinspdethinspviandethinspouthinspdrsquoalimentsthinspfritsthinspouthinspgrasthinspthinspjeucircnethinspdethinsp8thinspheuresthinsp

CMQ - OIIQ - OPIQ 20

15thinspPERSEacuteDATION-ANALGEacuteSIEthinsp

APPROCHEthinspPHARMACOLOGIQUE

Lrsquoadministrationthinspdethinsptoutthinspmeacutedicamentthinspneacutecessitethinsplrsquoobtentionthinspdrsquounethinspordonnancethinsp

faitethinspenthinspvertuthinspdethinsplrsquoarticlethinsp393thinspduthinspCode des professions du QueacutebecthinspDrsquoailleursthinspthinsplathinspmeilleurethinspfaccedilonthinspdrsquoencadrerthinsplathinsppratiquethinspdethinsplrsquoinfirmiegraverethinspetthinspdethinsplrsquoinhalotheacuterapeutethinspestthinsplrsquoadoptionthinspdrsquounthinspprotocoleordonnancethinspcollectivethinspcomprenantthinspunthinspeacuteventailthinsptheacuterapeutiquethinspquithinsplaissethinspplacethinspauthinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspthinspUnthinsptelthinspdocumentthinspdoitthinspparthinspcontrethinspecirctrethinspenteacuterineacutethinspparthinsplesthinspresponsablesthinspmeacutedicauxthinspthinspdethinsplrsquoeacutetablissementthinspqursquoilthinspsoitthinsppublicthinspouthinsppriveacutethinsp

Soulignonsthinsplrsquoimportancethinspdrsquounthinspaccegravesthinspveineuxthinspfonctionnelthinspquithinspfaciliterathinsplrsquoadmi-nistrationthinspdesthinspagentsthinspseacutedatifsthinspetthinspanalgeacutesiquesthinspainsithinspquethinsplesthinsptraitementsthinsppharma-cologiquesthinspdesthinspcomplications

LethinspmeacutedecinthinsplrsquoinfirmiegraverethinspetthinsplrsquoinhalotheacuterapeutethinspdoiventthinsputiliserthinspunethinspmeacutedicationthinspqursquoilsthinspconnaissentthinspetthinspquithinspestthinspreconnuethinspRappelonsthinspqursquoilsthinspdoiventthinspecirctrethinspenthinspmesurethinspdethinspprendrethinspenthinspchargethinsptoutethinspcomplicationthinsppotentiellethinspythinspcompristhinsplathinspgestionthinspdrsquounthinsppassagethinspmomentaneacutethinspagravethinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspsupeacuterieurthinspagravethinspceluithinspquithinspthinspathinspeacuteteacutethinspplanifieacute

LethinspchoixthinspdethinsplathinspmeacutedicationthinsppeutthinspvarierthinspselonthinsplathinspsituationthinspcliniquethinspetthinsplesthinspfacteursthinsppropresthinspauthinsppatientthinspParthinspexemplethinspcertainsthinsppatientsthinspnethinsptolegraverentthinsppasthinsplesthinspdosagesthinsphabituelsthinspouthinsppreacutesententthinspdesthinspcontre-indications

Ilthinspestthinspimportantthinspdethinspretenirthinspquethinsplethinsptitragethinspdethinsptoutethinspmeacutedicationthinspdoitthinspecirctrethinspthinspprivileacutegieacutethinspetthinspquethinspsonthinspadministrationthinspdoitthinspsethinspfairethinspparthinsppetitesthinspdosesthinspdethinspthinspfaccedilonthinspprogressivethinspjusqursquoagravethinsplrsquoobtentionthinspduthinspniveauthinspdethinspseacutedationthinspetthinspdrsquoanalgeacutesiethinspthinspdeacutesireacutethinsptoutthinspenthinsplaissantthinspsrsquoeacutecoulerthinspsuffisammentthinspdethinsptempsthinspentrethinspdeuxthinspdosesthinsppourthinspquethinsplethinspmeacutedicamentthinspproduisethinspsesthinspeffetsthinsp

Lesthinspmeacutedicamentsthinsputiliseacutesthinspenthinspseacutedation-analgeacutesiethinspontthinspunthinspeffetthinspsynergiquethinspthinspParthinspexemplethinsplrsquoassociationthinspdrsquounethinspbenzodiazeacutepinethinspavecthinspunthinspopioiumldethinspaugmentethinspthinsplesthinsprisquesthinspdethinspdeacutepressionthinsprespiratoirethinspLeurthinspdosagethinspdoitthinspdoncthinspecirctrethinspajusteacutethinspenthinspconseacutequencethinspSithinsplrsquoobstructionthinspdesthinspvoiesthinspaeacuteriennesthinsplrsquoapneacuteethinspetthinsplrsquohypotensionthinspthinspsontthinsplesthinspcomplicationsthinsplesthinspplusthinspfreacutequentesthinspenthinspseacutedation-analgeacutesiethinspilthinspfautthinspretenirthinspquethinspcertainesthinspcomplicationsthinsppeuventthinspecirctrethinspparticuliegraveresthinspagravethinsplathinspmeacutedicationthinsputiliseacuteethinspthinspCitonsthinspagravethinsptitrethinspdrsquoexemplethinsplrsquoassociationthinsplaryngospasmethinspetthinspkeacutetaminethinsp

CMQ - OIIQ - OPIQ 21

Lorsquethinspdesthinspbenzodiazeacutepinesthinspouthinspdesthinspopioiumldesthinspsontthinspadministreacutesthinspparthinspvoiethinspthinspintraveineusethinspleursthinspantagonistesthinsprespectifsthinsp(pthinspexthinspthinspflumazeacutenilthinsp[Anexatereg]thinspthinspnaloxonethinsp[Narcanreg])thinspdoiventthinspecirctrethinsprapidementthinspdisponiblesthinspIlsthinspserontthinsputiliseacutesthinspthinspauthinspmomentthinspdrsquounethinspdeacutepressionthinsprespiratoirethinspinduitethinspparthinsplathinspmeacutedicationthinspet non en prophylaxiethinspchezthinsplethinsppatientthinspstablethinspIlthinspestthinsphabituellementthinsppreacutefeacuterablethinspdethinspthinsprenverserthinspdrsquoabordthinsplrsquoagentthinspseacutedatifthinspafinthinspdethinspmaintenirthinspintactthinsplrsquoeffetthinspanalgeacutesiquethinspthinspSithinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspdemeurethinspcompromisethinspilthinspserathinspalorsthinspthinspneacutecessairethinspdethinsprenverserthinsplrsquoeffetthinspanalgeacutesique

IlthinspfautthinspsethinsprappelerthinspquethinsplathinspdureacuteethinspdrsquoactionthinspdesthinspantagonistesthinspestthinspbienthinspinfeacuterieurethinspthinspagravethinsplathinspdureacuteethinspdrsquoactionthinspduthinspmeacutedicamentthinspdevantthinspecirctrethinspneutraliseacutethinspParthinspconseacutequentthinspthinsplathinspreacuteapparitionthinspdethinsplrsquoeffetthinspindeacutesirablethinspestthinspagravethinspsurveillerthinspchezthinsplethinsppatientthinspquithinspreccediloitthinspunthinspantagonistethinsp

VousthinsptrouverezthinspunethinspfichethinspinformativethinspsurthinsplrsquoutilisationthinspdethinsplathinspnaloxonethinspetthinspduthinspflumazeacutenilthinspagravethinsplrsquoannexethinspXI

Lesthinspdirectivesthinspeacutenonceacuteesthinspdansthinspcesthinsplignesthinspdirectricesthinspnrsquoontthinsppasthinsppourthinspobjectifthinspdethinspdeacutecrirethinspdansthinsplethinspdeacutetailthinsplathinspmeacutedicationthinsputiliseacuteethinspenthinspseacutedation-analgeacutesiethinspleursthinspagentsthinsp

antagonistesthinspetthinsplesthinspmeacutedicamentsthinspdrsquourgencethinspIlthinsprevientthinspauthinspmeacutedecinthinspdethinspbienthinsp

connaicirctrethinsplathinspmeacutedicationthinspetthinspdethinspchoisirthinspunethinspmeacutedicationthinspouthinspunethinspcombinaisonthinspdethinspmeacutedicamentsthinspreconnuethinspEtthinspilthinsprevientthinspauxthinspprofessionnelsthinspquithinsplesthinspadministrentthinsp

dethinspbienthinsplesthinspconnaicirctrethinspeacutegalementthinsp(eacuteleacutementsthinspdethinspsurveillancethinspcliniquethinsptechniquethinspdrsquoadministrationthinspeffetsthinspsecondairesthinspinteractionsthinspcontre-indicationsthinspseuilsthinspthinsptoxiquesthinspetc)thinspetthinspdethinspmaintenirthinspagravethinspjourthinspleursthinspconnaissancesthinspdansthinspcethinspdomaine

thinspPRINCIPALESthinspCLASSESthinspPHARMACOTHEacuteRAPEUTIQUESthinspUTILISEacuteESthinspthinspthinspENthinspSEacuteDATION-ANALGEacuteSIEthinsp

Lathinsplistethinspdesthinspmeacutedicamentsthinspabordeacutesthinspci-dessousthinspnrsquoestthinsppasthinsplimitativethinsp

a BenzodiazeacutepinesthinspProprieacuteteacutesthinspthinspanxiolytiquethinspamneacutesiquethinsphypnotiquethinsprelaxantthinspmusculairethinspetthinspanticonvulsivantthinspthinspIlthinspfautthinspprivileacutegierthinsplesthinspmoleacuteculesthinspagravethinspcourtethinspdemi-viethinsp(pthinspexthinspthinspmidazolamthinsp[Versedreg])thinspenthinspretenantthinspqursquoilthinspfautthinspajusterthinsplethinspdosagethinspchezthinspcertainsthinsppatientsthinsp(pthinspexthinspthinspacircgeacutesthinspouthinspaffaiblis)thinspetthinsplorsthinspdethinsplrsquoutilisationthinspconcomitantethinspdrsquoautresthinspmeacutedicamentsthinspaffectantthinsplethinspsystegravemethinspnerveuxthinspcentralthinspDethinspplusthinsplathinspdemi-viethinsp

CMQ - OIIQ - OPIQ 22

dethinspcesthinspmeacutedicamentsthinsppeutthinspecirctrethinspaugmenteacuteethinsplorsthinspdethinspleurthinspadministrationthinspenthinspperfusionthinspcontinuethinsp(context sensitive half-life)thinsp

b OpioiumldesthinspProprieacuteteacutesthinspthinspanalgeacutesiquethinspetthinspseacutedativethinspLathinspmorphinethinspconstituethinspunthinspopioiumldethinspdontthinsplrsquoefficaciteacutethinspestthinspreconnuethinspCependantthinspellethinspfavorisethinsplathinsplibeacuterationthinspdrsquohistaminethinspcethinspquithinsppeutthinspcauserthinspduthinsppruritthinspetthinspdethinsplrsquohypotensionthinspUnethinspdysfonctionthinspreacutenalethinspseacutevegraverethinspentraicircnethinsplrsquoaccumulationthinspdethinspsesthinspmeacutetabolitesthinspactifsthinsp

thinsprsaquo lethinspfentanylthinsp(Sublimazereg)thinspestthinspunthinspopioiumldethinspsyntheacutetiquethinsppuissantthinspetthinspdethinspcourtethinspdureacuteethinspdrsquoactionthinspIlthinspnethinspdeacuteclenchethinsppasthinspdethinsplibeacuterationthinspdrsquohistaminethinsp(doncthinsppeuthinspdrsquoeffetthinspheacutemodynamique)thinspIlthinspfautthinspcependantthinspsethinspmeacutefierthinspdesthinspdosesthinspeacuteleveacuteesthinspetthinspdesthinspinjectionsthinsprapidesthinspquithinsppeuventthinspprovoquerthinspunethinsprigiditeacutethinspmusculairethinspthinspetthinspunethinspdeacutepressionthinsprespiratoire

thinsprsaquo lrsquohydromorphonethinsp(Dilaudidreg)thinspestthinspunthinspopioiumldethinspsemi-syntheacutetiquethinspdontthinsplesthinspmeacutetabolitesthinspconnusthinspsontthinsprarementthinspprobleacutematiquesthinspMoinsthinsputiliseacuteethinspenthinspthinspseacutedation-analgeacutesiethinspellethinspestthinspauthinspmoinsthinsp5thinspfoisthinspplusthinsppuissantethinspquethinsplathinspmorphinethinspthinspcethinspquithinspestthinspparfoisthinspsous-estimeacute

thinsprsaquo lathinspmeacutepeacuteridinethinsp(Demerolreg)thinspestthinspunthinspopioiumldethinspsyntheacutetiquethinspposseacutedantthinspunthinspmeacuteta-bolitethinspactifthinspneurotoxiquethinspEllethinspnrsquoestthinsphabituellementthinsppasthinsprecommandeacuteethinsp

c Anestheacutesiques geacuteneacuterauxthinspLethinspmeacutedecinthinspquithinspprocegravedethinspagravethinspunethinspinterventionthinspsousthinspseacutedation-analgeacutesiethinspenthinsputilisantthinspunthinspouthinspdesthinspanestheacutesiquesthinspgeacuteneacuterauxthinspdoitthinspecirctrethinspexpeacuterimenteacutethinspenthinspseacutedation-analgeacutesiethinspetthinspenthinspreacuteanimationthinspcardiorespiratoirethinspDansthinsplethinspcasthinspcontrairethinspilthinspdoitthinspsrsquoassurerthinspdethinsplathinspcollaborationthinspdrsquounthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspParthinspailleursthinsplethinspmeacutedecinthinspdoitthinspenthinsptoutthinsptempsthinspecirctrethinspsoutenuthinspparthinspunthinspouthinspdesthinspprofessionnelsthinspqualifieacutesthinsp

thinsprsaquo propofolthinsp(Diprivanreg)thinspProprieacuteteacutesthinspseacutedativethinsphypnotiquethinspamneacutesiquethinspanxiolytiquethinspAgravethinspnoterthinspqursquoilthinspnrsquoathinspaucune proprieacuteteacute analgeacutesiquethinsp

thinspIlthinsppossegravedethinspunethinspdemi-viethinspcourtethinsppeutthinspecirctrethinspcumulatifthinspetthinspnrsquoathinsppas drsquoantago-nistethinspIlthinspnrsquoestthinsppasthinsprecommandeacutethinspchezthinsplathinspfemmethinspenceintethinspouthinspquithinspallaitethinspEnthinspregraveglethinspgeacuteneacuteralethinspetthinspselonthinsplethinsptypethinspdrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspilthinsppeutthinspecirctrethinspplusthinspjudicieuxthinspdethinsplrsquoadministrerthinspenthinspinfusionthinspIVthinspplutocirctthinspthinspqursquoenthinspbolusthinspthinspthinspIlthinsppeutthinsprapidementthinspcauserthinspunethinspdiminutionthinspmarqueacuteethinspduthinspniveauthinspdethinspcon-sciencethinspetthinspunethinspdeacutepressionthinsprespiratoirethinsppouvantthinspconduirethinspmomentaneacute-

CMQ - OIIQ - OPIQ 23

mentthinspagravethinspunethinspanestheacutesiethinspgeacuteneacuteralethinspnonthinspdeacutesireacuteethinspLesthinspprofessionnelsthinspenthinspplacethinspdoiventthinspecirctrethinspenthinspmesurethinspdethinspprendrethinspenthinspchargethinspunethinsptellethinspsituationthinspLrsquoASAthinsp(AmericanthinspSocietythinspofthinspAnesthesiologiststhinspASAthinspHousethinspofthinspDelegatesthinsp2004bthinsp[Notrethinsptraduction])thinsprecommandethinspnotammentthinspquethinsplethinsppatientthinspagravethinspquithinsplrsquoonthinspadministrethinspduthinsppropofolthinspreccediloivethinspdesthinspsoinsthinspenthinsplienthinspavecthinspunethinspseacutedationthinsppro-fondethinsp(niveauthinspnonthinspviseacutethinspdansthinspcesthinsplignesthinspdirectrices)thinspetthinspquethinsplethinspprofessionnelthinsp(nonthinspanestheacutesiologiste)thinspadministrantthinsplethinsppropofolthinsppossegravedethinsplathinspformationthinsptheacuteoriquethinspetthinsppratiquethinspneacutecessairethinspagravethinsplrsquoidentificationthinspetthinspagravethinsplathinspprisethinspenthinspchargethinspdesthinspvoiesthinspaeacuteriennesthinspetthinspdesthinspchangementsthinspcardiovasculairesthinspquithinspsurvien-nentthinspchezthinspunthinsppatientthinspeacutevoluantthinspversthinspunthinspeacutetatthinspdrsquoanestheacutesiethinspgeacuteneacuteralethinsp(niveauthinspnonthinspviseacutethinspdansthinspcesthinsplignesthinspdirectrices)thinsp

thinspthinspLorsquethinsplethinsppropofolthinspestthinspadministreacutethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspthinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspthinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspthinspobligatoirethinsp(tableauthinsp3)thinspthinspthinsp

thinsprsaquo keacutetaminethinsp(Ketalarreg)thinspProprieacuteteacutesthinspthinspseacutedativethinspetthinspanalgeacutesiquethinspthinspUtiliseacuteethinspenthinsppeacutediatriethinspetthinspchezthinsplrsquoadultethinspEllethinspproduitthinspaussithinspunethinspbroncho-thinspdilatationthinspparfoisthinspsouhaiteacuteethinsplorsthinspdrsquointerventionsthinspdiagnostiquesthinspouthinsptheacutera-peutiquesthinspchezthinsplesthinsppatientsthinspasthmatiquesthinspEllethinspsrsquoaccompagnethinspdrsquounethinsplibeacutera-tionthinspdethinspcateacutecholaminesthinspetthinspdrsquoeffetsthinspsympathomimeacutetiquesthinsp(augmentationthinspdethinsplathinspsalivation)thinspEllethinsppeutthinspprovoquerthinspdesthinspsymptocircmesthinsppsychotiquesthinspouthinspdesthinspcomportementsthinspanormauxthinspCesthinspsymptocircmesthinsppeuventthinspnuirethinspagravethinsplrsquoeacutevaluationthinspdesthinsppatientsthinspsousthinspseacutedationthinspEllethinspabaissethinsplethinspseuilthinspconvulsifthinsp

Lorsquethinsplathinspkeacutetaminethinspestthinspadministreacuteethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspobligatoirethinsp(tableauthinsp3)thinspthinsp

thinsprsaquo protoxydethinspdrsquoazotethinsp(N2O)thinsp

ProprieacuteteacutesthinspthinspgazthinspseacutedatifthinspetthinspanalgeacutesiquethinspthinspActionthinspanalgeacutesiquethinspsemblablethinspagravethinspcellethinspdethinsplathinspmorphinethinspIlthinsppotentialisethinsplesthinspanalgeacutesiquesthinspcentrauxthinspetthinsplesthinspagentsthinsphypnotiquesthinspetthinsppeutthinspaussithinspdiminuerthinsplesthinspreacuteservesthinspenthinspoxygegravenethinspduthinsppatientthinspUtiliseacutethinspenthinspcombinaisonthinspavecthinsplrsquooxygegravenethinspIlthinsppeutthinsppolluerthinsplrsquoenvironnementthinspdethinsptravailthinsp(voirthinspnormesthinspCSST)thinspIlthinsppeutthinspecirctrethinsp

CMQ - OIIQ - OPIQ 24

utiliseacutethinspenthinsppeacutediatriethinspchezthinsplrsquoadultethinspetthinspchezthinsplathinspfemmethinspenceintethinsp(saufthinspauthinspthinsppremierthinsptrimestre)thinsp

thinspDansthinsplethinspcasthinspougravethinsplethinspprotoxydethinspdrsquoazotethinspestthinsputiliseacutethinspenthinspcombinaisonthinspavecthinspunthinspagentthinspseacutedatifthinspouthinspunthinspopioiumldethinspouthinspsithinsplrsquoappareilthinsputiliseacutethinsppermetthinspdethinspmodifierthinsplathinspconcentrationthinspdrsquooxygegravenethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivement agravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspthinsp

thinsprsaquo dexmeacutedeacutetomidinethinsp(PreacuteceacutedexMC)thinsp(Agonistethinspalpha2-adreacutenergique)thinspProprieacuteteacutesthinspthinspseacutedativethinspanalgeacutesiquethinspetthinspanxiolytiquethinspthinspLathinspdexmeacutedeacutetomidinethinspenthinspperfusionthinspintraveineusethinspcontinuethinspestthinspindiqueacuteethinspnotammentthinsppourthinsplathinspseacutedationthinspdethinsppatientsthinspnonthinspintubeacutesthinspavantthinspetouthinsppendantthinspunethinspinterventionthinspchirurgicalethinspouthinspdrsquoautresthinsptypesthinspdrsquointerventionsthinspthinspNethinspcausethinspaucunethinspdeacutepressionthinsprespiratoirethinspmaisthinsppeutthinspcauserthinspunethinspbradycar-diethinspetthinspunethinsphypotensionthinspthinsp

thinspLrsquoutilisationthinspdethinspdexmeacutedeacutetomidinethinspdevraitthinspecirctrethinspreacuteserveacuteethinspauthinspmilieuthinspthinsphospitalierthinspouthinspauxthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspthinspEllethinspdevraitthinspecirctrethinspadministreacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspthinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspetthinsprapidementthinspdisponiblethinspthinspLorsquethinspdethinsplathinspdexmeacutedeacutetomidinethinspestthinspadministreacuteethinspunthinspprofessionnelthinspthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspthinspduthinsppatientthinsp(tableauthinsp2)thinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspobligatoirethinsp(tableauthinsp3)thinspthinsp

Agravethinspnoterthinspqursquoilthinspestthinspobligatoirethinspdethinsptenirthinspunthinspregistrethinspdesthinspsubstancesthinspcontrocircleacuteesthinspetthinspdesthinspbenzodiazeacutepinesthinspcomportantthinspdesthinspsignatures

thinsp

CMQ - OIIQ - OPIQ 25

SURVEILLANCEthinspCLINIQUEthinspLathinspsurveillancethinspcliniquethinspcomprendthinspplusieursthinspeacuteleacutementsthinspquithinspconcernentthinspthinspnotammentthinsplesthinspsystegravemesthinsprespiratoirethinspcardiaquethinspetthinspneurologiquethinspEllethinspdoitthinspthinsptenirthinspcomptethinspentrethinspautresthinsp

thinsprsaquo dethinsplathinspconditionthinspduthinsppatientthinspavantthinspetthinsppendantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

thinsprsaquo dethinsplathinspcomplexiteacutethinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinsprsaquo dethinsplathinspmeacutedicationthinsputiliseacuteethinsp(dosethinspdureacuteethinspetthinsppicthinspdrsquoactionthinspvoiethinspetthinspvitessethinspthinsp

drsquoadministrationthinspcombinaisonthinspetthinspantagonistes)

thinsprsaquo dethinsplrsquoassistancethinspagravethinspapporterthinspauthinspmeacutedecin

Lethinspmeacutedecinthinspquithinsppratiquethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspchezthinspunthinsppatientthinspsousthinspseacutedation-analgeacutesiethinspdoitthinspcompterthinspsurthinsplathinsppreacutesencethinspdrsquoauthinspmoinsthinspunthinspautrethinspprofessionnelthinsphabiliteacutethinspduthinspmilieuthinspdethinsplathinspsanteacutethinsp(infirmiegraverethinspinhalotheacuterapeutethinspouthinspautrethinspmeacutedecin)thinsp(annexethinspII)thinspEnthinspeacutetroitethinspcollaborationthinspavecthinsplethinspmeacutedecinthinspreacuteali-santthinsplrsquointerventionthinspceux-cithinspassurentthinspthinsplathinspgestionthinspdethinsplathinspseacutedationthinspetthinspdethinsplrsquoanalgeacutesiethinspqui comprend entre autres la surveillance clinique du patientthinspresponsabiliteacutethinspthinspagravethinsplaquellethinspilsthinspdoiventthinspenthinsptoutthinsptempsthinspsethinspconsacrerthinspenthinspprioriteacutethinsp

Dansthinspcertainsthinspcasthinsplethinspprofessionnelthinspquithinspassurethinspen prioriteacutethinsplathinspsurveillancethinspthinspcliniquethinspduthinsppatientthinsppeutthinspecirctrethinspappeleacutethinspagravethinspassisterthinsplethinspmeacutedecinthinspdansthinsplathinspreacutealisationthinspthinspdethinspsonthinspinterventionthinspCettethinspassistancethinspquithinspdoitthinspsrsquoeffectuerthinspdansthinsplathinspmecircmethinsppiegravecethinspdoitthinspecirctrethinspdethinsptregravesthinspcourtethinspdureacuteethinspDethinspplusthinspellethinspdoitthinsppouvoirthinspecirctrethinspinterrompuethinspthinspagravethinsptoutthinspmomentthinsppourthinspintervenirthinspimmeacutediatementthinspaupregravesthinspduthinsppatientthinspenthinspcasthinspdethinsp

complicationsthinspouthinspdethinspbesoin

Parthinspailleursthinsplorsquethinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspthinspneacutecessitentthinspunethinspassistancethinsptechniquethinspcontinuellethinspauthinspmeacutedecinthinsplrsquoajoutthinspdrsquounthinsptroisiegravemethinspprofessionnelthinspdethinsplathinspsanteacutethinsphabiliteacutethinsp(meacutedecinthinspinfirmiegraverethinspouthinspinhalotheacuterapeute)thinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinspestthinsprequisthinsp

CMQ - OIIQ - OPIQ 26

Tableau 2 Tableau reacutecapitulatif du nombre de professionnels habiliteacutes requis en seacutedation-analgeacutesie - Clientegravele adulte

Toutthinspauthinsplongthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplathinspsurveillancethinspcliniquethinspthinspduthinsppatientthinspdoitthinspecirctrethinspcontinuethinspetthinsplathinspcommunicationthinspavecthinspcelui-cithinspmaintenue

Proceacutederthinspagravethinsplathinspsurveillancethinspcliniquethinspcrsquoestthinspeacutevaluerthinspqualitativementthinspetthinspquantitative-mentthinspdethinspfaccedilonthinspsoutenuethinspetthinspenthinspcontinuthinsplrsquoensemblethinspdesthinspparamegravetresthinspsuivantsthinsp(listethinsp

nonthinsplimitative)thinsp(tableauthinsp3)thinsp

thinsprsaquo mesurethinspdethinsplathinsppressionthinsparteacuteriellethinspduthinsppouls3thinspetthinspdethinsplathinsprespiration4thinsprsaquo lecturethinspdethinsplathinspsaturationthinspcapillairethinspenthinspoxygegravene

Ilthinspfautthinspnoterthinspquethinsplathinsptonaliteacutethinspdethinsppoulsthinspdoitthinspecirctrethinspactiveacuteethinspenthinsptoutthinsptempsthinspetthinspsonthinspniveauthinspdoitthinspecirctrethinspajusteacutethinspdethinspfaccedilonthinspagravethinspecirctrethinspentenduthinspclairement

thinsprsaquo eacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplathinspseacutedationthinsp(eacutevaluationthinspdethinsplathinspseacutedationagitationthinspetthinspduthinspniveauthinspdethinspconscience)thinsp(annexethinspIX)thinsp

thinsprsaquo eacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplrsquoanalgeacutesiethinsp(eacutevaluationthinspdethinsplathinspdouleur)thinspdethinsplrsquoanxieacuteteacutethinspetthinspdethinsplathinspreacuteactionthinspduthinsppatientthinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsp(annexethinspX)

thinsprsaquo eacutevaluationthinspdethinsplrsquoeacutetatthinspdethinsplathinspcolorationthinspetthinspdethinsplathinsptempeacuteraturethinspdethinsplathinsppeauthinsprsaquo eacutevaluationthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsprsaquo niveauthinspdrsquoO

2thinspdethinspCO

2thinspetthinspmonitoragethinspcardiaquethinspselonthinsplethinspcas

3thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp4thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

Nombrethinspdethinspprofessionnelsthinsphabiliteacutesthinsprequis

2 Nombrethinspmimimalthinsprequis

3 Sithinsputilisationthinspdethinsppropofolthinspkeacutetaminethinspouthinspdethinspdexmeacutedeacutetomidine

3 SithinsputilisationthinspconcomitantethinspdethinspN2Othinspetthinspdrsquounthinspagentthinspseacutedatifthinspouthinspthinsp

dunthinspopioiumldethinspouthinspsithinspconcentrationthinspdethinspN2Othinspmodifiable

3 Sithinsplassistancethinsptechniquethinspauthinspmeacutedecinthinspestthinspcontinuelle

CMQ - OIIQ - OPIQ 27

Tableau 3 Surveillance des paramegravetres cliniques en seacutedation-analgeacutesie - Clientegravele adulte

Paramegravetrethinspdethinspthinspsurveillancethinspthinspclinique

PatientNiveauthinspdethinspthinspseacutedation

MeacutedicationInterventionthinspdiagnostiquethinspouthinsptheacuterapeutique

TAthinspRC5thinspthinspRR6thinspthinspetthinspsaturationthinspdrsquoO

thinsp2thinspthinsp

rsaquothinspObligatoireChezthinsptousthinsplesthinsppatients

Niveauthinspdethinspthinsp-thinspseacutedationthinspthinspthinspagitationthinspthinspthinspthinspconscience-thinspdouleur

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

NiveauthinspdethinspCO2

SelonthinsplesthinspthinspcaracteacuteristiquesthinspAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspthinspmeacutedication

Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire

rsaquothinspAccegravesthinspindirectthinspthinspthinspthinspthinspouthinsprestreintthinspthinspthinspthinspauthinsppatientthinspthinspthinspthinsp(pthinspexthinspthinspIRM)

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

rsaquothinspRecommandeacute

rsaquothinspASAthinspgethinsp3thinsprsaquothinspApneacuteethinspthinspobstructivethinspthinspthinspthinspduthinspsommeilthinsprsaquothinspMaladiethinspthinspthinspthinsprespiratoirethinsprsaquothinspObeacutesiteacutethinspmorbide

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

Monitoragethinspcardiaque

SelonthinsplesthinspcaracteacuteristiquesAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

SelonthinsplathinspmeacutedicationSelonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoirersaquothinspASAthinspgethinsp3thinsprsaquothinspMaladiethinspthinspthinspthinspcardiaque

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

Interventionthinspdiagnostiquethinspthinspouthinsptheacuterapeutiquethinspprolongeacuteethinsp(effetthinspcumulatifthinspdethinsplathinspmeacutedication)

rsaquothinspRecommandeacute

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

thinspthinspthinspthinspthinspIlthinspnethinspsrsquoagitthinsppasthinspdrsquounethinsplistethinsplimiteacuteethinspdesthinspsituationsthinspcliniquesthinspDrsquoautresthinspsituationsthinspcliniquesthinsppeuventthinspneacutecessiterthinsplethinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspmonitoragethinspcardiaquethinspouthinspduthinspCO

2thinspIlthinsprevientthinspauxthinspprofessionnelsthinspdethinspjugerthinspdethinsplathinspsituationthinspenthinspfonctionthinspdethinspchaquethinspthinspthinsp

thinspthinspthinspthinspthinspthinsppatient5thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp6thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

CMQ - OIIQ - OPIQ 28

LethinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspimpliqueacutesthinspestthinspprimordialthinspetthinspcethinspmecircmethinspsithinsplrsquoappareillagethinspenthinspplacethinspestthinspcompletthinspetthinspfonctionnelthinspUnethinspbonnethinspcommunica-tionthinspentrethinspcesthinspderniersthinspestthinspdoncthinspessentiellethinspafinthinspdethinspbienthinspcoordonnerthinsplathinspseacutedationthinsp

etthinsplrsquoanalgeacutesiethinspavecthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspLes alarmes (audibles et visuelles) de chaque appareil doivent ecirctre en fonction et les paramegravetres ajusteacutes aux caracteacuteristiques du patient et agrave sa condition clinique

IlthinspfautthinspsrsquoassurerthinspdethinsplathinsptraccedilabiliteacutethinspdethinsplrsquoeacutevaluationthinspetthinspdethinsplathinspsurveillancethinspcliniquethinspthinspeffectueacuteesthinspparthinspunethinsptenuethinspdethinspdossiersthinspconformethinspauxthinspnormesthinspenthinspvigueurthinspLesthinspoutilsthinspdrsquoeacutevaluationthinsputiliseacutesthinspdoiventthinspecirctrethinspsimplesthinspstandardiseacutesthinspvalideacutesthinspdethinsppreacutefeacuterencethinspetthinspadapteacutesthinspauthinspcontextethinspetthinspauxthinspcaracteacuteristiquesthinspduthinsppatientthinspnotam-mentthinsppourthinsplrsquoeacutevaluationthinspduthinspniveauthinspdethinspseacutedationagitationthinspdethinspconsciencethinspetthinspdethinspdouleurthinsp(annexesthinspIXthinspetthinspX)

Lathinspfreacutequencethinspdethinsplathinspmesurethinspdethinspcesthinspparamegravetresthinspetthinspleurthinspenregistrementthinspdoiventthinspecirctrethinspdeacutetermineacutesthinspentrethinspautresthinspenthinspfonctionthinspdethinsplathinspmeacutedicationthinspetthinspdethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsp

Ideacutealementthinsplethinspprofessionnelthinspdoitthinsplesthinspdocumenterthinsp

thinsprsaquo avantthinsplethinspdeacutebutthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsprsaquo apregravesthinsplrsquoadministrationthinspdrsquounthinspagentthinspdethinspseacutedation-analgeacutesiethinspouthinspdrsquounthinspantagonistethinsprsaquo authinsppicthinspdrsquoactionthinspdethinspchacunthinspdesthinspagentsthinspadministreacutesthinspthinsprsaquo agravethinspintervallesthinspreacuteguliersthinsp(pthinspexthinspthinsp5thinspminutes)thinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-thinsp

analgeacutesiethinsprsaquo agravethinspintervallesthinspplusthinsprapprocheacutesthinsplorsquethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsplrsquoexigethinsprsaquo durantthinsplathinsppeacuteriodethinspdethinspreacutecupeacuterationthinspetthinspjusqursquoauthinspretourthinspduthinspniveauthinspdethinspconsciencethinsp

initialethinspselonthinsplathinspconditionthinspcliniquethinspduthinsppatientthinsprsaquo authinspmomentthinspduthinspcongeacute

ILthinspFAUTthinspSAVOIRthinspQUE

LathinspSocieacuteteacutethinspcanadiennethinspdesthinspanestheacutesiologistesthinsp(SCA)thinspindiquethinspquethinsplesthinspthinspdirectivesthinspgeacuteneacuteralesthinspdethinspsoinsthinsp(ythinspcompristhinsplethinspmonitorage)thinsppourthinsplathinspseacutedationthinspconscientethinspsontthinsplesthinspmecircmesthinspquethinsppourthinsplesthinspautresthinspformesthinspdrsquoanestheacutesiethinsp[]thinsp(Merchantthinspetthinspcollabthinsp2014b)thinspDethinspplusthinspellethinspindiquethinspquethinsplethinspcapnographethinspthinspestthinsprequisthinsplorsthinspdethinspseacutedation-analgeacutesiethinspdethinspniveauthinspplusthinspeacuteleveacutethinsp(pthinspexthinspthinspRamsaythinspthinsp4-6)thinsp(Merchantthinspetthinspcollabthinsp2014athinspop cit)

CMQ - OIIQ - OPIQ 29

thinsp16thinspPOSTSEacuteDATION-ANALGEacuteSIEthinsp

Lethinsppatientthinspestthinspagravethinsprisquethinspdethinspdeacutevelopperthinspdesthinspcomplicationsthinspagravethinsplathinspsuitethinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspsurtoutthinspsithinspcettethinspproceacutedurethinspestthinspdethinspcourtethinspdureacuteethinsp(pthinspexthinspthinspdeacutepressionthinsprespiratoirethinsphypotension)thinspEnthinspeffetthinspcertainsthinspmeacutedicamentsthinsptelsthinspquethinsplethinspmidazolamthinspetthinsplethinspfentanylthinspnethinspserontthinsppasthinspcomplegravetementthinspeacutelimineacutesthinspsithinsplathinspdureacuteethinspdethinsplrsquointerventionthinspestthinspmoinsthinspdethinsp30thinspminutesthinspDrsquoautresthinspfacteursthinsptelsthinspquethinsplethinspmanquethinspthinspdethinspstimulationthinspouthinsplrsquoabsorptionthinspretardeacuteethinspdrsquounthinspmeacutedicamentthinsppeuventthinspcontribuerthinspthinspagravethinspunethinspseacutedationthinspprolongeacuteethinspouthinsprebond

Unethinspdeacutepressionthinsprespiratoirethinsppeutthinspsurvenirthinspjusqursquoagravethinspeacuteliminationthinspcomplegravetethinspthinspduthinspmeacutedicamentthinsp

ParthinspconseacutequentthinspjusqursquoagravethinspsonthinspdeacutepartthinsplethinsppatientthinspdoitthinspecirctrethinspsousthinsplathinspsurveillancethinspdrsquounthinspprofessionnelthinsphabiliteacutethinspagravethinspreconnaicirctrethinsplesthinspcomplicationsthinspetthinspagravethinspintervenirthinsprapidementthinspplusthinspparticuliegraverementthinsppourthinspmaintenirthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspetthinspassurerthinsplrsquoassistancethinspventilatoirethinspLethinspmeacutedecinthinspayantthinspproceacutedeacutethinspagravethinsplrsquointerventionthinspsousthinspseacutedation-analgeacutesiethinspouthinspunthinspmeacutedecinthinspdeacutesigneacutethinspdoitthinspecirctrethinspdisponiblethinspenthinsptoutthinsptempsthinspafinthinspdethinsppouvoirthinspintervenirthinspsansthinspdeacutelaithinsplethinspcasthinspeacutecheacuteant

Rappelonsthinspquethinsplesthinspappareilsthinspdethinspmonitoragethinspdoiventthinspecirctrethinspenthinspfonctionthinspmaisthinspthinspenthinspaucunthinsptempsthinspilsthinspnethinspremplacentthinsplathinspsurveillancethinspdirectethinspduthinsppatientthinspparthinspthinsplethinspprofessionnel

Lethinsppatientthinspdoitthinspresterthinspagravethinsplathinspsallethinspdethinspreacutecupeacuterationthinspouthinspdrsquoobservationthinsppendantthinspthinsp30thinspminutesthinspauthinspminimumthinspapregravesthinspavoirthinspreccediluthinsplathinspderniegraverethinspdosethinspdethinspseacutedationthinspouthinspthinspdrsquoanalgeacutesiethinspintraveineusethinsp(Merchantthinspetthinspcollabthinsp2014bthinspop cit)

Sithinspunethinspmeacutedicationthinspantagonistethinspathinspeacuteteacutethinspadministreacuteethinsplethinsppatientthinspserathinspgardeacutethinspsousthinspthinspobservationthinsplethinsptempsthinspneacutecessairethinsp(lethinsptempsthinspserathinspaugmenteacutethinspdethinspgethinsp2thinspheuresthinspthinsp[Merchantthinspetthinspcollabthinsp2014bthinspop cit]thinspenthinspfonctionthinspdethinsplrsquoeacutetatthinspcliniquethinspduthinsppatient)thinsppourthinspsrsquoassurerthinspqursquoilthinspnrsquoythinspathinsppasthinspdethinspseacutedationthinsprebond

Parmithinsplesthinspcritegraveresthinspagravethinsprespecterthinspauthinspmomentthinspduthinspcongeacutethinsp

thinsprsaquo voiesthinspaeacuteriennesthinsppermeacuteablesthinspetthinspventilationthinspadeacutequatethinsprsaquo stabiliteacutethinspcardiovasculairethinspadeacutequatethinsprsaquo niveauthinspdethinspconsciencethinspduthinsppatientthinsprevenuthinspagravethinspsonthinspeacutetatthinspinitialthinsprsaquo douleurthinspreacutesiduellethinsptoleacuterablethinspabsentethinspouthinspcommethinspagravethinspsonthinspeacutetatthinspinitial

CMQ - OIIQ - OPIQ 30

thinsprsaquo mobiliteacutethinsprevenuethinspagravethinspsonthinspeacutetatthinspinitialthinsprsaquo peuthinspouthinsppasthinspdethinspvomissementsthinsprsaquo patientthinspouthinsppersonnethinspresponsablethinspduthinsppatientthinsppeutthinspcomprendrethinsplesthinspdirectivesthinsp

dethinspdeacutepart

thinsprsaquothinsprsaquo Cesthinspcritegraveresthinspdoiventthinspecirctrethinsprespecteacutesthinspdethinspfaccedilonthinspsysteacutematiquethinsp

Lesthinspprofessionnelsthinspdoiventthinspsrsquoassurerthinspquethinspquandthinsplethinsppatientthinspquittethinsplrsquoeacutetablis-sementthinspilthinspestthinspaccompagneacutethinspdrsquounthinspadultethinspresponsablethinspetthinspqursquounthinspdocumentthinsprelatifthinspauthinspcongeacutethinspcomprenantthinspdesthinspconsignesthinspclairesthinsppourthinsplathinspsurveillancethinspagravethinspdomicilethinsp(pthinspexthinspthinspquoithinspfairethinspenthinspcasthinspdrsquourgence)thinspleurthinspsoitthinspremisthinspetthinspexpliqueacutethinsp(annexethinspXII)thinsp

thinspthinsp17thinspDOCUMENTATIONthinspDESthinspSOINSthinspETthinspTENUEthinspthinspDEthinspDOSSIERSthinsp

Commethinsppourthinsptoutethinspautrethinspinterventionthinsplesthinspmecircmesthinspnormesthinspsrsquoappliquentthinsppourthinsplathinspreacutedactionthinspdesthinspnotesthinspenthinspseacutedation-analgeacutesiethinspthinsp

Enthinspplusthinspdesthinspeacuteleacutementsthinspgeacuteneacuteralementthinspverseacutesthinspauthinspdossierthinspcelui-cithinspdoitthinspcontenirthinsptoutesthinsplesthinspinformationsthinsprelativesthinspagravethinsplathinsppeacuteriodethinsppreacutethinspperthinspetthinsppostseacutedation-analgeacutesiethinspAinsithinsplesthinspeacuteleacutementsthinspsuivantsthinspdoiventthinspecirctrethinspdocumenteacutesthinspauthinspdossierthinspduthinsppatientthinsp

(listethinspnonthinsplimitative)thinsp

1 lrsquoidentificationthinspdesthinspfacteursthinspdethinsprisquethinsplieacutesthinspagravethinsplrsquointerventionthinspdiagnostiquethinspthinspouthinsptheacuterapeutiquethinspouthinspagravethinsplathinspseacutedation-analgeacutesie

2 lrsquoheurethinspduthinspdeacutebutthinspetthinspdethinsplathinspfinthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplrsquoheurethinspdrsquoarriveacuteethinspagravethinsplathinspsallethinspdethinspreacutecupeacuterationthinspouthinspdrsquoobservationthinsp(sithinspdiffeacuterente)thinspetthinsplrsquoheurethinspduthinspdeacutepart

3 lesthinspordonnancesthinspmeacutedicalesthinspcomplegravetes4 lathinspmeacutedicationthinspthinspdosagethinspquantiteacutethinspvoiethinspvitessethinspetthinspheurethinspdrsquoadministration5 lathinspconcentrationthinspouthinsplethinspdeacutebitthinspdethinsplrsquooxygegravenethinsp(outhinspduthinspmeacutelangethinspgazeux)thinspadministreacutethinspthinsp

lethinspcasthinspeacutecheacuteant

6 lathinspsurveillancethinspeffectueacuteethinspa lesthinspsignesthinspvitauxthinspavecthinsplrsquoheurethinspdesthinsplecturesb lethinsptauxthinspdethinspsaturationthinspcapillairethinspenthinspoxygegravenethinspavecthinsplrsquoheurethinspdesthinsplecturesc lethinspniveauthinspdethinspCO

2thinspthinsplethinspcasthinspeacutecheacuteantthinspavecthinsplrsquoheurethinspdesthinsplectures

d lathinspdescriptionthinsppeacuteriodiquethinspduthinspniveauthinspdethinspseacutedationagitationthinspetthinspdethinspthinspconsciencethinsplrsquoutilisationthinspdrsquounethinspeacutechellethinspestthinsprecommandeacuteethinsp(annexethinspIX)

e lathinspdescriptionthinsppeacuteriodiquethinspduthinspniveauthinspdethinspdouleurthinsplrsquoutilisationthinspdrsquounethinspeacutechellethinspestthinsprecommandeacuteethinsp(annexethinspX)

CMQ - OIIQ - OPIQ 31

f lathinspdescriptionthinspdethinsptoutethinspreacuteactionthinspdeacutefavorablethinsplethinspcasthinspeacutecheacuteantg lathinspdescriptionthinspdethinsplrsquoeacutetatthinspduthinsppatientthinspagravethinsplathinspfinthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-thinsp

analgeacutesieh lathinspdescriptionthinspdethinsplrsquoeacutetatthinspduthinsppatientthinspauthinspmomentthinspduthinspcongeacutethinspouthinsplathinspreacutefeacuterencethinspthinsp

agravethinspunthinspprotocolethinsp(critegraveresthinspdethinspcongeacute)7 lethinspmonitoragethinspthinspappareilthinspalarmethinspemplacementthinsplethinspcasthinspeacutecheacuteant8 lethinspconsentement9 unethinspcopiethinspdesthinsprecommandationsthinspeacutecritesthinspremisethinspauthinsppatientthinspauthinspmomentthinspduthinsp

congeacutethinsp(annexethinspXII)thinspouthinspagravethinspdeacutefautthinspunethinspnotethinspattestantthinsplathinspremisethinspdethinspcethinspdocumentthinspstandardiseacutethinspdontthinspunethinspcopiethinspestthinspconserveacutee

10 thinsplethinspprotocolethinspopeacuteratoire11 thinsplathinspnotethinspdethinspdeacutepart12 thinsptoutethinspautrethinspinformationthinspjugeacuteethinsppertinentethinsp(pthinspexthinspthinspreacutesultatthinspdrsquoauscultationthinspthinsp

complication)

Enfinthinsptousthinsplesthinspprofessionnelsthinspimpliqueacutesthinspdoiventthinspsrsquoassurerthinspduthinsprespectthinspdethinspleurthinspreacuteglementationthinspouthinspnormesthinsprespectivesthinspenthinspmatiegraverethinspdethinspdocumentationthinspdesthinspsoinsthinspetthinspdethinsptenuethinspdethinspdossiers

CMQ - OIIQ - OPIQ 32

Chapitre 2Patient peacutediatrique

thinspPREacuteAMBULEthinsp

Puisquethinsplrsquoenfantthinsppossegravedethinspdesthinspcaracteacuteristiquesthinspquithinspluithinspsontthinsppropresthinspetthinspquithinspeacutevoluentthinspenthinspfonctionthinspdethinspsonthinspstadethinspdethinspdeacuteveloppementthinspilthinspestthinspdoncthinspopportunthinspdrsquoeacutetablirthinspdesthinsplignesthinspdirectricesthinspparticuliegraveresthinspagravethinspcettethinspclientegravelethinsp

Cesthinsplignesthinspdirectricesthinspvisentthinsplesthinspenfantsthinspacircgeacutesthinspdethinspplusthinspdethinsp3thinspansthinsp

Unethinspseacutedation-analgeacutesiethinspreacuteussiethinspameacuteliorethinsplathinspqualiteacutethinspdesthinspexamensthinspdemandeacutesthinspdiminuethinsplathinspneacutecessiteacutethinspdethinsprecourirthinspagravethinspdesthinspcontentionsthinspphysiquesthinspameacuteliorethinsplathinspcollaborationthinspetthinsplathinspconfiancethinspdethinsplrsquoenfantthinspetthinspdesthinspparentsthinspquantthinspauxthinspsoinsthinspprodigueacutesthinspetthinspauxthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspreacutealiseacuteesthinsp

Lathinspseacutedation-analgeacutesiethinsp(tousthinspniveaux)thinspenthinsppeacutediatriethinspdoitthinspecirctrethinspreacuteserveacuteethinspauthinspmilieuthinsphospitalierthinspouthinspauxthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacuteces-sairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspetthinspcethinspenthinspraisonthinspduthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquithinspestthinspgeacuteneacuteralementthinspneacutecessairethinspEllethinspcomportethinspdesthinsprisquesthinspseacuterieuxthinsppeuthinspimportethinsplrsquoeacutetatthinspdethinspsanteacutethinspdethinsplrsquoenfantthinspLesthinspcomplicationsthinsplesthinspplusthinspfreacutequentesthinspsontthinsplrsquoobstructionthinspdesthinspvoiesthinspaeacuteriennesthinsplrsquoapneacuteethinsplrsquoaspirationthinspdethinspseacutecreacutetionsthinspthinspetthinsplesthinspvomissements

thinsp21thinspOBJECTIFSthinspETthinspCLIENTEgraveLEthinspCIBLEthinsp

OBJECTIFS

Outrethinsplesthinspobjectifsthinspdethinspseacutedation-analgeacutesiethinspdeacutefinisthinsppourthinsplathinspclientegravelethinspadultethinsp(pthinsp8)thinspthinsp

lathinspseacutedation-analgeacutesiethinsppourthinsplathinspclientegravelethinsppeacutediatriquethinspvisethinspeacutegalementthinspagravethinspthinsp

thinsprsaquo eacuteviterthinspunthinsptraumatismethinsppsychologiquethinsprsaquo diminuerthinsplrsquoanxieacuteteacutethinspetthinsplathinsppeurthinspdethinsplrsquoenfantthinspetthinspdesthinspparentsthinsprsaquo obtenirthinsplathinspcollaborationthinspdethinsplrsquoenfant

CMQ - OIIQ - OPIQ 33

CLIENTEgraveLEthinspCIBLE

EnthinsppeacutediatriethinsplethinspniveauthinspdethinspseacutedationthinsprequisthinspestthinsptributairethinspdethinsplrsquoacircgethinspduthinspstadethinspdethinspdeacuteveloppementthinspdethinsplathinspcapaciteacutethinspcognitivethinspetthinspdethinsplathinspcollaborationthinspdethinsplrsquoenfantthinspAinsithinspchezthinsplrsquoenfantthinspdethinsp

thinsprsaquo 3thinspagravethinsp6thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspmodeacutereacutethinspsrsquoavegraverethinsprarementthinspsuffisantethinspLathinspplupartthinspdesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspneacutecessitentthinspunthinspniveauthinspprofondthinsp(voirethinspunethinspanestheacutesiethinspgeacuteneacuterale)thinsp

thinsprsaquo 7thinspagravethinsp13thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspmodeacutereacutethinspsrsquoavegraverethinspgeacuteneacuteralementthinspsuffisantethinspToutefoisthinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinsppeuventthinspneacutecessiterthinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspprofondthinsp

thinsprsaquo gethinsp14thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspleacutegerthinspouthinspmodeacutereacutethinspsrsquoavegraverethinspsuffisantethinspToutefoisthinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinsppeuventthinspneacutecessiterthinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspprofond

Chezthinsplrsquoenfantthinspdethinspmoinsthinspdethinsp3thinspansthinspouthinspdansthinsplethinspcasthinspdrsquounethinspseacutedationthinspprofondethinspviseacuteethinsplethinspmeacutedecinthinspdoitthinspsrsquoassurerthinspdethinsplathinspcollaborationthinspdrsquounthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespira-toirethinsppeacutediatriquethinspavanceacutee

Dethinspplusthinspilthinspestthinsprecommandeacutethinspdrsquoutiliserthinsplathinspclassificationthinspdethinsplrsquoeacutetatthinspphysiquethinspduthinspthinsppatientthinspquethinsplrsquoonthinsptrouvethinspdansthinsplethinsptableauthinspdethinsplathinsppagethinspsuivante

CMQ - OIIQ - OPIQ 34

Tableau 4 Classification de lrsquoeacutetat physique du patient selon lrsquoAmerican Society of Anesthesiologists (ASA) (ASA Physical Status Classification System [En ligne]) (Notre traduction)

Classification Eacutetatthinspdethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp1 Patientthinspenthinspbonnethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp2Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspleacutegegravere

ASAthinspPhysicalthinspStatusthinsp3Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgrave

ASAthinspPhysicalthinspStatusthinsp4Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgravethinspquithinsprepreacutesentethinspunethinspmenacethinspconstantethinsppourthinspsathinspvie

ASAthinspPhysicalthinspStatusthinsp5Patientthinspmoribondthinspquithinspnethinspsurvivrathinsppasthinspthinspagravethinspmoinsthinspdrsquounethinspinterventionthinsp

ASAthinspPhysicalthinspStatusthinsp6Patientthinspdeacuteclareacutethinspenthinspeacutetatthinspdethinspmortthinspceacutereacutebralethinspdontthinsplesthinsporganesthinspontthinspeacuteteacutethinsppreacuteleveacutesthinspagravethinspdesthinspfinsthinspdethinspdon

CMQ - OIIQ - OPIQ 35

Volet organisationnelthinsp22thinspCOMPEacuteTENCESthinspPROFESSIONNELLESthinsp

Outrethinsplesthinspcompeacutetencesthinspprofessionnellesthinspmentionneacuteesthinsppourthinsplethinsppatientthinspadultethinspthinsp(pthinsp11)thinsptousthinsplesthinspprofessionnelsthinspdethinsplathinspsanteacutethinsp(meacutedecinthinspinfirmiegraverethinspetthinspinhalotheacutera-peute)thinspquithinspprocegravedentthinspagravethinspunethinspseacutedation-analgeacutesiethinspaupregravesthinspdethinsppatientsthinsppeacutediatriquesthinspdoiventthinspposseacutederthinsp

athinsp lesthinspconnaissancesthinspetthinsplesthinspcompeacutetences73neacutecessairesthinspagravethinsplathinspreacuteanimationthinspthinspcardiorespiratoirethinsppeacutediatrique84(dethinsppreacutefeacuterencethinspenthinspsoinsthinspavanceacutes)thinspcrsquoest-agrave-direthinspmaicirctriserthinspenthinspprioriteacutethinsplesthinsptechniquesthinspdethinsplathinspprisethinspenthinspchargethinspdethinsplathinspventilationthinspduthinspmassagethinspcardiaquethinspetthinspdethinsplathinspmeacutedicationthinspassocieacutee

bthinspunethinspexpertisethinspcliniquethinspspeacutecifiquethinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspagravethinspreacutealiserthinspthinsp

thinspthinsp23thinspRESSOURCESthinspMATEacuteRIELLESthinsp

Sithinsplesthinspressourcesthinspmateacuteriellesthinspdethinspbasethinspetthinsplrsquoemplacementthinspsontthinspessentiellementthinsplesthinspmecircmesthinspquethinspchezthinsplrsquoadultethinsp(pthinsp11)thinspcelles-cithinspdoiventthinsptoutefoisthinspecirctrethinspadapteacuteesthinspauthinsp

patientthinsppeacutediatriquethinsp(crsquoest-agrave-direthinsptaillethinsppoidsthinspetthinspparticulariteacutes)thinsp

Agravethinsptitrethinspdrsquoexemplethinsp(listethinspnonthinsplimitative)thinsp

thinsprsaquo capteurthinspduthinspsaturomegravetrethinspdethinspmodegravelethinsppeacutediatriquethinsprsaquo reacuteanimateurthinspautogonflantthinsp(Ambuthinspbag)thinspetthinspmasquesthinspdethinspdiffeacuterentesthinsptaillesthinspthinsprsaquo lamesthinspdethinsplaryngoscopethinspsondesthinspendotracheacutealesthinsp(avecthinspouthinspsansthinspballonnet)thinspdethinsp

taillesthinspdiffeacuterentesthinsprsaquo canulesthinsporonasopharyngeacuteesthinspdethinspdiffeacuterentesthinsptaillesthinsprsaquo tubulurethinspagravethinspsoluteacutethinspdethinsptypethinspmicrogouttesthinspavecthinspouthinspsansthinspburettethinsprsaquo outilsthinspsupraglottiquesthinsp(pthinspexthinspthinspmasquethinsplaryngeacute)thinspdethinspdiffeacuterentesthinsptaillesthinsprsaquo deacutefibrillateurthinspavecthinspeacutelectrodesthinsppeacutediatriquesthinsprsaquo steacutethoscopethinspdethinsptaillethinsppeacutediatriquethinsp(preacutecordialthinspouthinsppreacutetracheacutealthinsppourthinspeacutecoutethinspenthinsp

continuethinspsrsquoilthinspythinspathinsplieu)thinsprsaquo appareilthinspagravethinspaspirationthinsppouvantthinspgeacuteneacutererthinspunethinsppressionthinspneacutegativethinspdethinsp40thinspagravethinsp60thinspmmthinsp

Hgthinspouthinspunethinspcapaciteacutethinspdethinspflotthinspdethinsp100thinsplitresthinspparthinspminutethinspetthinsplethinspmateacuterielthinspneacutecessairethinspdethinsptaillethinspadapteacutee

7thinsp Onthinspentendthinspparthinspconnaissancesthinspetthinspcompeacutetencesthinspqursquoellesthinspsoientthinspmisesthinspagravethinspjourthinspselonthinsplesthinsprecommandationsthinspenthinspvigueur

8thinsp Onthinspentendthinspparthinspcertificationthinspenthinspreacuteanimationthinspcardiorespiratoirethinsplesthinspformationsthinspsuivantesthinspthinsp rsaquothinspReacuteanimationthinspcardiorespiratoirethinspdethinspbasethinspthinspSoinsthinspimmeacutediatsthinspenthinspreacuteanimationthinsp(SIR)thinsppourthinspprofessionnelsthinspdethinsplathinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspsanteacutethinspouthinsplrsquoeacutequivalentthinsp rsaquothinspReacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspSoinsthinspavanceacutesthinspenthinspreacuteanimationthinsppeacutediatriquethinsp(SARP)thinspouthinsplrsquoeacutequivalent

CMQ - OIIQ - OPIQ 36

Volet professionnelthinsp24thinspPREacuteSEacuteDATION-ANALGEacuteSIEthinsp

SEacuteLECTIONthinspDESthinspPATIENTS

Sithinspunethinspseacutelectionthinsprigoureusethinspdesthinsppatientsthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinspattentionthinspquethinspchezthinsplrsquoadultethinsp(pthinsp15)thinspcertainesthinspparticulariteacutesthinsppropresthinspagravethinsplrsquoenfantthinspdoiventthinsp

toutefoisthinspecirctrethinspprisesthinspenthinspcomptethinsp

LorsthinspdethinspsituationsthinspparticuliegraveresthinspouthinspcomplexesthinspapregravesthinsplrsquoeacutevaluationthinspduthinsppatientthinsplethinspmeacutedecinthinspdevraitthinspconsulterthinspunthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspCitonsthinspagravethinsptitrethinspdrsquoexemplethinspmaisthinspsansthinspsrsquoythinsplimiterthinsp

thinsprsaquo preacutesencethinspdethinspcertainsthinspsyndromesthinspdontthinsplathinsptrisomiethinsp21thinsprsaquo anomaliethinspdesthinspvoiesthinspaeacuteriennesthinsprsaquo anomaliethinspcranio-facialethinsprsaquo infectionthinsprespiratoirethinspasthmethinsprsaquo maladiethinspneuromusculairethinsprsaquo maladiethinspcardiaquethinsprsaquo troublethinsprespiratoirethinspduthinspsommeilthinspetthinsplathinsptheacuterapiethinspassocieacuteethinsprsaquo obeacutesiteacutethinspimportantethinsprsaquo refluxthinspgastro-œsophagienthinsprsaquo eacutetatthinspdethinspconsciencethinspalteacutereacutethinsprsaquo troublethinspenvahissantthinspduthinspdeacuteveloppementthinsp(pthinspexthinspthinspautisme)

Dethinspmecircmethinsptoutthinspcommethinspchezthinsplrsquoadultethinsplesthinspinterventionsthinspeffectueacuteesthinspsousthinspseacutedation-analgeacutesiethinspdoiventthinspecirctrethinspreacuteserveacuteesthinspprincipalementthinspauxthinsppatientsthinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp1thinspouthinspauxthinsppatientsthinspatteintsthinspdrsquounethinspaffectionthinsp

systeacutemiquethinspleacutegegraverethinspclasseacuteethinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp2thinsp

Notonsthinspquethinsplorsquethinspcestthinspjustifieacutethinspauthinspdossierthinspmeacutedicalthinsplathinspseacutedation-analgeacutesiethinsppeutthinspecirctrethinspeffectueacuteethinspchezthinsplesthinsppatientsthinspstablesthinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp3thinspetthinspexceptionnellementthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp4thinspToutefoisthinspellethinspdoitthinsplrsquoecirctrethinspdansthinspdesthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspDethinspplusthinspcesthinsppatientsthinspdoiventthinsp

fairethinsplrsquoobjetthinspdrsquounethinspeacutevaluationthinspindividualiseacuteethinspetthinspplusthinspapprofondiethinspEacuteVALUATIONthinspDESthinspPATIENTSthinsp

CMQ - OIIQ - OPIQ 37

EacuteVALUATIONthinspDESthinspPATIENTS

Sithinspunethinspeacutevaluationthinsprigoureusethinspdesthinsppatientsthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinspatten-tionthinspquethinspchezthinspladultethinsp(pthinsp15)thinspcettethinspeacutevaluationthinspdoitthinspaussithinspinclurethinspsansthinspsrsquoythinsplimiterthinsplrsquoacircgethinsplathinsptaillethinsplethinsppoidsthinsplethinspstadethinspdethinspdeacuteveloppementthinsplathinspcapaciteacutethinspcognitivethinsplesthinspallergiesthinsplesthinspproblegravemesthinspmeacutedicauxthinspouthinspfamiliauxthinsppertinentsthinsplesthinspmeacutedicamentsthinsp(outhinspautrethinspsubstancethinspnonthinspprescrite)thinsppristhinspreacuteguliegraverementthinspouthinspreacutecemmentthinspetthinsplrsquoheurethinspduthinspdernierthinspingestathinspainsithinspquethinsplethinsptypethinspetthinsplathinspquantiteacutethinspconsommeacutee

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsplrsquoeacutevaluationthinsp(anamnegravesethinspetthinspexamenthinspphysique)thinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinspthinsp

CONSENTEMENTthinsp(REacuteSUMEacute)

LethinsplecteurthinspdoitthinspsethinspreacutefeacutererthinspagravethinsplrsquoannexethinspVIIIthinsppourthinsplethinsptextethinspcomplet

ToutthinspcommethinspchezthinsplrsquoadultethinspilthinspestthinspobligatoirethinspauthinspQueacutebecthinspdrsquoobtenirthinsplethinspconsente-mentthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspinterventionthinspCelathinspditthinsppourthinsplathinspclientegravelethinsppeacutediatriquethinspilthinspfautthinspajouterthinspunethinsppreacutecisionthinspextraitethinspduthinsp

Code civil du QueacutebecthinspthinspSithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsp(traitementsthinspdethinspmeacutedecinethinspetthinspdethinspchirurgiethinspestheacutetiquethinspexpeacuterimentationthinspetthinspdonsthinspdrsquoorganes)thinsplethinsppatientthinspdoitthinspecirctrethinspinformeacutethinspdethinsptousthinsplesthinsprisquesthinsppossiblesthinspmecircmethinspsrsquoilsthinspsontthinspraresthinspthinspetthinsplethinspconsentementthinspdoitthinspecirctrethinspdonneacutethinspparthinspeacutecrit

thinsprsaquo Unethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsp(gethinsp14thinspans)thinsppeutthinspconsentirthinspseulethinspthinspagravethinspmoinsthinspqursquoilthinspsrsquoagissethinspdethinspsoinsthinspnonthinsprequisthinspetthinspcomportantthinspdesthinsprisques

thinsprsaquo Pourthinspunethinsppersonnethinspmineurethinspdethinspmoinsthinspdethinsp14thinspansthinsp(ltthinsp14thinspans)thinsplethinspconsentementthinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentale

Srsquoilthinspsrsquoagitthinspdethinspsoins requisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsplrsquoobligationthinspdrsquoinformerthinsp

croicirctthinspenthinspfonctionthinspdethinsplathinsppreacutevalencethinspetthinspdethinsplathinspgraviteacutethinspdesthinspcomplications

thinsprsaquo Lethinspconsentementthinspdrsquounethinsppersonnethinspmineurethinsp(ltthinsp18thinspans)thinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinsp

thinsprsaquo Unethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsp(gethinsp14thinspans)thinsppeutthinspconsentirthinspmaisthinspnethinsppeutthinsppasthinsprefuserthinspseulethinspdesthinspsoinsthinspquithinspseraientthinspjugeacutesthinsprequisthinsp

DIRECTIVESthinspETthinspCONSEILSthinsp

Toutthinspcommethinsppourthinsplrsquoadultethinsp(pthinsp19)thinsplrsquoenfantthinspetthinspsonthinspparentthinsp(outhinspremplaccedilant)thinspdoiventthinsprecevoirthinsplesthinspdirectivesthinspneacutecessairesthinspCelathinspditthinspauxthinspdirectivesthinsprelativesthinspauthinspjeucircnethinsp

CMQ - OIIQ - OPIQ 38

preacute-interventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspnonthinspurgentethinsp(eacutelective)thinspilthinspfautthinspajouterthinspcecithinsp(Merchantthinspetthinspcollabthinsp2014a op cit)thinsp

thinsprsaquo liquidethinspclairthinsp(pthinspexthinspthinspeauthinspjusthinspdethinspfruitthinsp[sansthinsppulpe])thinspthinspjeucircnethinspdethinsp2thinspheuresthinsprsaquo laitthinspmaternelthinspthinspjeucircnethinspdethinsp4thinspheuresthinsprsaquo formulesthinsplacteacuteesthinspnonthinsphumaniseacuteesthinspouthinsppreacuteparationsthinspcommercialesthinsppourthinsp

nourrissonsthinspthinspjeucircnethinspdethinsp6thinspheuresthinspthinspAucunthinspajoutthinspnrsquoestthinsppermisthinspauthinsplaitthinspmaternelthinsptireacutethinsp

thinsp25thinspPERSEacuteDATION-ANALGEacuteSIEthinsp

APPROCHEthinspPHARMACOLOGIQUEthinsp

Sithinsplathinspmeacutedicationthinspgeacuteneacuteralementthinsputiliseacuteethinspestthinsplathinspmecircmethinspquethinspchezthinsplrsquoadultethinsp(pthinsp20)thinsplathinspdosethinspdoitthinspecirctrethinspadapteacuteethinspnotammentthinspenthinspfonctionthinspduthinsppoidsthinspetthinspdethinsplathinspcondi-tionthinspcliniquethinspdethinsplrsquoenfantthinspParthinspailleursthinspilthinspfautthinspretenirthinspquethinsplathinsppharmacocineacutetiquethinspetthinsplathinsppharmacodynamiquethinspdesthinspagentsthinspdethinspseacutedation-analgeacutesiethinspsontthinspinfluenceacuteesthinspparthinsplrsquoacircgethinspduthinsppatientthinspAgravethinsptitrethinspdrsquoexemplethinsppourthinspunthinspenfantthinspacircgeacutethinspdethinspunthinspagravethinspsixthinspansthinsplathinspclairancethinspdesthinspagentsthinspdethinspseacutedation-analgeacutesiethinspestthinspsupeacuterieurethinspagravethinspcellethinspdethinsplrsquoadultethinspIlthinspfaudrathinspdoncthinspajusterthinsplesthinspdosesthinspchezthinspunthinspenfantthinspdrsquoacircgethinsppreacutescolairethinsp(Saunderthinspetthinsp

collabthinsp2008)thinsp

Lrsquoutilisationthinspdrsquounethinsppommadethinspanalgeacutesiquethinsp(pthinspexthinspthinsplathinspcregravemethinspEMLAreg)thinsppeutthinspecirctrethinspavantageusethinsppourthinspcontrerthinsplathinspdouleurthinspassocieacuteethinspagravethinsplathinspposethinspdrsquounthinspcatheacuteterthinspintra-veineuxthinspparthinspexemplethinsp(lethinsptempsthinspdrsquoattentethinspdethinsp60thinspagravethinsp90thinspminutesthinspdoitthinspecirctrethinsppristhinspenthinspconsideacuteration)thinsp

APPROCHEthinspNONthinspPHARMACOLOGIQUE

Pourthinsplrsquoenfantthinspquithinspnethinspbeacuteneacuteficiethinspquethinspdrsquounethinspanalgeacutesiethinsp(aucunethinspseacutedation)thinspilthinspfautthinspretenirthinspquethinsplathinspdistractionthinsp(attirerthinsplrsquoattentionthinspversthinspquelquethinspchosethinspdethinsppositif)thinsppen-dantthinspunthinspsointhinspdouloureuxthinsp(outhinspquithinspinquiegravete)thinsppeutthinspsrsquoaveacutererthinspunthinspmoyenthinspefficacethinsppourthinspdiminuerthinspsonthinspanxieacuteteacutethinspetthinsplathinspperceptionthinspdethinspsathinspdouleurthinsp(AssociationthinspSparadrapthinspthinsp[Enthinspligne])

Agravethinsptitrethinspdrsquoexemplethinspetthinspsansthinspsrsquoythinsplimiterthinsp

thinsprsaquo discuterthinspavecthinsplrsquoenfantthinspouthinsplrsquoadolescentthinspdethinspsesthinsppreacutefeacuterencesthinsprsaquo utiliserthinspunthinspjouetthinspchanterthinspunethinspchansonthinspouthinspraconterthinspunethinsphistoirethinspagravethinsplrsquoenfantthinspthinsp

plusthinspjeunethinsprsaquo lathinsppreacutesencethinspetthinsplathinspcollaborationthinspdrsquounthinspparentthinsppeuventthinspecirctrethinsppertinentes

CMQ - OIIQ - OPIQ 39

SURVEILLANCEthinspCLINIQUE

Lathinspsurveillancethinspcliniquethinspcomprendthinspplusieursthinspeacuteleacutementsthinspquithinspconcernentthinspnotam-mentthinsplesthinspsystegravemesthinsprespiratoirethinspcardiaquethinspetthinspneurologiquethinspetthinspellethinspdoitthinsptenirthinspcomptethinspentrethinspautresthinsp

thinsprsaquo dethinsplathinspconditionthinspduthinsppatientthinspavantthinspetthinsppendantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

thinsprsaquo dethinsplathinspcomplexiteacutethinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinsprsaquo dethinsplathinspmeacutedicationthinsputiliseacuteethinsp(dosethinspdureacuteethinspetthinsppicthinspdrsquoactionthinspvoiethinspetthinspvitessethinsp

drsquoadministrationthinspcombinaisonthinspetthinspantagonistes)thinsprsaquo dethinsplrsquoassistancethinspagravethinspapporterthinspauthinspmeacutedecin

Lethinspmeacutedecinthinspquithinsppratiquethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspchezthinspunthinspenfantthinspsousthinspseacutedation-analgeacutesiethinspdoitthinspcompterthinspsurthinsplathinsppreacutesencethinspdrsquoauthinspmoinsthinspunthinspautrethinspprofessionnelthinsphabiliteacutethinspduthinspmilieuthinspdethinsplathinspsanteacutethinsp(infirmiegraverethinspinhalotheacuterapeutethinspouthinspautrethinspmeacutedecin)thinsp(annexethinspII)thinspEnthinspeacutetroitethinspcollaborationthinspavecthinsplethinspmeacutedecinthinspreacuteali-santthinsplrsquointerventionthinspceux-cithinspassurentthinsplathinspgestionthinspdethinsplathinspseacutedationthinspetthinspdethinsplrsquoanalgeacutesiethinsp

qui comprend entre autres la surveillance clinique de lrsquoenfantthinspresponsabiliteacutethinspthinspagravethinsplaquellethinspilsthinspdoiventthinspenthinsptoutthinsptempsthinspsethinspconsacrerthinspen prioriteacutethinsp

Dansthinspcertainsthinspcasthinsplethinspprofessionnelthinspquithinspassurethinspen prioriteacutethinsplathinspsurveillancethinspthinspcliniquethinspdethinsplrsquoenfantthinsppeutthinspecirctrethinspappeleacutethinspagravethinspassisterthinsplethinspmeacutedecinthinspdansthinsplathinspreacutealisationthinspthinspdethinspsonthinspinterventionthinspCettethinspassistancethinspquithinspdoitthinspsrsquoeffectuerthinspdansthinsplathinspmecircmethinsppiegravecethinspdoitthinspecirctrethinspdethinsptregravesthinspcourtethinspdureacuteethinspDethinspplusthinspellethinspdoitthinsppouvoirthinspecirctrethinspinterrompuethinspagravethinsptoutthinspmomentthinsppourthinspintervenirthinspimmeacutediatementthinspaupregravesthinspdethinsplrsquoenfantthinspenthinspcasthinspdethinspcomplicationsthinspouthinspdethinspbesoin

Parthinspailleursthinsplorsquethinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspneacutecessitentthinspunethinspassistancethinsptechniquethinspcontinuellethinspauthinspmeacutedecinthinsplrsquoajoutthinspdrsquounthinsptroisiegravemethinspprofessionnelthinspdethinsplathinspsanteacutethinsphabiliteacutethinsp(meacutedecinthinspinfirmiegraverethinspouthinspinhalotheacutera-peute)thinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspdethinsplrsquoenfantthinspestthinsprequisthinsp

CMQ - OIIQ - OPIQ 40

Tableau 5 Tableau reacutecapitulatif du nombre de professionnels habiliteacutes requis en seacutedation-analgeacutesie - Clientegravele peacutediatrique

Toutthinspauthinsplongthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinspdoitthinspecirctrethinspcontinuethinspetthinsplathinspcommunicationthinspavecthinspcelui-cithinspmaintenuethinsp

Proceacutederthinspagravethinsplathinspsurveillancethinspcliniquethinspcrsquoestthinspeacutevaluerthinspqualitativementthinspetthinspquanti-tativementthinspdethinspfaccedilonthinspsoutenuethinspetthinspenthinspcontinuthinsplrsquoensemblethinspdesthinspparamegravetresthinspsui-vantsthinsp(listethinspnonthinsplimitative)thinsp(tableauthinsp6)thinsp

thinsprsaquo mesurethinspdethinsplathinsppressionthinsparteacuteriellethinspduthinsppouls95etthinspdethinsplathinsprespiration106

thinsprsaquo lecturethinspdethinsplathinspsaturationthinspcapillairethinspenthinspoxygegraveneLathinsptonaliteacutethinspdethinsppoulsthinspdoitthinspecirctrethinspactiveacuteethinspenthinsptoutthinsptempsthinspetthinspsonthinspniveauthinspdoitthinspecirctrethinspajusteacutethinspdethinspfaccedilonthinspagravethinspecirctrethinspentenduthinspclairement

thinsprsaquo eacutevaluationthinspdethinsplrsquoeacutetatthinspdethinsplathinspcolorationthinspetthinspdethinsplathinsptempeacuteraturethinspdethinsplathinsppeauthinsprsaquo niveauthinspdrsquoO

2thinspdethinspCO

2thinspetthinspmonitoragethinspcardiaquethinspselonthinsplethinspcasthinsp

Enthinspplusthinspdesthinspparamegravetresthinspdethinspmonitoragethinspcliniquethinsp(mentionneacutesthinsppreacuteceacutedemment)thinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsppeacutediatriquethinspdoitthinspcomprendrethinspthinsp

thinsprsaquo lrsquoeacutevaluationthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsp(pthinspexthinspthinspbradycardiethinsphypoxiquethinsppreacutecocethinspsithinspobstruction)

thinsprsaquo lrsquoapportthinspliquidienthinsprsaquo lathinsppertethinspdethinspchaleurthinsp(selonthinsplathinspdureacuteethinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesie)

9thinspthinspthinspthinspthinspLethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp10thinspthinspthinspthinspLathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinspetthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

Nombrethinspdethinspprofessionnelsthinsphabiliteacutesthinsprequis

2 Nombrethinspmimimalthinsprequis

3 Sithinsputilisationthinspdethinsppropofolthinspkeacutetaminethinspouthinspdethinspdexmeacutedeacutetomidine

3 SithinsputilisationthinspconcomitantethinspdethinspN2Othinspetthinspdrsquounthinspagentthinspseacutedatifthinspouthinspthinsp

dunthinspopioiumldethinspouthinspsithinspconcentrationthinspdethinspN2Othinspmodifiable

3 Sithinsplassistancethinsptechniquethinspauthinspmeacutedecinthinspestthinspcontinuelle

CMQ - OIIQ - OPIQ 41

thinsprsaquo lrsquoeacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplrsquoanalgeacutesiethinspetthinspdethinsplathinspseacutedationthinspagravethinsplrsquoaidethinspdrsquooutilsthinspadapteacutesthinspagravethinsplathinspconditionthinspetthinspagravethinsplrsquoacircgethinspdethinsplrsquoenfantthinsp(annexesthinspIXthinspetthinspX)

thinsprsaquo lathinsppositionthinspduthinsppatientthinspetthinsplesthinsppointsthinspdrsquoappuithinsp(compression)

Tableau 6 Surveillance des paramegravetres cliniques en seacutedation-analgeacutesie - Clientegravele peacutediatrique

Paramegravetrethinspdethinspthinspsurveillancethinspclinique

PatientNiveauthinspdethinspthinspseacutedation

MeacutedicationInterventionthinspdiagnostiquethinspouthinsptheacuterapeutique

TAthinspRC11thinspthinspRR12thinspthinspetthinspsaturationthinspdrsquoO

2thinspthinsp

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

Niveauthinspdethinspthinsp-thinspseacutedationagitationthinspthinspthinspthinspconscience-thinspdouleur

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

NiveauthinspdethinspCO2

SelonthinsplesthinspcaracteacuteristiquesthinspAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)thinsp

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspmeacutedication Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire rsaquothinspAccegravesthinspindirectthinspouthinspthinspthinspthinspthinsprestreintthinspauthinsppatientthinspthinspthinsp(pthinspexthinspthinspIRM)

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetaminethinsp

rsaquothinspRecommandeacute rsaquothinspASAthinspgethinsp3thinsprsaquothinspApneacuteethinspobstructivethinspthinspthinspduthinspsommeilthinsprsaquothinspMaladiethinspthinspthinsprespiratoirethinsprsaquothinspObeacutesiteacutethinspmorbide

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

Monitoragethinspcardiaque

SelonthinsplesthinspcaracteacuteristiquesAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspmeacutedication Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire rsaquothinspASAthinspgethinsp3thinsprsaquothinspMaladiethinspcardiaque

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

Interventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspprolongeacuteethinsp(effetthinspcumulatifthinspdethinsplathinspmeacutedication)

rsaquothinspRecommandeacute Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

thinspthinsp IlthinspnethinspsrsquoagitthinsppasthinspdrsquounethinsplistethinsplimiteacuteethinspdesthinspsituationsthinspcliniquesthinspDrsquoautresthinspsituationsthinspcliniquesthinsppeuventthinspneacutecessiterthinspthinsplethinspmonitoragethinspcardiaquethinspouthinspduthinspCO

2thinspIlthinsprevientthinspauxthinspprofessionnelsthinspdethinspjugerthinspdethinsplathinspsituationthinspenthinspfonctionthinspdethinspthinsp

chaquethinsppatient

11thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp12thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

CMQ - OIIQ - OPIQ 42

ILthinspFAUTthinspSAVOIRthinspQUE

LathinspSocieacuteteacutethinspcanadiennethinspdesthinspanestheacutesiologistesthinsp(SCA)thinspindiquethinspquethinsplesthinspthinspdirectivesthinspgeacuteneacuteralesthinspdethinspsoinsthinsp(ythinspcompristhinsplethinspmonitorage)thinsppourthinsplathinspseacutedationthinspthinspconscientethinspsontthinsplesthinspmecircmesthinspquethinsppourthinsplesthinspautresthinspformesthinspdrsquoanestheacutesiethinsp[]thinspthinsp(Merchantthinspetthinspcollabthinsp2014bthinspopthinspcit)thinspDethinspplusthinspellethinspindiquethinspquethinsplethinspthinspcapnographethinspestthinsprequisthinsplorsthinspdethinspseacutedation-analgeacutesiethinspdethinspniveauthinspplusthinspeacuteleveacutethinspthinsp(pthinspexthinspthinspRamsaythinsp4-6)thinsp(Merchantthinspetthinspcollabthinsp2014athinspop cit)

LethinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspimpliqueacutesthinspestthinspprimordialthinspetthinspcethinspmecircmethinspsithinsplrsquoappareillagethinspenthinspplacethinspestthinspcompletthinspetthinspfonctionnelthinspUnethinspbonnethinspcommunica-tionthinspentrethinspcesthinspderniersthinspestthinspdoncthinspessentiellethinspafinthinspdethinspbienthinspcoordonnerthinsplathinspseacutedationthinspetthinsplrsquoanalgeacutesiethinspavecthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspLes alarmes (audibles et visuelles) de chaque appareil doivent ecirctre en fonction et les paramegravetres ajusteacutes agrave lrsquoacircge et agrave la condition clinique de chaque enfant

IlthinspfautthinspsrsquoassurerthinspdethinsplathinsptraccedilabiliteacutethinspdethinsplrsquoeacutevaluationthinspetthinspdethinsplathinspsurveillancethinspcliniquethinspthinspeffectueacuteesthinspparthinspunethinsptenuethinspdethinspdossiersthinspconformethinspauxthinspnormesthinspenthinspvigueurthinspthinspLesthinspoutilsthinspdrsquoeacutevaluationthinsputiliseacutesthinspdoiventthinspecirctrethinspsimplesthinspstandardiseacutesthinspvalideacutesthinspdethinsppreacutefeacuterencethinspetthinspadapteacutesthinspauthinspcontextethinspetthinspauxthinspcaracteacuteristiquesthinspduthinsppatientthinspnotam-mentthinsppourthinsplrsquoeacutevaluationthinspduthinspniveauthinspdethinspseacutedationagitationthinspdethinspconsciencethinspetthinspdethinspdouleurthinsp(annexesthinspIXthinspetthinspX)

Lathinspfreacutequencethinspdethinsplathinspmesurethinspdethinspcesthinspparamegravetresthinspetthinspleurthinspenregistrementthinspdoiventthinspecirctrethinspdeacutetermineacutesthinspentrethinspautresthinspenthinspfonctionthinspdethinsplathinspmeacutedicationthinspetthinspdethinsplathinspconditionthinsp

cliniquethinspduthinsppatientthinsp

Ideacutealementthinsplethinspprofessionnelthinspdoitthinsplesthinspdocumenterthinsp

thinsprsaquo avantthinsplethinspdeacutebutthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsprsaquo apregravesthinsplrsquoadministrationthinspdrsquounthinspagentthinspdethinspseacutedation-analgeacutesiethinspouthinspdrsquounthinspantagonistethinsprsaquo authinsppicthinspdrsquoactionthinspdethinspchacunthinspdesthinspagentsthinspadministreacutesthinspthinsprsaquo agravethinspintervallesthinspreacuteguliersthinsp(pthinspexthinspthinsp5thinspminutes)thinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-

analgeacutesiethinsprsaquo agravethinspintervallesthinspplusthinsprapprocheacutesthinsplorsquethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsplrsquoexigethinsprsaquo durantthinsplathinsppeacuteriodethinspdethinspreacutecupeacuterationthinspetthinspjusqursquoauthinspretourthinspduthinspniveauthinspdethinspconsciencethinsp

initialthinspselonthinsplathinspconditionthinspcliniquethinspduthinsppatientthinsprsaquo authinspmomentthinspduthinspcongeacutethinsp

CMQ - OIIQ - OPIQ 43

thinsp26thinspPOSTSEacuteDATION-ANALGEacuteSIEthinsp

Commethinsppourthinsplethinsppatientthinspadultethinsp(pthinsp29)thinsplathinspsurveillancethinspcliniquethinspdoitthinspecirctrethinspcons-tantethinspetthinsprigoureusethinsptoutthinspauthinsplongthinspdethinsplathinsppeacuteriodethinsppostseacutedation-analgeacutesiethinspetthinspcethinspjusqursquoauthinspretourthinspdethinsplrsquoeacutetatthinspinitialthinspdethinsplrsquoenfantthinspenthinspfonctionthinspdethinspsonthinspstadethinspdethinspdeacutevelop-pement

Rappelonsthinspquethinsplesthinspappareilsthinspdethinspmonitoragethinspdoiventthinspecirctrethinspenthinspfonctionthinspthinspmaisthinspenthinspaucunthinsptempsthinspilsthinspnethinspremplacentthinsplathinspsurveillancethinspdirectethinspduthinsppatientthinspthinspparthinsplethinspprofessionnelthinsp

LathinsppeacuteriodethinspdrsquoobservationthinspenthinspeacutetablissementthinspdoitthinspecirctrethinspsuffisammentthinspprolongeacuteethinsppourthinsppreacutevenirthinsplesthinspproblegravemesthinsppendantthinspetthinspauthinspretourthinspagravethinsplathinspmaisonthinspComptethinsptenuthinspdethinspsonthinspacircgethinspetthinspdethinspsathinspconditionthinsplrsquoenfantthinspdoitthinspecirctrethinspcapablethinspdethinspsrsquoasseoirthinspdethinspboirethinspdethinspparlerthinspetthinspdethinspmarcherthinspavecthinspunethinspaidethinspminimalethinsp

Selonthinsplathinspdistancethinspagravethinspparcourirthinspauthinspretourthinspilthinsppeutthinspecirctrethinspjudicieuxthinspdethinspprolongerthinsplathinsppeacuteriodethinspdrsquoobservation

Unthinspdocumentthinsprelatifthinspauthinspcongeacutethinspcomprenantthinspdesthinspconsignesthinspclairesthinsppourthinsplathinspthinsp

surveillancethinspagravethinspdomicilethinspdoitthinspecirctrethinspremisthinspetthinspexpliqueacutethinspauxthinspparentsthinsp(annexethinspXII)

thinsp27thinspDOCUMENTATIONthinspDESthinspSOINSthinspETthinspTENUEthinspDEthinspDOSSIERSthinsp

Lathinsptenuethinspdethinspdossiersthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinsprigueurthinspetthinsplathinspmecircmethinsppreacutecisionthinspquethinspchezthinsplrsquoadultethinsp(pthinsp30)thinspCertainesthinspinformationsthinsppropresthinspagravethinsplrsquoenfantthinspdoiventthinspecirctrethinspajouteacuteesthinspnotammentthinsp

thinsprsaquo sithinsppreacutesencethinspdrsquounthinspparentthinsprsaquo lethinsppoidsthinspetthinsplrsquoacircgethinspdethinsplrsquoenfantthinsprsaquo lathinsptaillethinspouthinsplrsquoIMCthinspsrsquoilthinspythinspathinsplieu

CMQ - OIIQ - OPIQ 44

CONCLUSION

Lathinspseacutedation-analgeacutesiethinspvisethinspagravethinspalteacutererthinsplethinspniveauthinspdethinspconsciencethinspainsithinspqursquoagravethinspsoulagerthinsplrsquoanxieacuteteacutethinspetthinsplathinspdouleurthinspdrsquounthinsppatientthinspauthinspcoursthinspdrsquounethinspinterventionthinsptheacuterapeutiquethinspouthinspdiagnostiquethinspCettethinspproceacutedurethinspbienthinspquethinspfreacutequemmentthinsputiliseacuteethinspcomportethinspcependantthinspcertainsthinsprisques

On doit y recourir de faccedilon seacutecuritaire pour le patient et en tout temps preacutevenir et reconnaicirctre les complica-tions lieacutees agrave la seacutedation-analgeacutesie afin drsquoeffectuer rapidement et efficace-ment les manœuvres neacutecessaires

LethinsprespectthinspdesthinsplignesthinspdirectricesthinspeacutenonceacuteesthinspdansthinspcethinspdocumentthinspaiderathinsplesthinspprofessionnelsthinspagravethinspmenerthinspadeacutequatementthinspcettethinspproceacutedurethinspCeux-cithinspdemeurentthinsptoutefoisthinspresponsablesthinspdethinsplathinspmisethinspagravethinspjourthinspdethinspleursthinspconnaissancesthinspetthinspduthinspdeacuteveloppementthinspdethinspleursthinspcompeacutetencesthinsprespectivesthinsp

Parthinspailleursthinsplesthinspeacutetablissementsthinspdethinspsanteacutethinspetthinsplesthinspcliniquesthinspouthinspcabinetsthinsppriveacutesthinspdevraientthinspsrsquoinspirerthinspdethinspcesthinsplignesthinspdirectricesthinsppourthinspeacutelaborerthinspthinspdesthinspproceacuteduresthinsprelativesthinspagravethinsplathinspthinspseacutedation-analgeacutesiethinspetthinspenthinspassurerthinsplrsquoeacutevaluationthinsppeacuteriodiquethinspdethinsplathinspqualiteacutethinsp

CMQ - OIIQ - OPIQ 45

mdash Annexe

thinspANNEXEthinspIthinspndashthinspDEacuteFINITIONthinspDEthinspLrsquoANESTHEacuteSIEthinspGEacuteNEacuteRALEthinspETthinspthinsp

DESthinspNIVEAUXthinspDEthinspSEacuteDATION-ANALGEacuteSIEthinspSELONthinspLrsquoAMERICANthinspSOCIETYthinspOFthinsp

ANESTHESIOLOGISTSthinsp(ASA)thinsp(AMERICANthinspSOCIETYthinspOFthinspANESTHESIOLOGISTSthinsp

ASAthinspHOUSEthinspOFthinspDELEGATEthinsp2014AthinspOP CIT)thinsp(NOTREthinspTRADUCTION)

Seacutedationthinspminimalethinspthinspanxiolyse

Seacutedation-thinspthinspanalgeacutesiethinspthinspmodeacutereacutee(consciente)

Seacutedation-thinspanalgeacutesiethinspthinspprofonde

Anestheacutesiethinspthinspgeacuteneacuterale

Reacuteponse Reacuteponsethinspnormalethinspagravethinsplathinspstimulationthinspverbale

Reacuteponsethinspvolontairethinspagravethinsplathinspstimulationthinspverbalethinspouthinsptactile

Reacuteponsethinspvolontairethinspsuivantthinspunethinspstimulationthinspreacutepeacuteteacuteethinspouthinspdouloureuse

Nonthinspeacuteveillablethinspmecircmethinspavecthinspstimulusthinspdouloureux

Voiesthinspthinspaeacuteriennes

Nonthinspaffecteacutees Pasthinspdrsquointerventionthinsprequise

Interventionthinsppeutthinspecirctrethinsprequise

Interventionthinspthinspsouventthinsprequise

Ventilationspontaneacutee

Nonthinspaffecteacuteethinsp Adeacutequate Peutthinspecirctrethinspinadeacutequate

Freacutequemmentthinspinadeacutequate

Fonctionthinspcardio-thinspvasculaire

Nonthinspaffecteacutee Geacuteneacuteralementthinspthinspmaintenue

Geacuteneacuteralementthinspthinspmaintenue

Peutthinspecirctrethinspthinspcompromise

thinspthinspLethinspreacuteflexethinspdethinspretraitthinspagravethinsplathinspsuitethinspdrsquounethinspstimulationthinspdouloureusethinspnrsquoestthinsppasthinspconsideacutereacutethinspcommethinspunethinspreacuteponsethinspvolontaire

Rappelonsthinspquethinsplathinspseacutedation-analgeacutesiethinspprofondethinspchezthinsplrsquoadultethinspetthinsplrsquoanestheacutesiethinspgeacuteneacuteralethinsp(adultethinspetthinsppeacutediatrique)thinspthinspnethinspfontthinsppasthinsplrsquoobjetthinspdethinspcettethinsppublication

CMQ - OIIQ - OPIQ 46

mdash Annexe

thinspANNEXEthinspIIthinspndashthinspINFORMATIONthinspCOMPLEacuteMENTAIREthinsp-thinspLECTURESthinspDrsquoINTEacuteREcircT

COLLEgraveGEthinspDESthinspMEacuteDECINSthinspDUthinspQUEacuteBECthinsp(CMQ)

thinsprsaquo Proceacutedures et interventions en milieu extrahospitalier (2011)thinsprsaquo Code de deacuteontologie des meacutedecinsthinsp(2015)

ORDREthinspDESthinspINFIRMIEgraveRESthinspETthinspINFIRMIERSthinspDUthinspQUEacuteBECthinsp(OIIQ)thinsp

thinsprsaquo EacutediteurthinspofficielthinspduthinspQueacutebec Code de deacuteontologie des infirmiegraveres et infirmiers (2014)

thinsprsaquo Le champ drsquoexercice et les activiteacutes reacuteserveacutees des infirmiegraveresthinsp(2013)thinsp2ethinspeacutedthinspthinsprsaquo Mosaiumlque des compeacutetences cliniques de lrsquoinfirmiegravere Compeacutetences initiales

(2009)thinsp2ethinspeacutedthinspthinsprsaquo Les obligations deacuteontologiques de lrsquoinfirmiegravere et le consentement aux soins

(2005)

ORDREthinspPROFESSIONNELthinspDESthinspINHALOTHEacuteRAPEUTESthinspDUthinspQUEacuteBECthinsp(OPIQ)

thinsprsaquo Profil national des compeacutetencesthinspLrsquoalliancethinspdesthinsporganismesthinspdethinspregraveglementationthinspenthinsptheacuterapiethinsprespiratoirethinsp(2011)

thinsprsaquo Les notes au dossier dans le secteur de lrsquoassistance anestheacutesique et de la seacutedation analgeacutesiethinsp-thinspGuidethinspdethinsppratiquethinsp(2008)

thinsprsaquo Compeacutetences relatives agrave lrsquoentreacutee dans la pratique (2003)thinsprsaquo Regraveglement sur les dossiers les autres effets les cabinets et la cessation

drsquoexercice des membres de lrsquoOrdre professionnel des inhalotheacuterapeutes du Queacutebecthinsp(2002)thinsp

thinsprsaquo Code de deacuteontologie des inhalotheacuterapeutes du Queacutebec

CMQ - OIIQ - OPIQ 47

thinspANNEXEthinspIIIthinspndashthinspPROCEacuteDURESthinspPROTOCOLESthinspOUthinspALGORITHMESthinsp

Dansthinsptousthinsplesthinsplieuxthinspougravethinspsethinsppratiquethinsplathinspseacutedation-analgeacutesiethinspagravethinspdesthinspfinsthinspdiagnos-tiquesthinspouthinsptheacuterapeutiquesthinsplethinspmeacutedecinthinspresponsablethinspdoitthinspeacutelaborerthinspenthinspcollabora-tionthinspavecthinsplesthinspmembresthinspdethinspsonthinspeacutequipethinspsoignantethinsplesthinspproceacuteduresthinspprotocolesthinspouthinsp

algorithmesthinspconcernantthinspnotammentthinsplesthinspsujetsthinspsuivantsthinsp

PARMIthinspLESthinspPROCEacuteDURESthinspOUthinspPROTOCOLESthinsp(ADULTEthinspETthinspPEacuteDIATRIQUE)thinsp

thinsprsaquo allergiethinspauthinsplatexchocthinspanaphylactiquethinsprsaquo antagonistethinsprsaquo bradycardiethinsprsaquo critegraveresthinspcliniquesthinspdethinspcongeacutethinsprsaquo hypertensionthinspmalignethinsprsaquo seacutedation-analgeacutesiethinsprsaquo transfertthinspdrsquourgence

PARMIthinspLESthinspALGORITHMESthinsp(ADULTEthinspETthinspPEacuteDIATRIQUE)thinsp

thinsprsaquo gestionthinspdesthinspvoiesthinspaeacuteriennesthinspdifficilesthinsp(ventilationintubation)thinsprsaquo reacuteanimationthinspcardiorespiratoirethinsp

thinspthinspthinspILthinspFAUTthinspPENSERthinspAgravethinsp

thinsprsaquo Lrsquoaffichagethinspdesthinspproceacuteduresthinspprotocolesthinspouthinspalgorithmesthinspdrsquourgencethinspquithinsppermettrathinspdrsquoythinspavoirthinspaccegravesthinsprapidementthinspenthinspcasthinspdrsquourgencethinspetthinspdethinsplesthinspconsulterthinspreacuteguliegraverementthinspparthinsplathinspmecircmethinspoccasionthinsp

thinsprsaquo Lrsquoeacutelaborationthinspdrsquounthinspprogrammethinsppeacuteriodiquethinspdrsquoexercicethinsp(pthinspexthinspthinspsimulation)thinspquithinsppermettrathinspdethinsprevoirthinsplesthinspdiffeacuterentesthinspproceacuteduresthinspenthinspplacethinspavecthinsptousthinsplesthinspmembresthinspdethinsplrsquoeacutequipethinspsoignantethinspetthinspdrsquoinitierthinsplethinspnouveauthinsppersonnelthinspassurantthinspainsithinspunethinspmeilleurethinsprelegravevethinspDethinspmecircmethinspmettrethinsplethinspplanthinspenthinsppratiquethinsppermetthinspdrsquooptimiserthinsplathinsprapiditeacutethinspetthinsplathinsppreacutecisionthinspdesthinspgestesthinspposeacuteesthinspetthinspdrsquoidentifierthinspdesthinspproblegravemesthinsppotentielsthinsp(avecthinspdethinsplrsquoeacutequipementthinspparthinspexemple)thinspetthinspcethinspavantthinspqursquoilthinspythinspaitthinspurgencethinspdrsquoagirthinsp

mdash Annexe

CMQ - OIIQ - OPIQ 48

thinspANNEXEthinspIVthinspndashthinspEacuteVALUATIONthinspDESthinspVOIESthinspAEacuteRIENNESthinspSUPEacuteRIEURESthinspAUthinsp

thinspMOYENthinspDUthinspSCOREthinspDEthinspMALLAMPATIthinsp(DIEMUNSCHthinspETthinspCOLLABthinsp2008)thinsp

(Agravethinsptitrethinspinformatifthinspseulement)

Objectifthinspthinspthinsp Eacutevaluerthinsplathinspvisibiliteacutethinspdesthinspstructuresthinsporopharyngeacuteesthinspetthinsplathinsptaillethinspthinsp

dethinsplathinsplangue

Lesthinsp4thinspclassesthinspdethinspMallampatithinspmodifieacuteesthinsp(SamsoonthinspandthinspYoung)thinspsontthinsp

thinsprsaquo ClassethinspIthinspthinspluettethinsppiliersthinspduthinspvoilethinspduthinsppalaisthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIIthinspthinsppiliersthinspduthinspvoilethinspduthinsppalaisthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIIIthinspthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIVthinspthinsppalaisthinspdurthinspseulthinsp

LesthinspclassesthinspIthinspetthinspIIthinsppreacutesagentthinspdrsquounethinspintubationthinspathinsppriorithinspfacilethinsplesthinspclassesthinspIIIthinspetthinspIVthinspdrsquounethinspintubationthinspdifficile

ClassesthinspdethinspMallampatithinspmodifieacuteesthinsp(Jmarchnthinsp[Enthinspligne])

LrsquoinsuffisancethinspdethinsplathinspclassificationthinspdethinspMallampatithinspathinspeacuteteacutethinspspeacutecifiquementthinspmon-treacuteethinspchezthinsplrsquoobegravesethinspEllethinspnethinsppeutthinspecirctrethinspconsideacutereacuteethinspcommethinspunthinsppreacutedicteurthinspisoleacute-mentthinspsuffisantthinspdethinsplathinspdifficulteacutethinspdethinsplathinsplaryngoscopiethinspouthinspathinspfortiorithinspdethinsplrsquointuba-tionthinspdifficilethinsp

mdash Annexe

CMQ - OIIQ - OPIQ 49

ANNEXEthinspVthinspndashthinspOUTILthinspDrsquoEacuteVALUATIONthinspDEthinspLrsquoAPNEacuteEthinspOBSTRUCTIVEthinspDUthinspSOMMEILthinsp

(AOS)thinspADAPTEacutethinspAgravethinspLAthinspCONSULTATIONthinspPREacuteANESTHESIQUESEacuteDATION-thinsp

ANALGEacuteSIEthinspthinsp(ADAPTEacutethinspDEthinspCHUNGthinspETthinspSEETthinsp2010)thinsp(NOTREthinspTRADUCTION)

(Agravethinsptitrethinspinformatifthinspseulement)

mdash Annexe

Exemplethinspdethinspquestionnairethinspstop-bang

Question Reacuteponse

Sthinspnore PreacutesencethinspdethinspronflementVosthinspronflementsthinspsont-ilsthinspbruyants(suffisammentthinsppourthinspecirctrethinspentendusthinspagravethinsptraversthinspunethinspportethinspfermeacutee)

OuithinspouthinspNon

Tthinspiredthinspfatiguethinsporthinspsleepy PreacutesencethinspdethinspsomnolencethinspouthinspfatigueVousthinspsentez-vousthinspsouventthinspfatigueacutethinspeacutepuiseacutethinspouthinspsomnolentthinsppendantthinsplathinspjourneacutee

OuithinspouthinspNon

Othinspbservedthinspapnea ApneacuteethinspobserveacuteethinspQuelqursquounthinspa-t-ilthinspdeacutejagravethinspobserveacutethinspquethinspvousthinspthinsparrecirctiezthinspdethinsprespirerthinspenthinspdormant

OuithinspouthinspNon

Pthinspressure PreacutesencethinspdrsquoHTAAvez-vousthinspouthinspecirctes-vousthinsptraiteacutepourthinspunethinsptensionthinsparteacuteriellethinspeacuteleveacutee

OuithinspouthinspNon

BthinspMI IMCthinspgtthinsp35thinspkgm2 OuithinspouthinspNon

Athinspge Acircgethinspgtthinsp50thinspans OuithinspouthinspNon

Nthinspeck Circonfeacuterencethinspduthinspcouthinspgtthinsp40thinspcm OuithinspouthinspNon

Gthinspender Sexethinspmasculin OuithinspouthinspNon

INTERPREacuteTATIONthinspCLINIQUE

ltthinsp3thinspreacuteponsesthinsppositivesthinsp=thinspfaiblethinsprisquethinspdrsquoAOS

ge 3 reacuteponses positives = risque eacuteleveacute drsquoAOS

CMQ - OIIQ - OPIQ 50

thinspANNEXEthinspVIthinspndashthinspANAMNEgraveSEthinspthinspAIDEthinspMNEacuteMOTECHNIQUEthinsp

(Agravethinsptitrethinspinformatifthinspseulement)

ObjectifthinspthinspthinspthinspCetthinspoutilthinspdrsquoaidethinspmneacutemotechniquethinspsertthinspagravethinspstructurerthinsplathinspfaccedilonthinspdontthinspthinsponthinspprocegravedethinspagravethinsplathinspcollectethinspsommairethinspdesthinspdonneacuteesthinspdansthinsplethinspcadrethinspdethinsplrsquoeacutevaluationthinspcliniquethinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinspfacilitethinsplathinspcompreacutehensionthinspetthinsplathinspreacutealisationthinspdethinsplrsquoanamnegravesethinspchezthinsplrsquoadultethinspetthinsplrsquoenfant

SAMPLEthinsp(AdapteacutethinspdethinspAltonthinspetthinspcollabthinsp2007thinsp[Notrethinsptraduction])thinsp(outhinspvariante)

SthinspthinspSignesthinspetthinspsymptocircmes

AthinspthinspAllergiesthinspetthinspreacuteactionthinsp

MthinspthinspMeacutedicamentsthinspetthinspautresthinspsubstancesthinsp(prescritsthinspouthinspnon)thinspetthinsptraitement

PthinspthinspPasseacutethinspmeacutedicalfamilialthinsp

LthinspthinspLastthinspmeallunchthinsp(dernierthinsprepas)

EthinspthinspEnvironnementeacuteveacutenement

thinsp

mdash Annexe

CMQ - OIIQ - OPIQ 51

thinspANNEXEthinspVIIthinsp-thinspEXAMENthinspPHYSIQUEthinspthinspAIDEthinspMNEacuteMOTECHNIQUE

(Agravethinsptitrethinspinformatifthinspseulement)

Objectifthinspthinspthinsp Lrsquoexamenthinspphysiquethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinspcherchethinspagravethinspmettrethinspenthinspeacutevidencethinspcertainsthinspcritegraveresthinspreconnusthinsppourthinspecirctrethinspassocieacutesthinspagravethinspunethinspassis-tancethinspventilatoirethinspdifficilethinspquithinsppeutthinspsurvenirthinspdansthinsplethinspcasthinspdrsquounthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquethinspceluithinspviseacutethinspparthinspexemple

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinspfacilitethinsplathinspcompreacutehensionthinspetthinsplathinspreacutealisationthinspdethinsplrsquoexamenthinspphysiquethinsprelativementthinspauxthinspvoiesthinspaeacuteriennesthinspdethinsplrsquoadulte

1thinspIndicateursthinspdrsquounethinsppossiblethinspventilationthinspdifficilethinsp(MOANSthinsp[AdapteacutethinspdethinspWallsthinspetthinspthinspthinspthinspthinspMurphythinsp2012]thinsp[Notrethinsptraduction]thinspouthinspvariante)

Mthinspthinspmask sealthinsp(eacutetancheacuteiteacutethinspduthinspmasque)thinspthinspeacutetancheacuteiteacutethinspcompromisethinspenthinspraisonthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspdrsquounethinspbarriegraverethinspmeacutecaniquethinsp(barbethinspfourniethinsptraumatismethinspfacialthinspetc)

OthinspthinspobeacutesiteacuteobstructionthinspthinsppatientthinspdontthinsplrsquoIMCthinspestthinspgtthinsp25thinsp(kgm2)thinspfemmethinspenceintethinspthinspthinspthinspthinspthinspthinspthinspgtthinsp6thinspmoisthinsp(2ethinsptrimestre)thinspangio-œdegravemethinspabcegravesthinspetc

Athinspthinspacircgethinspthinsppatientthinspgethinsp55thinspansthinsp(variablethinspselonthinsplesthinspauteurs)thinspenthinspraisonthinspnotammentthinspthinspthinspthinspthinspthinspthinspdethinsplathinsppertethinspdrsquoeacutelasticiteacutethinspdesthinsptissus

Nthinspthinspno teeththinsp(eacutedenteacute)thinspthinspdifficulteacutethinsplorsthinspdethinsplrsquoassistancethinspventilatoire

Sthinspthinspstiffthinsp(rigiditeacute)thinspthinsppathologiesthinspagravethinspconseacutequencesthinspsurthinsplathinspcompliancethinspetthinsplathinspthinspthinspthinspthinspthinspreacutesistancethinsppulmonairethinsp(asthmethinspMPOCthinsppneumoniethinspdethinspstadethinspavanceacutethinspetc)

thinspthinspVentilationthinspdifficilethinsp(masquethinspouthinspoutilthinspextraglottiquethinsptelthinspquethinspmasquethinspthinspthinspthinspthinspthinsplaryngeacute)thinsp(AdapteacutethinspdethinsplrsquoAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinsp[Notrethinspthinspthinspthinspthinspthinsptraduction])thinspImpossiblethinspdrsquoeffectuerthinspunethinspventilationthinspdethinspfaccedilonthinspadeacutequatethinspthinspthinspthinspthinspthinspenthinspraisonthinspdethinsplrsquounethinspetouthinspdethinsplrsquoautrethinspdesthinspsituationsthinspsuivantesthinsp

athinspMauvaisethinspeacutetancheacuteiteacutethinspduthinspmasquethinspouthinspdethinsplrsquooutilthinspextraglottiquebthinspFuitethinspdethinspgazthinspexcessivecthinspReacutesistancethinspexcessivethinspagravethinsplrsquoinspirationthinspouthinspagravethinsplrsquoexpiration

thinsp

mdash Annexe

CMQ - OIIQ - OPIQ 52

2thinspIndicateursthinspdrsquounethinsppossiblethinsplaryngoscopiethinspouthinspintubationthinspdifficilethinsp(thinspLEMONthinspthinspthinspthinspthinspthinsp[WallsthinspetthinspMurphythinsp2012thinspopthinspcit]thinsp[Notrethinsptraduction]thinspouthinspvariante)

Lthinspthinspthinsplook externallythinsp(apparencethinspphysique)thinspthinspmicrognathiethinspmacroglossiethinspdenti-tionthinspirreacuteguliegraverethinspcirconfeacuterencethinspduthinspcouthinspgethinspgrossessethinspetc

thinspEthinspthinspthinspeacutevaluationthinspthinspregraveglethinspduthinsp3-3-2thinsp(variantethinsppossiblethinspselonthinsplesthinspauteurs)thinsp-thinspthinsp

consideacuterationsthinspgeacuteomeacutetriquesthinsp(agravethinsplrsquoaidethinspdesthinspdoigtsthinspduthinsppatient)3thinspthinsp ouverturethinspdethinspbouchethinspthinspinsertionthinspdethinsp3thinspdethinspsesthinspdoigts3thinspthinsp taillethinspduthinsplarynxthinsp(longueurthinspmandibulaire)thinspthinsp3thinspdoigtsthinspsousthinsplethinspmentonthinsp

(boutthinspdethinspsonthinspmentonthinspjusqursquoagravethinsplathinspjonctionthinspduthinspcouthinspauthinspniveauthinspdethinspthinsplrsquoosthinsphyoiumlde)

2thinspthinsp positionthinspduthinsplarynxthinspthinsp2thinspdethinspsesthinspdoigtsthinspentrethinsplathinspjonctionthinspcou-mentonthinsp(osthinspthinsphyoiumlde)thinspetthinsplethinspcartilagethinspthyroiumlde

thinspMthinspthinspthinspMallampatithinsp(annexethinspIV)thinspOthinspthinspthinspobeacutesiteacuteobstructionthinspthinspIMCthinspthinspœdegravemethinspduthinsplarynxthinspneacuteoplasiethinspdethinsplathinspsphegraverethinsp

ORLthinspcompressionthinspextrinsegravequethinspparthinspheacutematomethinspcervicalthinspdifficulteacutethinspagravethinspavalerthinspdyspneacutee

thinspNthinspthinspthinspneck mobilitythinsp(mobiliteacutethinspcervicale)thinspthinspimmobilisationthinspauthinspmoyenthinspdrsquounthinspcol-

lierthinspcervicalthinsppreacutesencethinspdrsquounethinsppathologiethinspouthinspdrsquounethinspsituationthinspcliniquethinspagravethinspconseacutequencethinspsurthinsplrsquoassistancethinspventilatoirethinspouthinspdethinsplrsquointubationthinsp(pthinspexthinspthinspthinsparthrosethinspouthinsparthritethinspimportantethinsptrisomiethinsp21thinspetc)

thinspthinsp Lanryngoscopiethinspdifficilethinspthinspimpossibiliteacutethinspdethinspvisualiserthinspnrsquoimportethinspquellethinsppartiethinspdesthinspcordesthinspvocalesthinspapregravesthinspdethinspmultiplesthinsptentativesthinspavecthinspunthinsplaryngoscopethinspconventionnelthinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinspop citthinsp[Notrethinsptraduction])thinsp

thinspthinspIntubationthinspendotracheacutealethinspdifficilethinspthinspintubationthinspquithinsprequiertthinspdethinspmultiplesthinspthinsptentativesthinspenthinsppreacutesencethinspouthinspenthinsplrsquoabsencethinspdrsquounethinsppathologiethinsptracheacutealethinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinspop citthinspthinsp[Notrethinsptraduction])

IlthinspfautthinspnoterthinspquethinsplrsquoinsuffisancethinspdethinsplathinspclassificationthinspdethinspMallampatithinspathinspeacuteteacutethinspspeacutecifiquementthinspmontreacuteethinspchezthinsplrsquoobegravesethinspellethinspnethinsppeutthinspecirctrethinspconsideacutereacuteethinspcommethinspunthinsppreacutedicteurthinspisoleacutementthinspsuffisantthinspdethinsplathinspdifficulteacutethinspdethinsplathinsplaryngoscopiethinspouthinspathinspfortiorithinspdethinsplrsquointubationthinspdifficile

mdash Annexe

ge

ge

CMQ - OIIQ - OPIQ 53

thinspANNEXEthinspVIIIthinsp-thinspLEthinspCONSENTEMENT

SelonthinsplethinspdroitthinspenthinspvigueurthinspilthinspestthinspobligatoirethinspauthinspQueacutebecthinspdrsquoobtenirthinsplethinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspintervention

LethinspCode civil du Queacutebec eacutetablitthinspdesthinspregraveglesthinspgeacuteneacuteralesthinspconcernantthinsplethinspconsente-mentthinspauxthinspsoinsthinspquithinspsrsquoappliquentthinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspOnthinspythinspfaitthinspcependantthinspcertainesthinspdistinctionsthinspselonthinspquethinsplesthinspsoinsthinspsontthinsprequisthinspouthinspnonthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspetthinspselonthinspquethinsplethinsppatientthinspestthinspaptethinspagravethinspconsentirthinspouthinspnon

Sithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsp(traitementsthinspdethinspmeacutedecinethinspetthinspdethinspchirurgiethinspestheacutetiquethinspexpeacuterimentationthinspetthinspdonsthinspdrsquoorganes)thinsplethinsppatientthinspdoitthinspecirctrethinspinformeacutethinspdethinsptousthinsplesthinsprisquesthinsppossiblesthinspmecircmethinspsrsquoilsthinspsontthinspraresthinspetthinsplethinspconsentementthinspdoitthinspecirctrethinspdonneacutethinspparthinspeacutecritthinspHabituellementthinspilthinspnethinsppeutthinspecirctrethinspdonneacutethinspquethinspparthinspunthinsppatientthinspaptethinspetthinspacircgeacutethinspdethinsp14thinspansthinspetthinspplusthinspparthinsplethinspmandatairethinsplethinsptuteurthinspouthinsplethinspcurateurthinspdrsquounethinsppersonnethinspinaptethinspouthinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinspdrsquounethinsppersonnethinspdethinspmoinsthinspdethinsp14thinspansthinspLrsquoautorisationthinspdethinsplathinspcourthinspestthinspenthinspoutrethinspneacutecessairethinspsithinsplesthinspsoinsthinsppreacutesententthinspunthinsprisquethinspseacuterieuxthinsppourthinsplathinspsanteacutethinspdethinspcesthinsppersonnesthinspouthinspsrsquoilsthinsppeuventthinspcauserthinspdesthinspeffetsthinspgravesthinspetthinsppermanentsthinspUnethinsppersonnethinspmineurethinspdethinspthinsp14thinspansthinspetthinspplusthinsppeutthinspconsentirthinspseulethinspagravethinspmoinsthinspqursquoilthinspsrsquoagissethinspdethinspsoinsthinspnonthinsprequisthinspetthinspthinspcomportantthinspdesthinsprisques

SrsquoilthinspsrsquoagitthinspdethinspsoinsthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsplrsquoobligationthinspdrsquoinformerthinspcroicirctthinspenthinspfonctionthinspdethinsplathinsppreacutevalencethinspetthinspdethinsplathinspgraviteacutethinspdesthinspcomplicationsthinspSithinsplethinsppatientthinspestthinspinaptethinspetthinspqursquoilthinspnrsquoestthinsppasthinsprepreacutesenteacutethinspparthinspunthinspmandatairethinspunthinsptuteurthinspouthinspunthinspcura-teurthinsplethinspconsentementthinsppeutthinspecirctrethinspdonneacutethinspparthinspunthinspconjointthinspouthinspagravethinspdeacutefautthinspduthinspconjointthinspparthinspunthinspprochethinspouthinspunethinsppersonnethinspquithinspdeacutemontrethinspunthinspinteacuterecirctthinspparticulierthinsppourthinsplathinspper-sonnethinspinaptethinspIlthinspnrsquoythinspathinsppasthinspdrsquoobligationthinspagravethinspcethinspquethinspcethinspconsentementthinspsoitthinspdonneacutethinspparthinspeacutecritthinspLethinspconsentementthinspauxthinspsoinsthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspdrsquounethinsppersonnethinspmi-neurethinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinspouthinsplethinsptuteurthinspUnethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsppeutthinspconsentirthinspmaisthinspnethinsppeutthinsppasthinsprefuserthinspseulethinspdesthinspsoinsthinspquithinspseraientthinspjugeacutesthinsprequisthinspEnthinspcasthinspdrsquourgencethinsplethinspconsentementthinspauxthinspsoinsthinspmeacutedicauxthinspnrsquoestthinsppasthinspneacutecessairethinsplorsquethinsplathinsppersonnethinspouthinspsonthinspinteacutegriteacutethinspestthinspmenaceacuteethinspetthinspquethinsplethinspconsentementthinspnethinsppeutthinspecirctrethinspobtenuthinspagravethinsptemps

LathinspLoi sur les servicesthinspdethinspsanteacutethinspetthinsplesthinspservicesthinspsociauxthinsp(LSSS)thinspeacutetablitthinspquantthinspagravethinspellethinspcertainesthinspregraveglesthinspenthinspmatiegraverethinspdethinspconsentementthinspauxthinspinterventionsthinspchirurgicalesthinspetthinspagravethinsplrsquoanestheacutesiethinsp

mdash Annexe

CMQ - OIIQ - OPIQ 54

Selonthinspcettethinsploithinsplethinspconsentementthinspagravethinspunethinspanestheacutesiethinspouthinspagravethinspunethinspinterventionthinspchirurgi-calethinspdoitthinspecirctrethinspattesteacutethinspparthinspunthinspdocumentthinspeacutecritthinspsigneacutethinspparthinsplethinsppatientthinspouthinspsonthinsprepreacutesen-tantthinspetthinspcethinspdocumentthinspdoitthinspfairethinspeacutetatthinspdesthinspinformationsthinspapproprieacuteesthinspconcernantthinspnotammentthinsplesthinsprisquesthinspouthinsplesthinspeffetsthinsppossiblesthinspCetthinspeacutecritthinspdoitthinspecirctrethinspcontresigneacutethinspparthinsplethinspmeacutedecinthinspouthinsplethinspdentistethinsptraitantthinspetthinspconserveacutethinspdansthinsplethinspdossierthinspduthinsppatientthinspLethinspdossierthinspdoitthinspcontenirthinspunthinspdocumentthinspattestantthinsplethinspconsentementthinsppourthinsplesthinspsoinsthinspetthinsplesthinspservicesthinspdispenseacutesthinspdansthinspunthinspcentrethinsphospitalierthinsp(CH)thinspunthinspcentrethinspdrsquoheacutebergementthinspetthinspdethinspsoinsthinspdethinsplonguethinspdureacuteethinsp(CHSLD)thinspetthinspunthinspcentrethinsplocalthinspdethinspservicesthinspcommunau-tairesthinsp(CLSC)

CesthinspdispositionsthinspnethinspsrsquoappliquentthinspqursquoauxthinspsoinsthinspdispenseacutesthinspenthinspeacutetablissementthinspthinspMaintenantthinspquethinspplusieursthinspinterventionsthinspautrefoisthinspreacuteserveacuteesthinspauxthinspeacutetablissementsthinsppeuventthinspecirctrethinspeffectueacuteesthinspenthinspdehorsthinspdethinspceux-cithinsplathinspquestionthinspsethinspposethinsptoutefoisthinspdethinspsavoirthinspsithinsplesthinspmecircmesthinspexigencesthinspdevraientthinspsrsquoappliquerthinsppartoutthinsp

Qursquoenthinspest-ilthinspparthinspexemplethinspdethinsplathinspsignaturethinspdrsquounthinspformulairethinspdethinspconsentementthinspEnthinsppratiquethinspetthinspagravethinsplrsquousagethinspilthinspsrsquoestthinspaveacutereacutethinspqursquounthinspformulairethinspdethinspconsentementthinspducircmentthinspsigneacutethinspnethinsppeutthinspagravethinspluithinspseulthinspprouverthinspquethinsplethinspconsentementthinspathinspeacuteteacutethinsplibrethinspetthinspeacuteclaireacutethinspUnethinspcourtethinspnotethinspverseacuteethinspauthinspdossierthinspreacutesumantthinsplesthinspinformationsthinsptransmisesthinspetthinsplesthinspeacutechangesthinspauxquelsthinspellesthinspontthinspdonneacutethinsplieuthinspestthinsppreacutesentementthinspjugeacuteethinspbeaucoupthinspplusthinsppertinentethinspagravethinspcetthinspeacutegardthinspLethinspformulairethinspdethinspconsentementthinspcomplegravetethinsplesthinsprenseigne-mentsthinspfournisthinspverbalementthinspIlthinspsrsquoagitthinspdrsquounthinspajoutthinspagravethinsplrsquoinformationthinspverbalethinsptransmisethinspthinsp

etthinspnonthinspdrsquounethinspmesurethinspvisantthinspagravethinsplathinspremplacer

LethinspCode de deacuteontologiethinspdes meacutedecinsthinsppreacutecisethinsplesthinspobligationsthinspdesthinspmeacutedecinsthinsp

quantthinspauthinspconsentementthinsp

Article 28Le meacutedecin doit sauf urgence avant drsquoentreprendre un examen une investiga-tion un traitement ou une recherche obtenir du patient ou de son repreacutesentant leacutegal un consentement libre et eacuteclaireacute

Article 29Le meacutedecin doit srsquoassurer que le patient ou son repreacutesentant leacutegal a reccedilu les explications pertinentes agrave leur compreacutehension de la nature du but et des conseacutequences possibles de lrsquoexamen de lrsquoinvestigation du traitement ou de la recherche qursquoil srsquoapprecircte agrave effectuer Il doit faciliter la prise de deacutecision du patient et la respecter

mdash Annexe

CMQ - OIIQ - OPIQ 55

DansthinspsesthinspguidesthinspdrsquoexercicethinspportantthinspsurthinsplathinsptenuethinspdesthinspdossiersthinsplethinspCollegravegethinspestimethinspdrsquoailleursthinspquethinsplethinspdossierthinspdrsquounthinsppatientthinspdoitthinspcontenirthinspunethinspnotethinspattestantthinspquethinsplesthinspin-formationsthinspneacutecessairesthinspagravethinspunethinspprisethinspdethinspdeacutecisionthinspeacuteclaireacuteethinspontthinspeacuteteacutethinsptransmisesthinspparthinsplethinspmeacutedecinthinspetthinspcomprisesthinspparthinsplethinsppatientthinspouthinspsonthinsprepreacutesentantthinsplorsquethinsplathinspchosethinspestthinspjugeacuteethinsppertinentethinspathinspfortiorithinsplorsqursquoilthinspsrsquoagitthinspdrsquounethinspinterventionthinspchirurgicalethinspdrsquounethinspinterventionthinspchirurgicalethinspsousthinspseacutedation-analgeacutesiethinspdrsquoanestheacutesiethinspreacutegionalethinspouthinspgeacuteneacuteralethinsp

DansthinsplethinspCode de deacuteontologie des infirmiegraveres et infirmiersthinsponthinsppreacutevoitthinspquethinsp

thinspArticle 40 Lrsquoinfirmiegravere ou lrsquoinfirmier doit fournir agrave son client toutes les explications neacuteces-saires agrave la compreacutehension des soins et des services qursquoil lui prodigue

Article 41Lorsque lrsquoobligation drsquoobtenir un consentement libre et eacuteclaireacute incombe agrave lrsquoin-firmiegravere ou agrave lrsquoinfirmier ce dernier doit fournir au client toutes les informations

requises

LethinspCode de deacuteontologie des inhalotheacuterapeutes du Queacutebecthinspnethinspcontientthinsppasthinspdethinsp

dispositionthinsptouchantthinsppreacuteciseacutementthinsplethinspconsentementthinspOnthinsppreacutecisethinspcependantthinspquethinsp

Article 13En plus des avis et des conseils lrsquoinhalotheacuterapeute doit fournir agrave son client les explications neacutecessaires agrave la compreacutehension et agrave lrsquoappreacuteciation des services qursquoil

lui rend

EnthinspcompleacutementthinspdansthinspsesthinspnormesthinspdethinsppratiquethinspportantthinspsurthinsplathinsptenuethinspdesthinspdossiersthinsplrsquoOrdrethinspprofessionnelthinspdesthinspinhalotheacuterapeutesthinspduthinspQueacutebecthinspdemandethinspquethinsplethinspdos-sierthinspdrsquounthinsppatientthinspcomportethinspunethinspmentionthinspdesthinspsoinsthinspetthinspdesthinspservicesthinspprodigueacutesthinspagravethinspsonthinspeacutegardthinspAgravethinspcetthinspeffetthinsptoutethinspactiviteacutethinspexerceacuteethinspparthinsplrsquoinhalotheacuterapeutethinsptellethinspquethinsplrsquoinformationthinsptransmisethinspauthinsppatientthinspeuthinspeacutegardthinspagravethinsplathinspseacutedation-analgeacutesiethinspdoitthinspecirctrethinspinscritethinspauthinspdossierthinspduthinsppatientthinspetthinspcethinspauthinspfurthinspetthinspagravethinspmesurethinspquethinsplesthinspactiviteacutesthinspsontthinspexerceacutees

EnthinspsommethinsplathinsploithinspexigethinspunthinspconsentementthinspeacutecritthinspsithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspainsithinspquethinsppourthinsplesthinspanestheacutesiesthinsplesthinspinterventionsthinspchirurgicalesthinspetthinsplesthinspsoinsthinspdispenseacutesthinspenthinspeacutetablissementthinspDansthinspsesthinspguidesthinspportantthinspsurthinsplesthinspproceacuteduresthinspetthinspinterventionsthinspenthinspmilieuthinspextrahospitalierthinspnotammentthinsplethinspCollegravegethinsprecommandethinsptoutefoisthinspquethinsplethinspmeacutedecinthinspversethinspunethinspnotethinspexplicativethinspauthinspdossierthinspetthinspobtiennethinspunthinspconsentementthinspeacutecritthinsppourthinsptoutethinspinterventionthinspmeacutedicalethinspouthinsp

mdash Annexe

CMQ - OIIQ - OPIQ 56

chirurgicalethinspeffractivethinspqursquoellethinspsoitthinspeffectueacuteethinspdansthinspunthinspbutthinspdiagnosticthinsptheacuterapeu-tiquethinspouthinspestheacutetiquethinspLorsquethinsplethinspconsentementthinspportethinspagravethinsplathinspfoisthinspsurthinsplathinspseacutedation-thinspthinspanalgeacutesiethinspetthinspsurthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsplrsquoinformationthinsptrans-misethinspdoitthinspinclurethinsplesthinsprisquesthinspdethinsplrsquointerventionthinspetthinspceuxthinspdethinsplathinspseacutedation-analgeacutesiethinspcelle-cithinsppouvantthinspcomporterthinspdesthinsprisquesthinspimportantsthinspmecircmethinspsithinsplrsquointerventionthinspestthinspmineure

Lrsquoobtentionthinspdrsquounthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspdemeurethinspunethinspobligationthinspthinspinheacuterentethinspagravethinsplrsquointerventionthinspmeacutedicalethinspelle-mecircmethinspIlthinsprelegravevethinspdoncthinspdethinsplathinspresponsabiliteacutethinspduthinspmeacutedecinthinspdethinspsrsquoassurerthinspdethinsplathinsptransmissionthinspdethinsplrsquoinformationthinsppertinentethinspauthinsppatientthinspetthinspdethinspsathinspcompreacutehensionthinspdethinsplathinspnaturethinspduthinspbutthinspetthinspdesthinsprisquesthinsprelatifsthinspagravethinsplrsquointerventionthinspToutefoisthinsplathinsptacircchethinspdethinsptransmettrethinspdethinsplrsquoinfor-mationthinspcompleacutementairethinspouthinspdethinspfairethinsplrsquoenseignementthinspauxthinsppatientsthinsppeutthinspecirctrethinspconfieacuteethinspagravethinspdrsquoautresthinspprofessionnelsthinspetthinspcellethinspdethinsprecueillirthinsplathinspsignaturethinspdrsquounthinspthinspformulairethinspdethinspconsentementthinspagravethinspdrsquoautresthinspmembresthinspdethinsplrsquoeacutequipethinspdethinspsoins

mdash Annexe

CMQ - OIIQ - OPIQ 57

mdash Annexe

thinspANNEXEthinspIXthinsp-thinspEacuteVALUATIONthinspDEthinspLrsquoEFFICACITEacutethinspDEthinspLAthinspSEacuteDATIONthinsp(EXEMPLES)thinsp

(Listethinspnonthinsplimitative)thinsp

1 Eacutechelle de seacutedation de Ramsay modifieacuteethinsp(Adapteacute de Merchant et collab 2014b op cit)

Instruction Descriptiondeacutefinition Valeur

thinspObserverthinsplethinsppatientEacuteveilleacutethinspthinsplethinsppatientthinspestthinspanxieuxthinspetthinspagiteacutethinspouthinspnerveuxthinspouthinsplesthinspdeux 1

ObserverthinsplethinsppatientLethinsppatientthinspeacutetablit-ilthinspunthinspcontactthinspvisuelthinspetthinspreacutepond-ilthinspauxthinspordres

Eacuteveilleacutethinspthinsplethinsppatientthinspestthinspcoopeacuteratifthinspthinsporienteacutethinspetthinspcalme 2

ParlerthinspauthinsppatientthinspLethinsppatientthinspeacutetablit-ilthinspunthinspcontactthinspvisuelthinspetthinspreacutepond-t-ilthinspauxthinspordres

Eacuteveilleacutethinspthinsplethinsppatientthinspreacutepondthinspseulementthinspauxthinspordres 3

StimulerthinspphysiquementthinsplethinsppatientthinspenthinspagitantthinspsonthinspeacutepaulethinsptoutthinspenthinspparlantthinspfortthinspLethinsppatientthinspreacuteagit-ilthinspdansthinsplesthinsp10thinspsecon-des

Endormithinspthinsplethinsppatientthinspreacuteagitthinspparthinspunethinspreacuteponsethinspvivethinspagravethinsplathinspstimulationthinspdethinsplathinspgla-bellethinspouthinspagravethinspunthinspstimulusthinspauditifthinspintense 4

StimulerthinspphysiquementthinsplethinsppatientthinspenthinspagitantthinspsonthinspeacutepaulethinsptoutthinspenthinspparlantthinspfortthinspLethinsppatientthinspreacuteagit-ilthinspapregravesthinsp10thinspsecondes

Endormithinspthinsplethinsppatientthinspreacuteagitthinspparthinspunethinspreacuteponsethinspfaiblethinspagravethinsplathinspstimulationthinspdethinsplathinspglabellethinspouthinspagravethinspunthinspstimulusthinspauditifthinspintense

5

UtiliserthinspdesthinspstimulithinspdouloureuxAucunethinspreacuteaction

Endormithinspthinsplethinsppatientthinspnethinspreacuteagitthinsppasthinspagravethinsplathinspdouleur 6

thinsp Peuthinspimportethinsplrsquoeacutechellethinsputiliseacuteethinspcelle-cithinspdoitthinspecirctrethinspchoisiethinspselonthinsplathinspclientegravelethinspetthinsplethinspcontextethinspdonneacutethinspDethinspmecircmethinspsonthinsputilisationthinspdoitthinspecirctrethinspuniformethinspetthinspstandardiseacuteethinspauthinspseinthinspdrsquounethinspmecircmethinspeacutequipethinsp

CettethinspeacutechellethinsppeutthinspecirctrethinsputiliseacuteethinspchezthinsplrsquoenfantthinspToutefoisthinspellethinspserathinspdavantagethinsputilethinspdansthinsplethinspcadrethinspdrsquounethinspeacutevaluationthinsppostseacutedationthinsp(soinsthinsppostproceacutedures)thinspcarthinspilthinsppeutthinspecirctrethinspcliniquementthinspinapproprieacutethinspdethinspstimulerthinspphysiquementthinspunthinspenfantthinspsousthinspseacutedationthinspprofondethinsp

CMQ - OIIQ - OPIQ 58

2 Eacutechelle de vigilance-agitation de Richmond (Richmond Agitation Sedation Scale - RASS) (Tireacute et adapteacute de Chanques et collab 2006)

Lathinsptraductionthinspfranccedilaisethinspdethinspcettethinspeacutechellethinspathinspfaitthinsplrsquoobjetthinspdrsquounethinspvalidationthinspdethinspsathinspthinspreproductibiliteacutethinspinterobservateurthinsp

mdash Annexe

Instruction DescriptionDeacutefinition Niveau

Observerthinsplethinsppatientthinspsansthinspfairethinspdethinspbruit

Srsquoilthinspmanifestethinspunethinspactiviteacutethinspmotricethinspspon-taneacuteethinspquantifierthinsplethinspniveauthinspdrsquoagitationthinsp

Combatifthinspthinspdangerthinspimmeacutediatthinspenversthinsplrsquoeacutequipe + 4Tregraves agiteacutethinspthinsptirethinsparrachethinsptuyauxthinspouthinspcatheacutetersthinspetouthinspagressifthinspenversthinsplrsquoeacutequipe + 3Agiteacutethinspthinspmouvementsthinspfreacutequentsthinspsansthinspbutthinsppreacutecisthinspetouthinspdeacutesadaptationthinspauthinsprespirateur + 2Ne tient pas en placethinspthinspanxieuxthinspouthinspcraintifthinspmaisthinspmouvementsthinsporienteacutesthinsppeuthinspfreacutequentsthinspnonthinspvigoureuxthinspnonthinspagressifs

+ 1

Srsquoilthinspestthinspcalmethinspetthinspreacutepondthinspouthinspnonthinspauxthinspordresthinspsimplesthinsp

Eacuteveilleacute et calmethinspthinspcalmethinspetthinsplesthinspyeuxthinspouvertsConscientthinspthinspRASSthinsp0thinsp+thinspreacutepondthinspauxthinspordresthinspsimples

0

Srsquoilthinspestthinspcalmethinsplesthinspyeuxthinspfermeacutesthinspthinspquan-tifierthinsplethinspniveauthinspdrsquohypovigilancethinsp(outhinspdrsquoendormissement)thinspenthinspsrsquoadressantthinspauthinsppatientthinspparthinspsonthinspnomthinspsansthinsplethinsptoucherthinspenthinsputilisantthinspunethinspvoixthinspdethinspplusthinspenthinspplusthinspfortethinspetthinspdrsquoautantthinspplusthinspfortethinspquethinsplethinsppatientthinspestthinspsusceptiblethinspdrsquoecirctrethinspsourdthinsp(sujetthinspacircgeacutethinspseacutejourthinspprolongeacutethinspenthinspreacuteanimationthinspthinspbouchonthinspdethinspceacuterumenthinsptoxiciteacutethinspdesthinspantibiotiquesthinspetthinspduthinspfuroseacutemide)thinsp

Somnolentthinspthinsppasthinspcomplegravetementthinspeacuteveilleacutethinspmaisthinsprestethinspeacuteveilleacutethinspauthinspcontactthinspvisuelthinspagravethinsplrsquoappelthinspthinsp(gtthinsp10thinsps)

- 1

Diminution leacutegegravere de la vigilancethinspthinsprestethinspeacuteveilleacutethinspbriegravevementthinspavecthinspcontactthinspvisuelthinspagravethinsplrsquoappelthinsp(ltthinsp10thinsps)

- 2

Diminution modeacutereacutee de la vigilancethinspthinspnrsquoimportethinspquelthinspmouvementthinspagravethinsplrsquoappelthinsp(ouverturethinspdesthinspyeux)thinspmaisthinsppasthinspdethinspcon-tactthinspvisuel

- 3

Sithinsplethinsppatientthinspnethinspfaitthinspaucunthinspmouvementthinspythinspcompristhinspenthinsplrsquoappelantthinspdrsquounethinspvoixthinspfortethinspthinspfrictionnerthinspdrsquoabordthinsplrsquoeacutepaulethinsppuisthinsplethinspster-numthinspsansthinspecirctrethinspnociceptifthinsp

Diminution profonde de la vigilancethinspthinspau-cunthinspmouvementthinspagravethinsplrsquoappelthinspnrsquoimportethinspquelthinspmouvementthinspagravethinsplathinspstimulationthinspphysiquethinsp(frictionthinspnonthinspnociceptivethinspdethinsplrsquoeacutepaulethinspouthinspduthinspsternum)

- 4

Non reacuteveillablethinspthinspaucunethinspmouvementthinspnithinspagravethinsplrsquoappelthinspnithinspagravethinsplathinspstimulationthinspphysiquethinsp(frictionthinspnonthinspnociceptivethinspdethinsplrsquoeacutepaulethinspouthinspduthinspsternum)

- 5

CMQ - OIIQ - OPIQ 59

thinspANNEXEthinspXthinsp-thinspEacuteVALUATIONthinspDEthinspLrsquoEFFICACITEacutethinspDEthinspLrsquoANALGEacuteSIEthinsp(EXEMPLES)

(Listethinspnonthinsplimitative)thinsp

Selonthinsplrsquoacircgethinspduthinsppatientthinspsathinspconditionthinspetthinsplethinspcontextethinspcliniquethinspdeuxthinspstrateacutegiesthinspdrsquoeacuteva-luationthinsppeuventthinspecirctrethinsputiliseacuteesthinspsoitthinsplrsquoauto-eacutevaluationthinsp(parthinspdesthinspmotsthinspdesthinspchiffresthinspthinspouthinspdesthinspdessins)thinspouthinsplrsquoheacuteteacutero-eacutevaluationthinspcomportementalethinspCelathinspditthinspsithinsplrsquoauto-thinspeacutevaluationthinspestthinspagravethinspprivileacutegierthinspcrsquoestthinsptoutefoisthinsplrsquoacircgethinspduthinsppatientthinsp(patientthinsppeacutediatrique)thinspetthinspsathinspcapaciteacutethinspcognitivethinspquithinspguiderontthinsplethinspchoixthinspduthinspclinicienthinspdansthinsplathinspseacutelectionthinspduthinspmeilleurthinspoutilthinsp

Pourthinsplethinsppatientthinspnrsquoayantthinsppasthinsplathinspcapaciteacutethinsp(pthinspexthinspthinsphabiliteacutethinspverbalethinspouthinspcognitivethinsplimiteacutee)thinspdrsquoeacutevaluerthinsplui-mecircmethinsplrsquointensiteacutethinspdethinsplathinspdouleurthinspunethinspreacuteponsethinspverbalethinsp(ouinon)thinspouthinspgestuellethinspsignifiantthinsplathinsppreacutesencethinspouthinsplrsquoabsencethinspdethinspdouleurthinspconstituethinspunethinspformethinspdrsquoauto-eacutevaluationthinspacceptablethinspenthinsppratiquethinspcliniquethinspaupregravesthinspdethinspcertainesthinsppopulationsthinsptellesthinspquethinsplethinspjeunethinspenfantthinsplethinsppatientthinspdeacutementthinspouthinspceluithinspvivantthinspavecthinspunethinspdeacuteficiencethinspintellectuellethinsp(McCafferythinspciteacutethinspdansthinspHerrthinspetthinspcollabthinsp2011thinsp[Notrethinsptraduc-

tion])

thinspthinsp Peuthinspimportethinsplrsquoeacutechellethinsputiliseacuteethinspcelle-cithinspdoitthinspecirctrethinspchoisiethinspselonthinsplathinspclientegravelethinspetthinsplethinspcontextethinspdonneacutethinspDethinspmecircmethinspsonthinsputilisationthinspdoitthinspecirctrethinspuniformethinspetthinspstandardiseacuteethinspauthinspseinthinspdrsquounethinspmecircmethinspeacutequipethinspsoignantethinsp

ADULTE-AIcircNEacutethinsp

AUTO-EacuteVALUATIONthinsp(DOULEURthinspAIGUEuml)

thinsprsaquo Eacutechellethinspnumeacuteriquethinsp(0thinspagravethinsp10)thinsp(EN)thinsprsaquo Eacutechellethinspverbalethinspsimplethinsp(EVS)thinsprsaquo Eacutechellethinspvisuellethinspanalogiquethinsp(EVA)

HEacuteTEacuteRO-EacuteVALUATIONthinspCOMPORTEMENTALEthinsp(DOULEURthinspAIGUEuml)

thinsprsaquo ALGOPLUSthinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspdesthinsptroublesthinspdethinsplathinspcommunicationthinspverbale)

thinsprsaquo PACSLACthinspouthinspPACSLAC-Fthinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspunethinspcapaciteacutethinsplimiteacuteethinspagravethinspcommuniquer

thinsprsaquo PAINADthinsp(anglais)thinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspunethinspdeacutemencethinspouthinspautrethinsptroublethinspcognitifthinspetthinspquithinspnethinsppeutthinspcommuniquerthinspdethinspmaniegraverethinspfiable

Les hyperliens concernant ces eacutechelles sont fournis agrave titre informatif seulement

mdash Annexe

CMQ - OIIQ - OPIQ 06

INTRODUCTIONLesthinsppreacutesentesthinsplignesthinspdirectricesthinspremplacentthinspcellesthinspduthinspCollegravegethinspdesthinspmeacutedecinsthinspduthinspQueacutebecthinsp(Utilisation de la seacutedation-analgeacutesiethinspndashthinsp2009)thinspetthinsplethinspguidethinspdethinsppratiquethinspcliniquethinspdethinsplrsquoOrdrethinspprofessionnelthinspdesthinspinhalotheacuterapeutesthinspduthinspQueacutebecthinsp(La seacutedation-analgeacutesiethinspndashthinsp2009)thinspEllesthinspontthinspeacuteteacutethinspeacutelaboreacuteesthinspconjointementthinspparthinsplethinspCollegravegethinspdesthinspmeacutedecinsthinspduthinspQueacutebecthinsp(CMQ)thinsplrsquoOrdrethinspdesthinspinfirmiegraveresthinspetthinspinfirmiersthinspduthinspQueacutebecthinsp(OIIQ)thinspetthinsplrsquoOrdrethinspprofessionnelthinspdesthinspinhalotheacuterapeutesthinspduthinspQueacutebecthinsp(OPIQ)thinspetthinspellesthinspontthinsppourthinspobjectifthinspdrsquoharmoniserthinsplathinsppratiquethinspcliniquethinspdethinsplathinspseacutedation-analgeacutesiethinsp

Ellesthinspconcernentthinspsurtoutthinsplesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspeffectueacuteesthinspsousthinspseacutedation-analgeacutesiethinspdethinspniveauthinspminimalthinspagravethinspmodeacutereacutethinspchezthinspdesthinsppatientsthinspclasseacutesthinspprincipalementthinspdansthinsplesthinspcateacutegoriesthinspASAthinspPhysicalthinspStatusthinsp1thinspetthinsp2thinspetthinspsousthinspcertainesthinspconditionsthinspdethinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp3thinspetthinsp4thinspLathinspseacutedation-analgeacutesiethinspdethinspniveauthinspprofondthinspetthinsplrsquoanestheacutesiethinspgeacuteneacuteralethinspnethinspfontthinsppasthinsplrsquoobjetthinspdethinspcettethinsppublicationthinspetthinspdoiventthinspecirctrethinspplutocirctthinspreacutealiseacuteesthinspdansthinspdesthinspeacutetablissementsthinspposseacutedantthinsptoutesthinsplesthinspinstallationsthinspetthinsplesthinspressourcesthinspprofessionnellesthinspayantthinsplrsquoexpertisethinspthinsprequisethinsppourthinspassurerthinspunethinspprisethinspthinspenthinspchargethinspoptimalethinspetthinspseacutecuritaire

Ellesthinspdeacutecriventthinsplrsquoensemblethinspdesthinspconditionsthinspexigeacuteesthinsplorsquethinsplrsquoonthinspprocegravedethinspagravethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspsousthinspseacutedation-analgeacutesiethinspquethinspcethinspsoitthinsppourthinspunthinspadultethinspouthinspunthinspenfantthinspEllesthinspsontthinspconccediluesthinspdansthinsplethinspbutthinspdrsquooffrirthinspdesthinsprecommandationsthinspvisantthinspunthinspdegreacutethinspoptimalthinspdethinspseacutecuriteacutethinspnotammentthinspenthinspcethinspquithinspconcernethinsplrsquoeacutevaluationthinsplathinspsurveillancethinspcliniquethinspythinspcompristhinsplethinspmonitoragethinspetthinsplathinspmeacutedicationthinsppeu importethinsplrsquoendroitthinspougravethinsplathinspseacutedation-analgeacutesiethinspestthinspeffectueacuteethinspEllesthinspdeacutecriventthinspeacutegalementthinsplesthinspcompeacutetencesthinspprofessionnellesthinspneacutecessairesthinsppourthinsplathinspreacutealisationthinspdrsquounethinspseacutedation-analgeacutesiethinspoptimalethinspetthinspseacutecuritairethinsplesthinspressourcesthinsphumainesthinspetthinspmateacuteriellesthinsprequisesthinsplathinspmarchethinspagravethinspsuivrethinsplesthinsppreacutecautionsthinsprelativesthinspauthinspbien-ecirctrethinspetthinspagravethinsplathinspseacutecuriteacutethinspduthinsppatientthinspainsithinspquethinsplesthinspeacuteleacutementsthinspquithinspdoiventthinspecirctrethinspinscritsthinspauthinspdossierthinsp

Ellesthinspontthinspeacuteteacutethinspconccediluesthinsppourthinspquethinsplesthinspmembresthinspdethinspchacunthinspdesthinspordresthinsppuissentthinspfacilementthinspsrsquoythinspreconnaicirctrethinspselonthinsplesthinspmodaliteacutesthinspquithinspencadrentthinsplrsquoexercicethinspdethinspleurthinspprofessionthinsprespectivethinspdansthinspunthinspcontextethinspdethinsppratiquethinspinterprofessionnellethinsp

thinspthinspthinsp

CMQ - OIIQ - OPIQ 07

Puisquethinsplrsquoenfantthinsppossegravedethinspdesthinspcaracteacuteristiquesthinspquithinspluithinspsontthinsppropresthinspunethinspsectionthinspparticuliegraverethinspluithinspestthinspconsacreacuteethinsp

Enthinsptoutthinsptempsthinspnousthinspdevonsthinsprecourirthinspagravethinsplathinspseacutedation-analgeacutesiethinspavecthinspthinspcirconspectionthinspetthinspprudencethinspLrsquoeacutevaluationthinspduthinsppatientthinsplrsquoadministrationthinspthinspdethinsplathinspmeacutedicationthinspetthinsplathinspsurveillancethinspcliniquethinspdoiventthinspecirctrethinspeffectueacuteesthinspthinspavecthinsplathinspmecircmethinsprigueurthinspquethinsppourthinsplrsquoanestheacutesiethinspgeacuteneacuteralethinsp

CMQ - OIIQ - OPIQ 08

Chapitre 1 Patient adulte

thinsp11thinspDEacuteFINITIONthinspOBJECTIFSthinspETthinspCLIENTEgraveLEthinspCIBLEthinsp

Lathinspseacutedation-analgeacutesiethinspestthinspunethinspproceacutedurethinspquithinspsethinspdeacutefinitthinspcommethinspeacutetantthinsplrsquoadmi-nistrationthinspdethinspmeacutedicamentsthinspouthinspdethinspsubstancesthinspservantthinspagravethinspalteacutererthinsplethinspniveauthinspdethinspconsciencethinspdrsquounethinsppersonnethinspsathinspperceptionthinspdethinsplathinspdouleurthinspetthinspsathinsptoleacuterancethinspagravethinsplrsquoen-vironnementthinsptoutthinspenthinspluithinsppermettantthinspunethinspreacuteponsethinspagravethinsplathinspstimulationthinspverbalethinspouthinsptactilethinspetthinsplethinspmaintienthinspdrsquounethinspfonctionthinspcardiaquethinspetthinspventilatoirethinspadeacutequatethinspenthinsptousthinsppointsthinsp(OPIQthinsp2009)

Ellethinsppermetthinspdoncthinspdethinspmieuxthinsptoleacutererthinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspdethinspfaccedilonthinspseacutecuritairethinspCertainsthinsppatientsthinsprequerrontthinspsurtoutthinspunethinspseacutedationthinspdrsquoautresthinspunethinspanalgeacutesiethinspetthinsplathinspplupartthinsplesthinspdeuxthinspagravethinsplathinspfoisthinspLesthinspmeacutedicamentsthinspetthinsplathinspproceacutedurethinsputiliseacutesthinspdeacutependrontthinspprincipalementthinspduthinspniveauthinspdethinspseacutedationthinspetthinspdrsquoanal-geacutesiethinspdeacutesireacutethinspselonthinsplathinspnaturethinspetthinsplathinspdureacuteethinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacutera-peutiquethinspetthinspselonthinsplesthinspcaracteacuteristiquesthinspduthinsppatientthinspDrsquoailleursthinsplesthinspbesoinsthinspparticu-liersthinspduthinsppatientthinspdoiventthinspecirctrethinsppristhinspenthinspconsideacuteration

Lesthinspobjectifsthinspviseacutesthinspparthinsplathinspseacutedation-analgeacutesiethinsplorsthinspdrsquounethinspinterventionthinspdiagnos-tiquethinspouthinsptheacuterapeutiquethinspsontthinspdrsquoassurerthinsplathinspseacutecuriteacutethinspetthinsplethinspbien-ecirctrethinspduthinsppatientthinspetthinspdethinsppermettrethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspdethinspqualiteacutethinspenthinsp

a fournissantthinspunethinspanalgeacutesiethinspunethinspseacutedationthinspetthinspunethinspamneacutesiethinspadapteacutees

b controcirclantthinsplesthinspcomportementsthinspmoteursthinspnuisiblesthinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

c minimisantthinsplesthinspreacuteponsesthinsppsychologiquesthinspdeacutefavorablesthinspassocieacuteesthinspauxthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspdouloureusesthinspouthinspanxiogegravenesthinsp

Lathinspseacutelectionthinspdesthinsppatientsthinsppourthinsplathinspseacutedation-analgeacutesiethinspestthinspfondeacuteethinspsurthinsplrsquoeacutevaluationthinspcliniquethinspdethinspleurthinspeacutetatthinspdethinspsanteacutethinspAgravethinspcettethinspfinthinspilthinspestthinsprecommandeacutethinspdrsquoutiliserthinsplathinspclassi-ficationthinspdethinsplrsquoeacutetatthinspphysiquethinspduthinsppatientthinspquethinsplrsquoonthinsptrouvethinspdansthinsplethinsptableauthinspdethinsplathinsppagethinspsuivante

CMQ - OIIQ - OPIQ 09

Classification Eacutetatthinspdethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp1 Patientthinspenthinspbonnethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp2Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspleacutegegravere

ASAthinspPhysicalthinspStatusthinsp3Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgrave

ASAthinspPhysicalthinspStatusthinsp4Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgravethinspquithinsprepreacutesentethinspthinspunethinspmenacethinspconstantethinsppourthinspsathinspvie

ASAthinspPhysicalthinspStatusthinsp5Patientthinspmoribondthinspquithinspnethinspsurvivrathinsppasthinspthinspagravethinspmoinsthinspdrsquounethinspinterventionthinsp

ASAthinspPhysicalthinspStatusthinsp6Patientthinspdeacuteclareacutethinspenthinspeacutetatthinspdethinspmortthinspceacutereacutebralethinspdontthinsplesthinsporganesthinspontthinspeacuteteacutethinsppreacuteleveacutesthinspagravethinspdesthinspfinsthinspdethinspdon

Tableau 1Classification de lrsquoeacutetat physique du patient selon lrsquoAmerican Society of Anesthesiologists (ASA) (ASA Physical Status Classification System) [En ligne] (Notre traduction)

Ainsithinsplorsquethinsplathinspseacutedation-analgeacutesiethinspestthinspreacutealiseacuteethinspparthinspunthinspmeacutedecinthinspsansthinsplathinspcolla-borationthinspdirectethinspdrsquounthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesio-logiethinspouthinspenthinspreacuteanimationthinspcardiorespiratoirethinspavanceacuteethinsplesthinspinterventionsthinspdiagnos-tiquesthinspouthinsptheacuterapeutiquesthinspdoiventthinspecirctrethinspreacuteserveacuteesthinspprincipalementthinspauxthinsppatientsthinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp1thinspouthinspauxthinsppatientsthinspatteintsthinspdrsquounethinspaffectionthinspsysteacutemiquethinspleacutegegraverethinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp2thinsp

CMQ - OIIQ - OPIQ 10

Notonsthinspquethinspdansthinspdesthinspsituationsthinspparticuliegraveresthinspetthinspjustifieacuteesthinspauthinspdossierthinspmeacutedi-calthinsplathinspseacutedation-analgeacutesiethinsppeutthinspecirctrethinspeffectueacuteethinspchezthinsplesthinsppatientsthinspstablesthinspdethinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp3thinspetthinspexceptionnellementthinspdethinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp4thinspToutefoisthinspellethinspdoitthinsplrsquoecirctrethinspdansthinspdesthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspopti-malethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespira-toirethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspDethinspplusthinspcesthinsppatientsthinspdoiventthinspfairethinsplrsquoobjetthinspdrsquounethinspeacutevaluationthinspindividualiseacuteethinspetthinspplusthinspapprofondiethinsp

Lathinspprofondeurthinspdethinsplathinspseacutedationthinspetthinsplethinspniveauthinspdrsquoanalgeacutesiethinsprechercheacutethinspenthinspseacutedation-analgeacutesiethinspdoiventthinspcorrespondrethinspauxthinspniveauxthinsppermettantthinsplrsquoatteintethinspdesthinspobjectifsthinspviseacutesthinspetthinspecirctrethinspmesureacutesthinspagravethinsplrsquoaidethinspdrsquoeacutechellesthinspstandardiseacuteesthinspvalideacuteesthinspdethinsppreacutefeacuterencethinspetthinspadapteacuteesthinspauthinspcontextethinspetthinspagravethinsplathinspconditionthinspduthinsppatientthinspLesthinspniveauxthinspdethinspseacutedation-analgeacutesiethinspviseacutesthinsptelsthinspquethinspdeacutefinisthinspdansthinsplathinspclassificationthinspdethinsplrsquoASAthinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinspASAthinspHousethinspofthinspDelegatethinsp2014a)thinsp(annexethinspI)thinspdoiventthinspcorrespondentthinspagravethinsplrsquounthinspouthinsplrsquoautrethinspdesthinspdeuxthinspniveauxthinspsuivantsthinsp(CMQthinsp2009)thinsp

thinsprsaquo seacutedationthinspminimalethinspouthinsplaquothinspanxiolysethinspraquothinspougravethinsplrsquoappreacutehensionthinspduthinsppatientthinspestthinspdiminueacuteethinspsansthinspchangementthinspdethinspsonthinspniveauthinspdethinspconsciencethinspetthinspsansthinspalteacutererthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsplathinspventilationthinspetthinsplathinspfonctionthinspcardiovasculaire

thinsprsaquo seacutedationthinspmodeacutereacuteethinspougravethinsplathinspreacuteponsethinspauxthinspstimulithinspverbauxthinspouthinsptactilesthinspleacutegersthinspestthinspvolontairethinspsansthinspaffecterthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsplathinspventilationthinspspontaneacuteethinspetthinsplathinspfonctionthinspcardiovasculaire

Notonsthinsptoutefoisthinspquethinsplrsquoeacutequipethinspsoignantethinspparticipantthinspagravethinsplathinspproceacutedurethinspdoitthinspconnaicirctrethinsplethinspniveauthinspdethinspseacutedation-analgeacutesiethinspgeacuteneacuteralementthinspneacutecessairethinsppourthinspunethinspinterventionthinspdonneacuteethinspDethinspmecircmethinspellethinspdoitthinspecirctrethinsppreacutepareacuteethinspagravethinspgeacutererthinsplethinsppassagethinspmomentaneacutethinspagravethinspunthinspniveauthinspdethinspseacutedationthinspsupeacuterieurthinspagravethinspceluithinspquithinspathinspeacuteteacutethinspplanifieacutethinsp(crsquoest-agrave-direthinspplusthinspprofondthinspquethinsppreacutevu)thinspcethinspquithinsppeutthinspsurvenirthinspenthinsptoutthinsptempsthinsplorsthinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsp

CMQ - OIIQ - OPIQ 11

Volet organisationnel

thinsp12thinspCOMPEacuteTENCESthinspPROFESSIONNELLESthinsp

Consideacuterantthinspquethinsplathinspseacutedation-analgeacutesiethinspsrsquoinscritthinspdansthinspunethinsppratiquethinspdethinspcollabo-rationthinspentrethinsplethinspmeacutedecinthinspetthinspdrsquoautresthinspprofessionnelsthinspdethinsplathinspsanteacutethinsp(infirmiegraveresthinspetthinspinhalotheacuterapeutes)thinspilthinspimportethinspdethinsppreacuteciserthinspqursquounethinsputilisationthinspjudicieusethinspdethinspleursthinspcompeacutetencesthinspestthinspdethinspmisethinsppourthinspassurerthinsplathinspqualiteacutethinspetthinsplrsquoefficiencethinspdesthinspsoinsthinspAinsithinsptousthinspdoiventthinspavoirthinsplesthinspqualificationsthinsprequisesthinspdansthinsplethinspdomainethinspdethinsplathinspseacutedation-thinspanalgeacutesie

Dethinspplusthinsplrsquoeacutequipethinspsoignantethinspquithinspreacutealisethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacutera-peutiquethinspsousthinspseacutedation-analgeacutesiethinspdoitthinsp

a ecirctrethinspenthinspmesurethinspdrsquoeacutevaluerthinspadeacutequatementthinsplathinspconditionthinspdethinspsanteacutethinspduthinsppatientthinspetthinspdrsquoenthinspassurerthinsplathinspsurveillancethinspclinique

b connaicirctrethinspetthinsputiliserthinspjudicieusementthinsplathinspmeacutedicationthinspainsithinspquethinspsesthinspantagonistes

c posseacutederthinsplesthinspconnaissancesthinspetthinsplesthinspcompeacutetences1thinspneacutecessairesthinsppourthinspintervenirthinspenthinspsituationthinspdrsquourgencethinsptellethinspquethinsplathinspreacuteanimationthinspcardiorespiratoire2thinsp(dethinsppreacutefeacuterencethinspenthinspsoinsthinspavanceacutes)thinspcrsquoest-agrave-direthinspmaicirctriserthinspenthinspprioriteacutethinsplesthinsptechniquesthinspdethinsplathinspprisethinspenthinspchargethinspdethinsplathinspventilationthinspduthinspmassagethinspcardiaquethinspetthinspdethinsplathinspmeacutedicationthinspassocieacutee

d avoirthinsplrsquoexpertisethinsprequisethinspselonthinsplathinspclientegravelethinspviseacuteethinspetthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspagravethinspreacutealiserthinsp

thinsp13thinspRESSOURCESthinspMATEacuteRIELLESthinsp

1thinspLOCAUX

LrsquoameacutenagementthinspdesthinsplocauxthinspdoitthinsppermettrethinspdethinspreacutealiserthinspdethinspfaccedilonthinspadeacutequatethinspetthinspenthinsptoutthinsptempsthinspunethinspreacuteanimationthinspcardiorespiratoirethinspainsithinspqursquounethinspeacutevacuationthinspdrsquourgencethinsplethinspcasthinspeacutecheacuteantthinspEntrethinspautresthinsplathinspsuperficiethinspdoitthinsppermettrethinspauthinsppersonnelthinspdethinspcircu-lerthinsplibrementthinsplrsquoeacuteclairagethinspdoitthinspecirctrethinspsuffisantthinsplethinspmateacuterielthinspdrsquourgencethinsp(pthinspexthinspthinspdethinspreacuteani-mation)thinspdoitthinspecirctrethinspfacilementthinspaccessiblethinspetthinspentreposeacutethinspdansthinspunthinsplieuthinspconnuthinspdethinsptousthinsp

Selonthinsplesthinspmodaliteacutesthinspdethinspfonctionnementthinspetthinsplethinsptypethinspdrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsppratiqueacutethinspilthinspestthinspdrsquousagethinspdethinspdisposerthinspdrsquounethinspsallethinspdethinspreacutecupeacutera-tionthinspouthinspdrsquoobservation

1thinspthinspthinspthinspOnthinspentendthinspparthinspconnaissancesthinspetthinspcompeacutetencesthinspqursquoellesthinspsoientthinspmisesthinspagravethinspjourthinspselonthinsplesthinsprecommandationsthinspenthinspvigueur2thinspthinspthinspOnthinspentendthinspparthinspcertificationthinspenthinspreacuteanimationthinspcardiorespiratoirethinsplesthinspformationsthinspsuivantesthinspthinsp thinsprsaquothinspReacuteanimationthinspcardiorespiratoirethinspdethinspbasethinspthinspSoinsthinspimmeacutediatsthinspenthinspreacuteanimationthinsp(SIR)thinsppourthinspprofessionnelsthinspdethinsplathinspsanteacutethinspthinspthinspthinspthinspthinspthinspthinspthinspouthinsplrsquoeacutequivalentthinsp thinsprsaquothinspReacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspSoinsthinspavanceacutesthinspenthinspreacuteanimationthinspcardiovasculairethinsp(SARC)thinspouthinsplrsquoeacutequivalent

CMQ - OIIQ - OPIQ 12

Pourthinspinformationthinspcompleacutementairethinsp(annexethinspII)thinspProceacutedures et interventions en milieu extrahospitalierthinsp(CMQthinsp2011)

2thinspEacuteQUIPEMENTthinsp(INTRAthinspETthinspEXTRAHOSPITALIER)

OBLIGATOIRE

Enthinspplusthinspduthinspmateacuterielthinspdirectementthinsplieacutethinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspjustifiantthinsplathinspseacutedation-analgeacutesiethinsponthinspdoitthinsptrouverthinspminimalementthinsplrsquoeacutequipe-

mentthinspsuivant

Dansthinsplathinspsallethinsp

thinsprsaquo tablethinspdrsquoexamenthinspciviegraverethinspouthinsptablethinspdethinspchirurgiethinsprsaquo tablethinsppourthinsplesthinspinstrumentsthinsprsaquo soluteacutesthinspetthinspmateacuterielthinspneacutecessairethinsppourthinsplrsquoinstallationthinspetthinsplethinspmaintienthinspdrsquounethinspvoiethinsp

endoveineusethinsprsaquo saturomegravetrethinsp(oxymegravetrethinspdethinsppouls)thinsp

Lethinspmonitoragethinspdethinsplathinspsaturationthinspenthinspoxygegravenethinsppermetthinsplrsquoeacutevaluationthinspdethinsplrsquooxy-geacutenationthinsp(deacutetectionthinsppreacutecocethinspdrsquounethinsphypoxeacutemie)thinspmaisthinspilthinspnethinsppeutthinsppasthinspdeacutetecterthinsppreacutecocementthinspunethinspobstructionthinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(AmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2012)thinspthinsp

thinsprsaquo steacutethoscopethinspthinsprsaquo sphygmomanomegravetrethinspouthinspappareilthinspautomatiseacutethinspnonthinspinvasifthinsppourthinsplathinspprisethinspdethinsplathinsp

pressionthinsparteacuteriellethinsprsaquo sourcethinspdrsquooxygegravenethinspcomprimeacutethinspenthinspquantiteacutethinspsuffisantethinsppourthinspenthinsppermettrethinsp

llsquoadministrationthinspagravethinspunthinspdeacutebitthinspdethinsp15thinsplitresthinspparthinspminutethinsppendantthinsp60thinspminutesthinspetthinspthinsplethinspmateacuterielthinspneacutecessairethinspagravethinsplrsquooxygeacutenotheacuterapie

thinsprsaquo appareilthinspagravethinspaspirationthinsppouvantthinspgeacuteneacutererthinspunethinsppressionthinspneacutegativethinspdethinsp40ndash60thinspmmthinspHgthinspouthinspunethinspcapaciteacutethinspdethinspflotthinspdethinsp100thinsplitresthinspparthinspminutethinspetthinsplethinspmateacuterielthinspneacutecessairethinspthinspagravethinsplrsquoaspiration

thinsprsaquo lethinspmateacuterielthinspneacutecessairethinspagravethinsplathinspprisethinspenthinspchargethinspventilatoirethinspentrethinspautresthinspreacuteanimateurthinspmanuelthinspautogonflablethinsp(Ambuthinspbag)thinspmasquethinspcanulesthinspnasothinspthinspetthinsporopharyngeacuteesthinspdethinsptaillesthinspvarieacutees

Ce mateacuteriel doit ecirctre disponible agrave porteacutee de la main

CMQ - OIIQ - OPIQ 13

thinsprsaquo appareilthinspdrsquoalimentationthinspeacutelectriquethinspdethinspsecoursthinsppourthinsplethinspfonctionnementthinspdesthinspeacutequipementsthinspdrsquourgence

Peutthinspecirctrethinspagravethinsplrsquoexteacuterieurthinspdethinsplathinspsallethinsp(maisthinspfacilethinspdrsquoaccegravesthinspetthinsprapidementthinspdisponible)thinsp

thinsprsaquo thinsparmoirethinspfermeacuteethinsppourthinspentreposerthinspsousthinspcleacutethinspauthinspbesointhinsplethinspmateacuterielthinspetthinsplesthinspsubstancesthinspcontrocircleacuteesthinspainsithinspquethinsplesthinspbenzodiazeacutepines

thinsprsaquo mateacuterielthinspneacutecessairethinspagravethinsplrsquointubationthinspendotracheacutealethinspentrethinspautresthinspsondesthinspendotracheacutealesthinspetthinsplamesthinspdethinsplaryngoscopethinspdethinsptaillesthinspvarieacuteesthinspainsithinspquethinspdesthinspalternativesthinspagravethinsplrsquointubationthinspdifficilethinsp(pthinspexthinspthinspoutilsthinspextraglottiquesthinsptelsthinspquethinspmasquesthinsplaryngeacutes)

thinsprsaquo deacutefibrillateurthinspcardiaquethinsp(dethinsppreacutefeacuterencethinspunthinspdeacutefibrillateurthinspexternethinspautomatiseacutethinsp[DEA])

thinsprsaquo pharmaciethinsp(troussethinspouthinspchariot)thinspcontenantthinsplesthinspmeacutedicamentsthinspneacutecessairesthinspauthinsptraitementthinspdesthinspsituationsthinspdrsquourgencethinsptellesthinspquethinspthinspsurdosagethinspauxthinspopioiumldesthinspouthinspauxthinspbenzodiazeacutepinesthinspurgencethinspcardiaquethinspreacuteactionthinspallergiquethinspcrisethinspdrsquoasthmethinspcrisethinspconvulsivethinspchocthinspvagalthinsphypoglyceacutemiethinspetc

RECOMMANDEacutethinspSELONthinspLAthinspSITUATION

thinsprsaquo moniteurthinspcardiaquethinspthinspdansthinspcertainsthinspcasthinspbienthinspdeacutefinisthinsplethinspmonitoragethinspcardiaquethinsppeutthinspecirctrethinsprecommandeacutethinspouthinspobligatoirethinsp(tableauthinsp3)

thinsprsaquo capnographethinspthinspdansthinspcertainsthinspcasthinspbienthinspdeacutefinisthinsplethinspmonitoragethinspduthinspCO2thinsppeutthinspecirctrethinsp

recommandeacutethinspouthinspobligatoirethinsp(tableauthinsp3)thinspthinspLethinspmonitoragethinspduthinspCO

2thinsppermetthinspdrsquoidentifierthinsppreacutecocementthinsplesthinspcomplicationsthinsp

tellesthinsplathinspseacutedationthinspexcessivethinsplrsquohypoventilationthinspetthinsplrsquoapneacuteethinspenthinspplusthinspdethinsppermettrethinspdethinspmieuxthinspcontrocirclerthinsplethinspniveauthinspdethinspseacutedationthinspenthinspfonctionthinspdethinsplrsquointerventionthinspthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinspSonthinsputilisationthinsppermetthinspeacutegalementthinspthinspdethinspsuivrethinsplethinspmonitoragethinspventilatoirethinspCelathinspestthinspparticuliegraverementthinspapproprieacutethinspthinsplorsqursquoilthinspnrsquoexistethinsppasthinspdrsquoantagonistesthinspagravethinsplathinspmeacutedicationthinsputiliseacuteethinsp(pthinspexthinspthinsppropofol)thinsp

OPTIONNEL

thinsprsaquo moniteurthinspdethinsptempeacuteraturethinspetthinspdispositifthinspdethinspreacutechauffementthinspduthinsppatientthinspselonthinsplethinsppatientthinspetthinsplathinspdureacuteethinspdethinsplrsquointerventionthinsp

thinsprsaquo systegravemethinspdrsquoantipollutionthinsp(eacutevacuationthinspduthinspprotoxydethinspdrsquoazote)thinspsrsquoilthinspythinspathinsplieuthinsprsaquo analyseurthinspdrsquooxygegravenethinsplorsqursquounthinspmeacutelangethinspestthinsputiliseacutethinsp(pthinspexthinspthinspO

2thinspetthinspprotoxydethinsp

drsquoazote)thinsprsaquo steacutethoscopethinsppreacutecordialthinspouthinsppreacutetracheacutealthinsppourthinspeacutecoutethinspenthinspcontinu

CMQ - OIIQ - OPIQ 14

LrsquoensemblethinspdethinspcesthinspeacutequipementsthinspdoitthinspecirctrethinspadapteacutethinspauthinsppatientthinspIlsthinspdoiventthinspecirctrethinspenthinspeacutetatthinspdethinspfonctionnerthinspetthinsplesthinspattestationsthinspdesthinspveacuterificationsthinsppeacuteriodiquesthinspdoiventthinspecirctrethinspconserveacuteesthinspdansthinspunthinspregistrethinsppreacutevuthinspagravethinspcettethinspfin

Pendantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplesthinspprofessionnelsthinspdoiventthinspthinsprespecterthinsplesthinspregraveglesthinspdethinsppreacuteventionthinspetthinspdethinspcontrocirclethinspdesthinspinfections

Unethinspproceacutedurethinsprelativethinspauxthinspsituationsthinspdrsquourgencethinsp(annexethinspIII)thinspagravethinsplrsquoaccegravesthinspauxthinspser-vicesthinspdrsquourgencethinsppreacutehospitaliersthinspetthinspdethinsptransfertthinspselonthinspunethinspententethinspintereacutetablisse-mentsthinspdoitthinspecirctrethinspeacutelaboreacuteethinspmaintenuethinspagravethinspjourthinspfacilementthinspdisponiblethinspenseigneacuteethinspagravethinsptoutthinsplethinsppersonnelthinspetthinspfairethinsplrsquoobjetthinspdrsquounthinsprappelthinspaupregravesthinspdethinspcethinspdernierthinspsurthinspunethinspbasethinsp

peacuteriodiquethinsp

CMQ - OIIQ - OPIQ 15

Volet professionnel

thinsp14thinspPREacuteSEacuteDATION-ANALGEacuteSIEthinsp

SEacuteLECTIONthinspDESthinspPATIENTS

Lathinspseacutelectionthinspdesthinsppatientsthinspdoitthinsptenirthinspcomptethinspnotammentthinspdethinsplrsquoeacutevaluationthinspdesthinspvoiesthinspaeacuteriennesthinspetthinspdethinsplrsquoeacutetatthinspdethinspsanteacutethinspgeacuteneacuteralthinspduthinsppatientthinspquithinspaurontthinspmisthinspenthinspeacutevi-dencethinsplathinsppreacutesencethinspouthinsplrsquoabsencethinspdrsquoindicateursthinspdethinsppossiblesthinspcomplicationsthinsplorsthinspdethinsplathinspseacutedation-analgeacutesiethinspIlthinspexistethinspdeuxthinsptypesthinspdethinsprisquesthinspenthinspseacutedation-analgeacutesiethinspthinsplesthinsprisquesthinsppreacutevisiblesthinsp(difficulteacutethinsppotentiellethinsplieacuteethinspagravethinsplathinspgestionthinspdesthinspvoiesthinspaeacuteriennesthinspouthinspinstabiliteacutethinspduthinsppatient)thinspetthinsplesthinsprisquesthinspimpreacutevisiblesthinsp(incidentaccidentthinsperreurthinsphu-mainethinspetc)thinspUnethinspeacutevaluationthinspinitialethinsp(histoirethinspexamenthinspphysique)thinspadeacutequatethinspavantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspdiminuethinspdethinsptelsthinsprisques

Agravethinsppartirthinspdethinsplrsquoensemblethinspdesthinspeacutevaluationsthinspeffectueacuteesthinsplethinspmeacutedecinthinspseacutelectionnethinsplesthinsppatientsthinspaptesthinspagravethinsprecevoirthinspunethinspseacutedation-analgeacutesiethinspselonthinspnotammentthinsp

thinsprsaquo lesthinspfacteursthinspdethinsprisquethinspidentifieacutesthinspagravethinsplathinspsuitethinspdethinsplrsquoeacutevaluationthinsp(cardiovasculairethinsprespiratoirethinspheacutepatiquethinspneurologique)thinspdethinsplathinsppossibiliteacutethinspdethinspgrossessethinspchezthinsplathinspfemmethinspenthinspacircgethinspdethinspprocreacuteerthinspouthinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspenvisageacutee

thinsprsaquo lrsquoeacutevaluationthinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(annexethinspIV)thinspafinthinspdethinsppreacuteciserthinsplethinsprisquethinspdrsquoassistancethinspventilatoirethinspetthinspdrsquointubationthinspdifficilethinsp

thinsprsaquo lesthinspanteacuteceacutedentsthinspanestheacutesiquesthinspetthinspchirurgicauxthinspafinthinspdrsquoidentifierthinsplesthinspcomplicationsthinsppotentielles

thinsprsaquo lesthinspcomorbiditeacutesthinspdontthinsplesthinsptroublesthinsprespiratoiresthinspduthinspsommeilthinsp(annexethinspV)thinsprsaquo lathinspmeacutedicationthinspouthinspautresthinspsubstancesthinsp(prescritesthinspouthinspenthinspventethinsplibre)thinspafinthinsp

drsquoidentifierthinsplesthinsprisquesthinspdrsquointeractionsthinspavecthinsplesthinspmeacutedicamentsthinsputiliseacutesthinsplorsthinspdethinsplrsquointerventionthinspouthinspdethinsplathinspseacutedation-analgeacutesie

thinsprsaquo lrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspquithinsppourraitthinspneacutecessiterthinspunethinspseacutedation-analgeacutesiethinspdrsquounthinspniveauthinspsupeacuterieurthinspagravethinspceluithinspdontthinspilthinspestthinspquestionthinspdansthinspcesthinsplignesthinspdirectrices

thinsprsaquo lesthinspcaracteacuteristiquesthinsppropresthinspauthinsppatientthinsp(fonctionsthinspcognitivesthinspisolementthinspsocialthinspautonomiethinspetc)

EacuteVALUATIONthinspDESthinspPATIENTS

Cettethinspeacutevaluationthinspdoitthinspsethinspfairethinsppeuthinspdethinsptempsthinsp(moinsthinspdethinsp3thinspmoisthinspenthinsplrsquoabsencethinspdethinspchangementthinspnotablethinspdansthinsplathinspconditionthinspcliniquethinspduthinsppatient)thinspavantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspetthinspdoitthinspnotammentthinsppreacuteciserthinspcethinspquithinspsuit

CMQ - OIIQ - OPIQ 16

AgravethinspLrsquoANAMNEgraveSEthinspthinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsp

lrsquoeacutevaluationthinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinsp(annexethinspVI)thinsp

thinsprsaquo raison(s)thinspdethinspconsultationthinspetthinsphistoirethinspdethinsplathinspmaladiethinspactuellethinsprsaquo anteacuteceacutedentsthinsprsaquo reacuteactionthinspanteacuterieurethinspagravethinsplathinspseacutedation-analgeacutesiethinspagravethinsplrsquoanestheacutesiethinspetthinspagravethinsplathinspchirurgiethinsprsaquo allergiesthinsprsaquo momentthinspduthinspdernierthinspingestathinsp(preacuteciserthinsplethinsptypethinspetthinsplathinspquantiteacute)thinsprsaquo meacutedicationthinspetthinspautresthinspsubstancesthinsp(prescritesthinspouthinspnon)thinsprsaquo preacutemeacutedicationthinspreccediluethinsp(pthinspexthinspthinspadministrationthinspdethinspmorphinethinspchezthinspunthinsppatientthinspenthinsp

attentethinspdrsquounethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutique)thinsprsaquo habitudesthinspdethinspviethinsp(tabacthinspalcoolthinspouthinspdrogues)thinsprsaquo troublethinsprespiratoirethinspduthinspsommeilthinspetthinsplathinsptheacuterapiethinspassocieacutee

AgravethinspLrsquoEXAMENthinspPHYSIQUEthinsp

Lrsquoexamenthinspphysiquethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinspcherchethinspagravethinspmettrethinspenthinspeacutevi-dencethinspcertainsthinspcritegraveresthinspreconnusthinsppourthinspecirctrethinspassocieacutesthinspagravethinspunethinspassistancethinspventila-toirethinspdifficilethinspquithinsppeutthinspsurvenirthinspdansthinsplethinspcasthinspdrsquounthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquethinspceluithinspviseacutethinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsplrsquoeacutevaluationthinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinsp(annexethinspVII)thinsp

Lrsquoexamenthinspphysiquethinspdoitthinspecirctrethinspadapteacutethinspagravethinspchaquethinsppatientthinspetthinspporterthinspnotammentthinspsurthinspdesthinspeacuteleacutementsthinsptelsthinspquethinspceux-cithinsp

thinsprsaquo preacutesencethinspdrsquoobeacutesiteacutethinsprsaquo tecirctethinspetthinspcouthinsp

thinsprsaquo mobiliteacutethinspcervicalethinspcompromisethinsprsaquo couthinspcourtthinspouthinsplargethinsp(circonfeacuterencethinsp )thinsprsaquo pathologiethinspouthinspanomaliethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(pthinspexthinspthinspmassethinsp

cervicale)thinspthinsprsaquo bouchethinsp

thinsprsaquo petitethinspouverturethinsprsaquo dentitionthinsp(pthinspexthinspthinspbouchethinspeacutedenteacuteethinspdentsthinspinstablesthinspincisivesthinspproeacuteminentesthinsp

outhinspappareilthinspdentairethinspmalocclusionthinspimportante)thinsp

LethinspscorethinspdethinspMallampatithinspmodifieacutethinspestthinspunthinspoutilthinspagravethinspprivileacutegierthinsp(annexethinspIV)

CMQ - OIIQ - OPIQ 17

UnethinspbonnethinspeacutevaluationthinspdethinsptousthinsplesthinspaspectsthinsprelatifsthinspauthinspmaintienthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspestthinspessentiellethinspDethinspplusthinspchezthinsplethinsppatientthinspsymptomatiquethinspthinsp(pthinspexthinspthinspdyspneacutee)thinspcettethinspeacutevaluationthinspdoitthinspecirctrethinspcompleacuteteacuteethinspparthinsplrsquoauscultation cardiorespiratoirethinspFinalementthinspsithinspdrsquoautresthinspexamensthinspdoiventthinspecirctrethinspfaitsthinspleurthinspchoixthinspserathinspguideacutethinspparthinsplesthinspproblegravemesthinspmeacutedicauxthinspsous-jacents

Bienthinspquethinsplathinspseacutedation-analgeacutesiethinspnethinsppreacutevoitthinspnormalementthinsppasthinspdethinspprisethinspenthinspchargethinspcomplegravetethinspdethinsplathinspventilationthinsp(assistancethinspventilatoirethinspouthinspintubationthinspthinspendotracheacuteale)thinspilthinspestthinspimportantthinspdrsquoeffectuerthinspcettethinspeacutevaluationthinsppuisqursquoagravethinspthinsptoutthinspmomentthinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspunethinspventilationthinspthinspassisteacuteethinspavecthinspouthinspsansthinspintubationthinspendotracheacutealethinsppeutthinspsrsquoaveacutererthinspneacutecessairethinspthinspsithinsplathinsprespirationthinspestthinspcompromisethinsp

Lorsthinspdethinspsituationsthinspparticuliegraveresthinspouthinspcomplexesthinsplethinspmeacutedecinthinspdevraitthinspconsulterthinspunthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinsp

cardiorespiratoirethinspavanceacutee

CONSENTEMENTthinsp(REacuteSUMEacute)

LethinsplecteurthinspdoitthinspsethinspreacutefeacutererthinspagravethinsplrsquoannexethinspVIIIthinsppourthinsplethinsptextethinspcomplet

SelonthinsplethinspdroitthinspenthinspvigueurthinspauthinspQueacutebecthinspilthinspestthinspobligatoirethinspdrsquoobtenirthinsplethinspconsentementthinspdrsquounthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspintervention

LethinspCode civil du QueacutebecthinspeacutetablitthinspdesthinspregraveglesthinspgeacuteneacuteralesthinspconcernantthinsplethinspconsentementthinspauxthinspsoinsthinspquithinspsrsquoappliquentthinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspdispenseacutesthinspOnthinspythinspfaitthinspcependantthinspcertainesthinspdistinctionsthinspselonthinspquethinsplethinsppatientthinspestthinspaptethinspouthinspnonthinspagravethinspconsentirthinspetthinspselonthinspquethinsplesthinspsoinsthinspsontthinsprequisthinspouthinspnonthinsp

parthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspLathinspLoi sur les services de santeacute et les services sociaux (LSSSS)thinspeacutetablitthinspquantthinspagravethinspellethinsplesthinspregraveglesthinspapplicablesthinspenthinspeacutetablissementthinspenthinspmatiegraverethinspdethinspconsentementthinspauxthinspinterventionsthinspchirurgicalesthinspetthinspagravethinsplrsquoanestheacutesiethinsp

LethinspCode de deacuteontologie des meacutedecinsthinspstipulethinspquethinsplethinspmeacutedecinthinspdoitthinspobtenirthinspunthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspavantthinsptoutethinspinterventionthinspilthinspestthinsppreacuteciseacutethinspquethinsplethinspmeacutedecinthinspdoitthinspsrsquoassurerthinspquethinsplrsquoinformationthinsppertinentethinspathinspeacuteteacutethinsptransmisethinspfaciliterthinsplathinspprisethinspdethinspdeacutecisionthinspduthinsppatientthinspetthinsplathinsprespecterthinspLethinspCode de deacuteontologie

des infirmiegraveres et infirmiersthinspstipulethinspquantthinspagravethinspluithinspquethinsplrsquoinfirmiegraverethinspouthinsplrsquoinfirmierthinspdoitthinspfournirthinspauthinspclientthinsptoutesthinsplesthinspinformationsthinsprequisesthinsplorsquethinsplrsquoobligationthinspdrsquoobtenirthinspunthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspincombethinspagravethinsplrsquoinfirmiegraverethinspouthinspagravethinsplrsquoinfirmierthinspIlthinspnrsquoythinspathinsppasthinspdethinspdispositionthinsptouchantthinsppreacuteciseacutementthinsplethinspconsentementthinspdansthinsplethinspCode de

CMQ - OIIQ - OPIQ 18

deacuteontologie des inhalotheacuterapeutes du QueacutebecthinspCependantthinspilthinspestthinsppreacuteciseacutethinspqursquoenthinspplusthinspdesthinspavisthinspetthinspdesthinspconseilsthinsplrsquoinhalotheacuterapeutethinspdoitthinspfournirthinspagravethinspsonthinspclientthinsplesthinspexplicationsthinspneacutecessairesthinspagravethinsplathinspcompreacutehensionthinspetthinspagravethinsplrsquoappreacuteciationthinspdesthinspservicesthinspqursquoilthinspluithinsprend

TousthinsplesthinspprofessionnelsthinspsontthinspeacutevidemmentthinsptenusthinspdethinsprespecterthinsplesthinspdispositionsthinspleacutegalesthinspexistantesthinspndashthinspincluantthinspleurthinspcodethinspdethinspdeacuteontologiethinsprespectifthinspndashthinspetthinsplesthinspnormesthinspdethinsppratiquethinspeacutetabliesthinspparthinspleurthinspordrethinspprofessionnelthinspToutefoisthinsplathinspquestionthinspsethinspposethinspdethinspsavoirthinspcommentthinspcesthinspexigencesthinspdoiventthinspsrsquoappliquerthinspmaintenantthinspquethinspplusieursthinspinterventionsthinspreacutealiseacuteesthinspautrefoisthinspenthinspeacutetablissementthinspsontthinspeffectueacuteesthinspenthinspdehorsthinspthinspdethinspceux-cithinspetthinspquethinsplesthinspprofessionnelsthinsppartagentthinspcertainesthinspactiviteacutesthinspetthinsptravaillentthinsp

enthinspeacutetroitethinspcollaboration

Mecircmethinspsithinsplathinsploithinspnethinsplrsquoexigethinsppasthinsptoujoursthinspilthinspestthinsprecommandeacutethinsp

thinsprsaquo quethinsplethinsppatientthinspdonnethinspunthinspconsentementthinspeacutecritthinsplorsqursquoilthinspythinspathinspseacutedation-analgeacutesiethinspthinspetthinspcethinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspprodigueacutes

thinsprsaquo quethinsplethinspconsentementthinspportethinspagravethinsplathinspfoisthinspsurthinsplathinspseacutedation-analgeacutesiethinspetthinspsurthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspquethinspcettethinspderniegraverethinsppermet

thinsprsaquo quethinsplrsquoinformationthinsptransmisethinspauthinsppatientthinspverbalementthinspouthinspparthinspeacutecritthinspcomprennethinsplesthinsprisquesthinspdethinsplathinspseacutedation-analgeacutesiethinspetthinsplesthinsprisquesthinspdethinsplrsquointerventionthinspelle-mecircme

thinsprsaquo quethinsplethinspmeacutedecinthinspouthinsplethinspprofessionnelthinspagravethinspquithinspilthinspathinspconfieacutethinsplathinsptacircchethinspversethinspauthinspdossierthinspduthinsppatientthinspunethinspnotethinspexplicativethinspsurthinsplesthinspinformationsthinspfourniesthinspetthinsplethinspconsentementthinspobtenu

Lrsquoobtentionthinspdrsquounthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspdemeurethinspunethinspobligationthinspthinspinheacuterentethinspagravethinsplrsquointerventionthinspmeacutedicalethinspelle-mecircmethinspIlthinsprelegravevethinspdoncthinspdethinsplathinspresponsabiliteacutethinspduthinspmeacutedecinthinspdethinspsrsquoassurerthinspdethinsplathinsptransmissionthinspdethinsplrsquoinformationthinsppertinentethinspauthinsppatientthinspetthinspdethinspsathinspcompreacutehensionthinspdethinsplathinspnaturethinspduthinspbutthinspetthinspdesthinsprisquesthinsprelatifsthinspagravethinsplrsquointerventionthinspToutefoisthinsplathinsptacircchethinspdethinsptransmettrethinspdethinsplrsquoinformationthinspcompleacutementairethinsppeutthinspecirctrethinspconfieacuteethinspagravethinspdrsquoautresthinspprofessionnelsthinspthinspetthinspcellethinspdethinsprecueillirthinsplathinspsignaturethinspdrsquounthinspformulairethinspdethinspconsentementthinspagravethinspdrsquoautresthinspmembresthinspdethinsplrsquoeacutequipethinspdethinspsoins

CMQ - OIIQ - OPIQ 19

DIRECTIVESthinspETthinspCONSEILSthinsp

Avantthinspdethinspsubirthinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspsousthinspseacutedationthinsp-analgeacutesiethinsplethinsppatientthinspdoitthinsprecevoirthinsplesthinspdirectivesthinspneacutecessairesthinspdethinsppreacutefeacuterencethinspdansthinsp

unthinspdocumentthinspcontenantthinspentrethinspautresthinsplesthinsprecommandationsthinspsuivantesthinsp

a eacuteviterthinspdethinspconsommerthinsptoutethinspboissonthinspalcooliseacuteethinspdroguethinspouthinspsubstancethinspenthinspventethinsplibrethinsp(agravethinspmoinsthinspqursquoellethinspsoitthinspprescrite)thinsppouvantthinspalteacutererthinsplethinspniveauthinspdethinspconsciencethinspthinsp24thinspheuresthinspavantthinspetthinspapregravesthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

b observerthinspunethinsppeacuteriodethinspdethinspjeucircnethinspquithinspsrsquoappliquethinspagravethinsptoutthinspacircgethinspauxthinspcasthinspeacutelectifsthinsp(nonthinspurgents)thinspetthinspselonthinsplrsquoeacutevaluationthinspduthinsplaquothinsprapportthinsprisquebeacuteneacuteficethinspraquothinsppourthinsplesthinspcasthinspurgents

c suivrethinsplesthinsprecommandationsthinspduthinspmeacutedecinthinspquithinsppreacutecisethinspsithinsplesthinspmeacutedicamentsthinspprescritsthinspsurthinspunethinspbasethinspreacuteguliegraverethinsppeuventthinspecirctrethinspadministreacutesthinspcommethinspagravethinsplrsquoaccoutumeacuteethinspetthinspquithinspfaitthinsppartthinspdesthinspexceptionsthinsp(pthinspexthinspthinspanticoagulantthinsppsychotropethinspetc)thinspsrsquoilthinspythinspathinsplieuthinsp

Unethinspseacutedation-analgeacutesiethinspleacutegegraverethinspougravethinsplesthinspreacuteflexesthinspdethinspprotectionthinspdesthinspvoiesthinspthinspaeacuteriennesthinspsontthinsppreacuteserveacutesthinspestthinsppeuthinspsusceptiblethinspdrsquoinduirethinspunethinspaspirationthinspduthinspcon-tenuthinspgastriquethinspcontrairementthinspagravethinspunethinspseacutedationthinspplusthinspprofondethinspIlthinspestthinsptoutthinspdethinspmecircmethinspraisonnablethinspdethinsppenserthinspquethinsplethinsprisquethinspdrsquoaspirationthinspestthinspdiminueacutethinsplorsquethinsplrsquoestomacthinspestthinspvidethinspetthinspqursquounethinsppeacuteriodethinspdethinspjeucircnethinspavantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacutera-peutiquethinspestthinsppreacutefeacuterablethinspToutefoisthinspdansthinsptousthinsplesthinspcasthinsplrsquourgencethinspdethinsplrsquointerventionthinspetthinsplethinspniveauthinspdeacutesireacutethinspdethinspseacutedation-analgeacutesiethinspdoiventthinspecirctrethinspsoupeseacutesthinspauthinspregardthinspdesthinsprisquesthinspassocieacutesthinspagravethinspunthinspjeucircnethinspinadeacutequatthinspAinsithinsplethinspdeacutelaithinspentrethinsplrsquoheurethinspduthinspdernierthinsprepasthinspetthinsplethinspmomentthinspdethinsplathinspblessureaccidentthinspdoitthinspecirctrethinsppristhinspenthinspconsideacuterationthinsppourthinspestimerthinsplrsquoeacutetatthinspdethinspjeucircnethinspetthinspcethinspenthinspraisonthinspdethinsplrsquoileacuteusthinspreacuteflexethinsp

Avantthinsplathinspseacutedation-analgeacutesiethinspdrsquounethinspinterventionthinspnonthinspurgentethinsp(eacutelective)thinsplethinsppatientthinspdoitthinsprespecterthinsplesthinspdeacutelaisthinspsuivantsthinspselonthinsplathinspnaturethinspetthinsplathinspquantiteacutethinspingeacutereacuteethinspdethinspthinsp(Merchantthinspetthinspcollabthinsp2014a)thinsp

thinsprsaquo liquidethinspclairthinsp(pthinspexthinspthinspeauthinspjusthinspdethinspfruitthinsp[sansthinsppulpe]thinsptheacutethinspetthinspcafeacutethinspnoir)thinspthinspjeucircnethinspdethinsp2thinspheures

thinsprsaquo repasthinspleacutegerthinsp(pthinspexthinspthinsppainthinspgrilleacutethinsp+thinspliquidethinspclair)thinspthinspjeucircnethinspdethinsp6thinspheuresthinsprsaquo repasthinspcomposeacutethinspdethinspviandethinspouthinspdrsquoalimentsthinspfritsthinspouthinspgrasthinspthinspjeucircnethinspdethinsp8thinspheuresthinsp

CMQ - OIIQ - OPIQ 20

15thinspPERSEacuteDATION-ANALGEacuteSIEthinsp

APPROCHEthinspPHARMACOLOGIQUE

Lrsquoadministrationthinspdethinsptoutthinspmeacutedicamentthinspneacutecessitethinsplrsquoobtentionthinspdrsquounethinspordonnancethinsp

faitethinspenthinspvertuthinspdethinsplrsquoarticlethinsp393thinspduthinspCode des professions du QueacutebecthinspDrsquoailleursthinspthinsplathinspmeilleurethinspfaccedilonthinspdrsquoencadrerthinsplathinsppratiquethinspdethinsplrsquoinfirmiegraverethinspetthinspdethinsplrsquoinhalotheacuterapeutethinspestthinsplrsquoadoptionthinspdrsquounthinspprotocoleordonnancethinspcollectivethinspcomprenantthinspunthinspeacuteventailthinsptheacuterapeutiquethinspquithinsplaissethinspplacethinspauthinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspthinspUnthinsptelthinspdocumentthinspdoitthinspparthinspcontrethinspecirctrethinspenteacuterineacutethinspparthinsplesthinspresponsablesthinspmeacutedicauxthinspthinspdethinsplrsquoeacutetablissementthinspqursquoilthinspsoitthinsppublicthinspouthinsppriveacutethinsp

Soulignonsthinsplrsquoimportancethinspdrsquounthinspaccegravesthinspveineuxthinspfonctionnelthinspquithinspfaciliterathinsplrsquoadmi-nistrationthinspdesthinspagentsthinspseacutedatifsthinspetthinspanalgeacutesiquesthinspainsithinspquethinsplesthinsptraitementsthinsppharma-cologiquesthinspdesthinspcomplications

LethinspmeacutedecinthinsplrsquoinfirmiegraverethinspetthinsplrsquoinhalotheacuterapeutethinspdoiventthinsputiliserthinspunethinspmeacutedicationthinspqursquoilsthinspconnaissentthinspetthinspquithinspestthinspreconnuethinspRappelonsthinspqursquoilsthinspdoiventthinspecirctrethinspenthinspmesurethinspdethinspprendrethinspenthinspchargethinsptoutethinspcomplicationthinsppotentiellethinspythinspcompristhinsplathinspgestionthinspdrsquounthinsppassagethinspmomentaneacutethinspagravethinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspsupeacuterieurthinspagravethinspceluithinspquithinspthinspathinspeacuteteacutethinspplanifieacute

LethinspchoixthinspdethinsplathinspmeacutedicationthinsppeutthinspvarierthinspselonthinsplathinspsituationthinspcliniquethinspetthinsplesthinspfacteursthinsppropresthinspauthinsppatientthinspParthinspexemplethinspcertainsthinsppatientsthinspnethinsptolegraverentthinsppasthinsplesthinspdosagesthinsphabituelsthinspouthinsppreacutesententthinspdesthinspcontre-indications

Ilthinspestthinspimportantthinspdethinspretenirthinspquethinsplethinsptitragethinspdethinsptoutethinspmeacutedicationthinspdoitthinspecirctrethinspthinspprivileacutegieacutethinspetthinspquethinspsonthinspadministrationthinspdoitthinspsethinspfairethinspparthinsppetitesthinspdosesthinspdethinspthinspfaccedilonthinspprogressivethinspjusqursquoagravethinsplrsquoobtentionthinspduthinspniveauthinspdethinspseacutedationthinspetthinspdrsquoanalgeacutesiethinspthinspdeacutesireacutethinsptoutthinspenthinsplaissantthinspsrsquoeacutecoulerthinspsuffisammentthinspdethinsptempsthinspentrethinspdeuxthinspdosesthinsppourthinspquethinsplethinspmeacutedicamentthinspproduisethinspsesthinspeffetsthinsp

Lesthinspmeacutedicamentsthinsputiliseacutesthinspenthinspseacutedation-analgeacutesiethinspontthinspunthinspeffetthinspsynergiquethinspthinspParthinspexemplethinsplrsquoassociationthinspdrsquounethinspbenzodiazeacutepinethinspavecthinspunthinspopioiumldethinspaugmentethinspthinsplesthinsprisquesthinspdethinspdeacutepressionthinsprespiratoirethinspLeurthinspdosagethinspdoitthinspdoncthinspecirctrethinspajusteacutethinspenthinspconseacutequencethinspSithinsplrsquoobstructionthinspdesthinspvoiesthinspaeacuteriennesthinsplrsquoapneacuteethinspetthinsplrsquohypotensionthinspthinspsontthinsplesthinspcomplicationsthinsplesthinspplusthinspfreacutequentesthinspenthinspseacutedation-analgeacutesiethinspilthinspfautthinspretenirthinspquethinspcertainesthinspcomplicationsthinsppeuventthinspecirctrethinspparticuliegraveresthinspagravethinsplathinspmeacutedicationthinsputiliseacuteethinspthinspCitonsthinspagravethinsptitrethinspdrsquoexemplethinsplrsquoassociationthinsplaryngospasmethinspetthinspkeacutetaminethinsp

CMQ - OIIQ - OPIQ 21

Lorsquethinspdesthinspbenzodiazeacutepinesthinspouthinspdesthinspopioiumldesthinspsontthinspadministreacutesthinspparthinspvoiethinspthinspintraveineusethinspleursthinspantagonistesthinsprespectifsthinsp(pthinspexthinspthinspflumazeacutenilthinsp[Anexatereg]thinspthinspnaloxonethinsp[Narcanreg])thinspdoiventthinspecirctrethinsprapidementthinspdisponiblesthinspIlsthinspserontthinsputiliseacutesthinspthinspauthinspmomentthinspdrsquounethinspdeacutepressionthinsprespiratoirethinspinduitethinspparthinsplathinspmeacutedicationthinspet non en prophylaxiethinspchezthinsplethinsppatientthinspstablethinspIlthinspestthinsphabituellementthinsppreacutefeacuterablethinspdethinspthinsprenverserthinspdrsquoabordthinsplrsquoagentthinspseacutedatifthinspafinthinspdethinspmaintenirthinspintactthinsplrsquoeffetthinspanalgeacutesiquethinspthinspSithinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspdemeurethinspcompromisethinspilthinspserathinspalorsthinspthinspneacutecessairethinspdethinsprenverserthinsplrsquoeffetthinspanalgeacutesique

IlthinspfautthinspsethinsprappelerthinspquethinsplathinspdureacuteethinspdrsquoactionthinspdesthinspantagonistesthinspestthinspbienthinspinfeacuterieurethinspthinspagravethinsplathinspdureacuteethinspdrsquoactionthinspduthinspmeacutedicamentthinspdevantthinspecirctrethinspneutraliseacutethinspParthinspconseacutequentthinspthinsplathinspreacuteapparitionthinspdethinsplrsquoeffetthinspindeacutesirablethinspestthinspagravethinspsurveillerthinspchezthinsplethinsppatientthinspquithinspreccediloitthinspunthinspantagonistethinsp

VousthinsptrouverezthinspunethinspfichethinspinformativethinspsurthinsplrsquoutilisationthinspdethinsplathinspnaloxonethinspetthinspduthinspflumazeacutenilthinspagravethinsplrsquoannexethinspXI

Lesthinspdirectivesthinspeacutenonceacuteesthinspdansthinspcesthinsplignesthinspdirectricesthinspnrsquoontthinsppasthinsppourthinspobjectifthinspdethinspdeacutecrirethinspdansthinsplethinspdeacutetailthinsplathinspmeacutedicationthinsputiliseacuteethinspenthinspseacutedation-analgeacutesiethinspleursthinspagentsthinsp

antagonistesthinspetthinsplesthinspmeacutedicamentsthinspdrsquourgencethinspIlthinsprevientthinspauthinspmeacutedecinthinspdethinspbienthinsp

connaicirctrethinsplathinspmeacutedicationthinspetthinspdethinspchoisirthinspunethinspmeacutedicationthinspouthinspunethinspcombinaisonthinspdethinspmeacutedicamentsthinspreconnuethinspEtthinspilthinsprevientthinspauxthinspprofessionnelsthinspquithinsplesthinspadministrentthinsp

dethinspbienthinsplesthinspconnaicirctrethinspeacutegalementthinsp(eacuteleacutementsthinspdethinspsurveillancethinspcliniquethinsptechniquethinspdrsquoadministrationthinspeffetsthinspsecondairesthinspinteractionsthinspcontre-indicationsthinspseuilsthinspthinsptoxiquesthinspetc)thinspetthinspdethinspmaintenirthinspagravethinspjourthinspleursthinspconnaissancesthinspdansthinspcethinspdomaine

thinspPRINCIPALESthinspCLASSESthinspPHARMACOTHEacuteRAPEUTIQUESthinspUTILISEacuteESthinspthinspthinspENthinspSEacuteDATION-ANALGEacuteSIEthinsp

Lathinsplistethinspdesthinspmeacutedicamentsthinspabordeacutesthinspci-dessousthinspnrsquoestthinsppasthinsplimitativethinsp

a BenzodiazeacutepinesthinspProprieacuteteacutesthinspthinspanxiolytiquethinspamneacutesiquethinsphypnotiquethinsprelaxantthinspmusculairethinspetthinspanticonvulsivantthinspthinspIlthinspfautthinspprivileacutegierthinsplesthinspmoleacuteculesthinspagravethinspcourtethinspdemi-viethinsp(pthinspexthinspthinspmidazolamthinsp[Versedreg])thinspenthinspretenantthinspqursquoilthinspfautthinspajusterthinsplethinspdosagethinspchezthinspcertainsthinsppatientsthinsp(pthinspexthinspthinspacircgeacutesthinspouthinspaffaiblis)thinspetthinsplorsthinspdethinsplrsquoutilisationthinspconcomitantethinspdrsquoautresthinspmeacutedicamentsthinspaffectantthinsplethinspsystegravemethinspnerveuxthinspcentralthinspDethinspplusthinsplathinspdemi-viethinsp

CMQ - OIIQ - OPIQ 22

dethinspcesthinspmeacutedicamentsthinsppeutthinspecirctrethinspaugmenteacuteethinsplorsthinspdethinspleurthinspadministrationthinspenthinspperfusionthinspcontinuethinsp(context sensitive half-life)thinsp

b OpioiumldesthinspProprieacuteteacutesthinspthinspanalgeacutesiquethinspetthinspseacutedativethinspLathinspmorphinethinspconstituethinspunthinspopioiumldethinspdontthinsplrsquoefficaciteacutethinspestthinspreconnuethinspCependantthinspellethinspfavorisethinsplathinsplibeacuterationthinspdrsquohistaminethinspcethinspquithinsppeutthinspcauserthinspduthinsppruritthinspetthinspdethinsplrsquohypotensionthinspUnethinspdysfonctionthinspreacutenalethinspseacutevegraverethinspentraicircnethinsplrsquoaccumulationthinspdethinspsesthinspmeacutetabolitesthinspactifsthinsp

thinsprsaquo lethinspfentanylthinsp(Sublimazereg)thinspestthinspunthinspopioiumldethinspsyntheacutetiquethinsppuissantthinspetthinspdethinspcourtethinspdureacuteethinspdrsquoactionthinspIlthinspnethinspdeacuteclenchethinsppasthinspdethinsplibeacuterationthinspdrsquohistaminethinsp(doncthinsppeuthinspdrsquoeffetthinspheacutemodynamique)thinspIlthinspfautthinspcependantthinspsethinspmeacutefierthinspdesthinspdosesthinspeacuteleveacuteesthinspetthinspdesthinspinjectionsthinsprapidesthinspquithinsppeuventthinspprovoquerthinspunethinsprigiditeacutethinspmusculairethinspthinspetthinspunethinspdeacutepressionthinsprespiratoire

thinsprsaquo lrsquohydromorphonethinsp(Dilaudidreg)thinspestthinspunthinspopioiumldethinspsemi-syntheacutetiquethinspdontthinsplesthinspmeacutetabolitesthinspconnusthinspsontthinsprarementthinspprobleacutematiquesthinspMoinsthinsputiliseacuteethinspenthinspthinspseacutedation-analgeacutesiethinspellethinspestthinspauthinspmoinsthinsp5thinspfoisthinspplusthinsppuissantethinspquethinsplathinspmorphinethinspthinspcethinspquithinspestthinspparfoisthinspsous-estimeacute

thinsprsaquo lathinspmeacutepeacuteridinethinsp(Demerolreg)thinspestthinspunthinspopioiumldethinspsyntheacutetiquethinspposseacutedantthinspunthinspmeacuteta-bolitethinspactifthinspneurotoxiquethinspEllethinspnrsquoestthinsphabituellementthinsppasthinsprecommandeacuteethinsp

c Anestheacutesiques geacuteneacuterauxthinspLethinspmeacutedecinthinspquithinspprocegravedethinspagravethinspunethinspinterventionthinspsousthinspseacutedation-analgeacutesiethinspenthinsputilisantthinspunthinspouthinspdesthinspanestheacutesiquesthinspgeacuteneacuterauxthinspdoitthinspecirctrethinspexpeacuterimenteacutethinspenthinspseacutedation-analgeacutesiethinspetthinspenthinspreacuteanimationthinspcardiorespiratoirethinspDansthinsplethinspcasthinspcontrairethinspilthinspdoitthinspsrsquoassurerthinspdethinsplathinspcollaborationthinspdrsquounthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspParthinspailleursthinsplethinspmeacutedecinthinspdoitthinspenthinsptoutthinsptempsthinspecirctrethinspsoutenuthinspparthinspunthinspouthinspdesthinspprofessionnelsthinspqualifieacutesthinsp

thinsprsaquo propofolthinsp(Diprivanreg)thinspProprieacuteteacutesthinspseacutedativethinsphypnotiquethinspamneacutesiquethinspanxiolytiquethinspAgravethinspnoterthinspqursquoilthinspnrsquoathinspaucune proprieacuteteacute analgeacutesiquethinsp

thinspIlthinsppossegravedethinspunethinspdemi-viethinspcourtethinsppeutthinspecirctrethinspcumulatifthinspetthinspnrsquoathinsppas drsquoantago-nistethinspIlthinspnrsquoestthinsppasthinsprecommandeacutethinspchezthinsplathinspfemmethinspenceintethinspouthinspquithinspallaitethinspEnthinspregraveglethinspgeacuteneacuteralethinspetthinspselonthinsplethinsptypethinspdrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspilthinsppeutthinspecirctrethinspplusthinspjudicieuxthinspdethinsplrsquoadministrerthinspenthinspinfusionthinspIVthinspplutocirctthinspthinspqursquoenthinspbolusthinspthinspthinspIlthinsppeutthinsprapidementthinspcauserthinspunethinspdiminutionthinspmarqueacuteethinspduthinspniveauthinspdethinspcon-sciencethinspetthinspunethinspdeacutepressionthinsprespiratoirethinsppouvantthinspconduirethinspmomentaneacute-

CMQ - OIIQ - OPIQ 23

mentthinspagravethinspunethinspanestheacutesiethinspgeacuteneacuteralethinspnonthinspdeacutesireacuteethinspLesthinspprofessionnelsthinspenthinspplacethinspdoiventthinspecirctrethinspenthinspmesurethinspdethinspprendrethinspenthinspchargethinspunethinsptellethinspsituationthinspLrsquoASAthinsp(AmericanthinspSocietythinspofthinspAnesthesiologiststhinspASAthinspHousethinspofthinspDelegatesthinsp2004bthinsp[Notrethinsptraduction])thinsprecommandethinspnotammentthinspquethinsplethinsppatientthinspagravethinspquithinsplrsquoonthinspadministrethinspduthinsppropofolthinspreccediloivethinspdesthinspsoinsthinspenthinsplienthinspavecthinspunethinspseacutedationthinsppro-fondethinsp(niveauthinspnonthinspviseacutethinspdansthinspcesthinsplignesthinspdirectrices)thinspetthinspquethinsplethinspprofessionnelthinsp(nonthinspanestheacutesiologiste)thinspadministrantthinsplethinsppropofolthinsppossegravedethinsplathinspformationthinsptheacuteoriquethinspetthinsppratiquethinspneacutecessairethinspagravethinsplrsquoidentificationthinspetthinspagravethinsplathinspprisethinspenthinspchargethinspdesthinspvoiesthinspaeacuteriennesthinspetthinspdesthinspchangementsthinspcardiovasculairesthinspquithinspsurvien-nentthinspchezthinspunthinsppatientthinspeacutevoluantthinspversthinspunthinspeacutetatthinspdrsquoanestheacutesiethinspgeacuteneacuteralethinsp(niveauthinspnonthinspviseacutethinspdansthinspcesthinsplignesthinspdirectrices)thinsp

thinspthinspLorsquethinsplethinsppropofolthinspestthinspadministreacutethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspthinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspthinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspthinspobligatoirethinsp(tableauthinsp3)thinspthinspthinsp

thinsprsaquo keacutetaminethinsp(Ketalarreg)thinspProprieacuteteacutesthinspthinspseacutedativethinspetthinspanalgeacutesiquethinspthinspUtiliseacuteethinspenthinsppeacutediatriethinspetthinspchezthinsplrsquoadultethinspEllethinspproduitthinspaussithinspunethinspbroncho-thinspdilatationthinspparfoisthinspsouhaiteacuteethinsplorsthinspdrsquointerventionsthinspdiagnostiquesthinspouthinsptheacutera-peutiquesthinspchezthinsplesthinsppatientsthinspasthmatiquesthinspEllethinspsrsquoaccompagnethinspdrsquounethinsplibeacutera-tionthinspdethinspcateacutecholaminesthinspetthinspdrsquoeffetsthinspsympathomimeacutetiquesthinsp(augmentationthinspdethinsplathinspsalivation)thinspEllethinsppeutthinspprovoquerthinspdesthinspsymptocircmesthinsppsychotiquesthinspouthinspdesthinspcomportementsthinspanormauxthinspCesthinspsymptocircmesthinsppeuventthinspnuirethinspagravethinsplrsquoeacutevaluationthinspdesthinsppatientsthinspsousthinspseacutedationthinspEllethinspabaissethinsplethinspseuilthinspconvulsifthinsp

Lorsquethinsplathinspkeacutetaminethinspestthinspadministreacuteethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspobligatoirethinsp(tableauthinsp3)thinspthinsp

thinsprsaquo protoxydethinspdrsquoazotethinsp(N2O)thinsp

ProprieacuteteacutesthinspthinspgazthinspseacutedatifthinspetthinspanalgeacutesiquethinspthinspActionthinspanalgeacutesiquethinspsemblablethinspagravethinspcellethinspdethinsplathinspmorphinethinspIlthinsppotentialisethinsplesthinspanalgeacutesiquesthinspcentrauxthinspetthinsplesthinspagentsthinsphypnotiquesthinspetthinsppeutthinspaussithinspdiminuerthinsplesthinspreacuteservesthinspenthinspoxygegravenethinspduthinsppatientthinspUtiliseacutethinspenthinspcombinaisonthinspavecthinsplrsquooxygegravenethinspIlthinsppeutthinsppolluerthinsplrsquoenvironnementthinspdethinsptravailthinsp(voirthinspnormesthinspCSST)thinspIlthinsppeutthinspecirctrethinsp

CMQ - OIIQ - OPIQ 24

utiliseacutethinspenthinsppeacutediatriethinspchezthinsplrsquoadultethinspetthinspchezthinsplathinspfemmethinspenceintethinsp(saufthinspauthinspthinsppremierthinsptrimestre)thinsp

thinspDansthinsplethinspcasthinspougravethinsplethinspprotoxydethinspdrsquoazotethinspestthinsputiliseacutethinspenthinspcombinaisonthinspavecthinspunthinspagentthinspseacutedatifthinspouthinspunthinspopioiumldethinspouthinspsithinsplrsquoappareilthinsputiliseacutethinsppermetthinspdethinspmodifierthinsplathinspconcentrationthinspdrsquooxygegravenethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivement agravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspthinsp

thinsprsaquo dexmeacutedeacutetomidinethinsp(PreacuteceacutedexMC)thinsp(Agonistethinspalpha2-adreacutenergique)thinspProprieacuteteacutesthinspthinspseacutedativethinspanalgeacutesiquethinspetthinspanxiolytiquethinspthinspLathinspdexmeacutedeacutetomidinethinspenthinspperfusionthinspintraveineusethinspcontinuethinspestthinspindiqueacuteethinspnotammentthinsppourthinsplathinspseacutedationthinspdethinsppatientsthinspnonthinspintubeacutesthinspavantthinspetouthinsppendantthinspunethinspinterventionthinspchirurgicalethinspouthinspdrsquoautresthinsptypesthinspdrsquointerventionsthinspthinspNethinspcausethinspaucunethinspdeacutepressionthinsprespiratoirethinspmaisthinsppeutthinspcauserthinspunethinspbradycar-diethinspetthinspunethinsphypotensionthinspthinsp

thinspLrsquoutilisationthinspdethinspdexmeacutedeacutetomidinethinspdevraitthinspecirctrethinspreacuteserveacuteethinspauthinspmilieuthinspthinsphospitalierthinspouthinspauxthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspthinspEllethinspdevraitthinspecirctrethinspadministreacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspthinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspetthinsprapidementthinspdisponiblethinspthinspLorsquethinspdethinsplathinspdexmeacutedeacutetomidinethinspestthinspadministreacuteethinspunthinspprofessionnelthinspthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspthinspduthinsppatientthinsp(tableauthinsp2)thinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspobligatoirethinsp(tableauthinsp3)thinspthinsp

Agravethinspnoterthinspqursquoilthinspestthinspobligatoirethinspdethinsptenirthinspunthinspregistrethinspdesthinspsubstancesthinspcontrocircleacuteesthinspetthinspdesthinspbenzodiazeacutepinesthinspcomportantthinspdesthinspsignatures

thinsp

CMQ - OIIQ - OPIQ 25

SURVEILLANCEthinspCLINIQUEthinspLathinspsurveillancethinspcliniquethinspcomprendthinspplusieursthinspeacuteleacutementsthinspquithinspconcernentthinspthinspnotammentthinsplesthinspsystegravemesthinsprespiratoirethinspcardiaquethinspetthinspneurologiquethinspEllethinspdoitthinspthinsptenirthinspcomptethinspentrethinspautresthinsp

thinsprsaquo dethinsplathinspconditionthinspduthinsppatientthinspavantthinspetthinsppendantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

thinsprsaquo dethinsplathinspcomplexiteacutethinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinsprsaquo dethinsplathinspmeacutedicationthinsputiliseacuteethinsp(dosethinspdureacuteethinspetthinsppicthinspdrsquoactionthinspvoiethinspetthinspvitessethinspthinsp

drsquoadministrationthinspcombinaisonthinspetthinspantagonistes)

thinsprsaquo dethinsplrsquoassistancethinspagravethinspapporterthinspauthinspmeacutedecin

Lethinspmeacutedecinthinspquithinsppratiquethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspchezthinspunthinsppatientthinspsousthinspseacutedation-analgeacutesiethinspdoitthinspcompterthinspsurthinsplathinsppreacutesencethinspdrsquoauthinspmoinsthinspunthinspautrethinspprofessionnelthinsphabiliteacutethinspduthinspmilieuthinspdethinsplathinspsanteacutethinsp(infirmiegraverethinspinhalotheacuterapeutethinspouthinspautrethinspmeacutedecin)thinsp(annexethinspII)thinspEnthinspeacutetroitethinspcollaborationthinspavecthinsplethinspmeacutedecinthinspreacuteali-santthinsplrsquointerventionthinspceux-cithinspassurentthinspthinsplathinspgestionthinspdethinsplathinspseacutedationthinspetthinspdethinsplrsquoanalgeacutesiethinspqui comprend entre autres la surveillance clinique du patientthinspresponsabiliteacutethinspthinspagravethinsplaquellethinspilsthinspdoiventthinspenthinsptoutthinsptempsthinspsethinspconsacrerthinspenthinspprioriteacutethinsp

Dansthinspcertainsthinspcasthinsplethinspprofessionnelthinspquithinspassurethinspen prioriteacutethinsplathinspsurveillancethinspthinspcliniquethinspduthinsppatientthinsppeutthinspecirctrethinspappeleacutethinspagravethinspassisterthinsplethinspmeacutedecinthinspdansthinsplathinspreacutealisationthinspthinspdethinspsonthinspinterventionthinspCettethinspassistancethinspquithinspdoitthinspsrsquoeffectuerthinspdansthinsplathinspmecircmethinsppiegravecethinspdoitthinspecirctrethinspdethinsptregravesthinspcourtethinspdureacuteethinspDethinspplusthinspellethinspdoitthinsppouvoirthinspecirctrethinspinterrompuethinspthinspagravethinsptoutthinspmomentthinsppourthinspintervenirthinspimmeacutediatementthinspaupregravesthinspduthinsppatientthinspenthinspcasthinspdethinsp

complicationsthinspouthinspdethinspbesoin

Parthinspailleursthinsplorsquethinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspthinspneacutecessitentthinspunethinspassistancethinsptechniquethinspcontinuellethinspauthinspmeacutedecinthinsplrsquoajoutthinspdrsquounthinsptroisiegravemethinspprofessionnelthinspdethinsplathinspsanteacutethinsphabiliteacutethinsp(meacutedecinthinspinfirmiegraverethinspouthinspinhalotheacuterapeute)thinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinspestthinsprequisthinsp

CMQ - OIIQ - OPIQ 26

Tableau 2 Tableau reacutecapitulatif du nombre de professionnels habiliteacutes requis en seacutedation-analgeacutesie - Clientegravele adulte

Toutthinspauthinsplongthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplathinspsurveillancethinspcliniquethinspthinspduthinsppatientthinspdoitthinspecirctrethinspcontinuethinspetthinsplathinspcommunicationthinspavecthinspcelui-cithinspmaintenue

Proceacutederthinspagravethinsplathinspsurveillancethinspcliniquethinspcrsquoestthinspeacutevaluerthinspqualitativementthinspetthinspquantitative-mentthinspdethinspfaccedilonthinspsoutenuethinspetthinspenthinspcontinuthinsplrsquoensemblethinspdesthinspparamegravetresthinspsuivantsthinsp(listethinsp

nonthinsplimitative)thinsp(tableauthinsp3)thinsp

thinsprsaquo mesurethinspdethinsplathinsppressionthinsparteacuteriellethinspduthinsppouls3thinspetthinspdethinsplathinsprespiration4thinsprsaquo lecturethinspdethinsplathinspsaturationthinspcapillairethinspenthinspoxygegravene

Ilthinspfautthinspnoterthinspquethinsplathinsptonaliteacutethinspdethinsppoulsthinspdoitthinspecirctrethinspactiveacuteethinspenthinsptoutthinsptempsthinspetthinspsonthinspniveauthinspdoitthinspecirctrethinspajusteacutethinspdethinspfaccedilonthinspagravethinspecirctrethinspentenduthinspclairement

thinsprsaquo eacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplathinspseacutedationthinsp(eacutevaluationthinspdethinsplathinspseacutedationagitationthinspetthinspduthinspniveauthinspdethinspconscience)thinsp(annexethinspIX)thinsp

thinsprsaquo eacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplrsquoanalgeacutesiethinsp(eacutevaluationthinspdethinsplathinspdouleur)thinspdethinsplrsquoanxieacuteteacutethinspetthinspdethinsplathinspreacuteactionthinspduthinsppatientthinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsp(annexethinspX)

thinsprsaquo eacutevaluationthinspdethinsplrsquoeacutetatthinspdethinsplathinspcolorationthinspetthinspdethinsplathinsptempeacuteraturethinspdethinsplathinsppeauthinsprsaquo eacutevaluationthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsprsaquo niveauthinspdrsquoO

2thinspdethinspCO

2thinspetthinspmonitoragethinspcardiaquethinspselonthinsplethinspcas

3thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp4thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

Nombrethinspdethinspprofessionnelsthinsphabiliteacutesthinsprequis

2 Nombrethinspmimimalthinsprequis

3 Sithinsputilisationthinspdethinsppropofolthinspkeacutetaminethinspouthinspdethinspdexmeacutedeacutetomidine

3 SithinsputilisationthinspconcomitantethinspdethinspN2Othinspetthinspdrsquounthinspagentthinspseacutedatifthinspouthinspthinsp

dunthinspopioiumldethinspouthinspsithinspconcentrationthinspdethinspN2Othinspmodifiable

3 Sithinsplassistancethinsptechniquethinspauthinspmeacutedecinthinspestthinspcontinuelle

CMQ - OIIQ - OPIQ 27

Tableau 3 Surveillance des paramegravetres cliniques en seacutedation-analgeacutesie - Clientegravele adulte

Paramegravetrethinspdethinspthinspsurveillancethinspthinspclinique

PatientNiveauthinspdethinspthinspseacutedation

MeacutedicationInterventionthinspdiagnostiquethinspouthinsptheacuterapeutique

TAthinspRC5thinspthinspRR6thinspthinspetthinspsaturationthinspdrsquoO

thinsp2thinspthinsp

rsaquothinspObligatoireChezthinsptousthinsplesthinsppatients

Niveauthinspdethinspthinsp-thinspseacutedationthinspthinspthinspagitationthinspthinspthinspthinspconscience-thinspdouleur

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

NiveauthinspdethinspCO2

SelonthinsplesthinspthinspcaracteacuteristiquesthinspAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspthinspmeacutedication

Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire

rsaquothinspAccegravesthinspindirectthinspthinspthinspthinspthinspouthinsprestreintthinspthinspthinspthinspauthinsppatientthinspthinspthinspthinsp(pthinspexthinspthinspIRM)

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

rsaquothinspRecommandeacute

rsaquothinspASAthinspgethinsp3thinsprsaquothinspApneacuteethinspthinspobstructivethinspthinspthinspthinspduthinspsommeilthinsprsaquothinspMaladiethinspthinspthinspthinsprespiratoirethinsprsaquothinspObeacutesiteacutethinspmorbide

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

Monitoragethinspcardiaque

SelonthinsplesthinspcaracteacuteristiquesAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

SelonthinsplathinspmeacutedicationSelonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoirersaquothinspASAthinspgethinsp3thinsprsaquothinspMaladiethinspthinspthinspthinspcardiaque

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

Interventionthinspdiagnostiquethinspthinspouthinsptheacuterapeutiquethinspprolongeacuteethinsp(effetthinspcumulatifthinspdethinsplathinspmeacutedication)

rsaquothinspRecommandeacute

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

thinspthinspthinspthinspthinspIlthinspnethinspsrsquoagitthinsppasthinspdrsquounethinsplistethinsplimiteacuteethinspdesthinspsituationsthinspcliniquesthinspDrsquoautresthinspsituationsthinspcliniquesthinsppeuventthinspneacutecessiterthinsplethinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspmonitoragethinspcardiaquethinspouthinspduthinspCO

2thinspIlthinsprevientthinspauxthinspprofessionnelsthinspdethinspjugerthinspdethinsplathinspsituationthinspenthinspfonctionthinspdethinspchaquethinspthinspthinsp

thinspthinspthinspthinspthinspthinsppatient5thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp6thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

CMQ - OIIQ - OPIQ 28

LethinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspimpliqueacutesthinspestthinspprimordialthinspetthinspcethinspmecircmethinspsithinsplrsquoappareillagethinspenthinspplacethinspestthinspcompletthinspetthinspfonctionnelthinspUnethinspbonnethinspcommunica-tionthinspentrethinspcesthinspderniersthinspestthinspdoncthinspessentiellethinspafinthinspdethinspbienthinspcoordonnerthinsplathinspseacutedationthinsp

etthinsplrsquoanalgeacutesiethinspavecthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspLes alarmes (audibles et visuelles) de chaque appareil doivent ecirctre en fonction et les paramegravetres ajusteacutes aux caracteacuteristiques du patient et agrave sa condition clinique

IlthinspfautthinspsrsquoassurerthinspdethinsplathinsptraccedilabiliteacutethinspdethinsplrsquoeacutevaluationthinspetthinspdethinsplathinspsurveillancethinspcliniquethinspthinspeffectueacuteesthinspparthinspunethinsptenuethinspdethinspdossiersthinspconformethinspauxthinspnormesthinspenthinspvigueurthinspLesthinspoutilsthinspdrsquoeacutevaluationthinsputiliseacutesthinspdoiventthinspecirctrethinspsimplesthinspstandardiseacutesthinspvalideacutesthinspdethinsppreacutefeacuterencethinspetthinspadapteacutesthinspauthinspcontextethinspetthinspauxthinspcaracteacuteristiquesthinspduthinsppatientthinspnotam-mentthinsppourthinsplrsquoeacutevaluationthinspduthinspniveauthinspdethinspseacutedationagitationthinspdethinspconsciencethinspetthinspdethinspdouleurthinsp(annexesthinspIXthinspetthinspX)

Lathinspfreacutequencethinspdethinsplathinspmesurethinspdethinspcesthinspparamegravetresthinspetthinspleurthinspenregistrementthinspdoiventthinspecirctrethinspdeacutetermineacutesthinspentrethinspautresthinspenthinspfonctionthinspdethinsplathinspmeacutedicationthinspetthinspdethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsp

Ideacutealementthinsplethinspprofessionnelthinspdoitthinsplesthinspdocumenterthinsp

thinsprsaquo avantthinsplethinspdeacutebutthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsprsaquo apregravesthinsplrsquoadministrationthinspdrsquounthinspagentthinspdethinspseacutedation-analgeacutesiethinspouthinspdrsquounthinspantagonistethinsprsaquo authinsppicthinspdrsquoactionthinspdethinspchacunthinspdesthinspagentsthinspadministreacutesthinspthinsprsaquo agravethinspintervallesthinspreacuteguliersthinsp(pthinspexthinspthinsp5thinspminutes)thinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-thinsp

analgeacutesiethinsprsaquo agravethinspintervallesthinspplusthinsprapprocheacutesthinsplorsquethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsplrsquoexigethinsprsaquo durantthinsplathinsppeacuteriodethinspdethinspreacutecupeacuterationthinspetthinspjusqursquoauthinspretourthinspduthinspniveauthinspdethinspconsciencethinsp

initialethinspselonthinsplathinspconditionthinspcliniquethinspduthinsppatientthinsprsaquo authinspmomentthinspduthinspcongeacute

ILthinspFAUTthinspSAVOIRthinspQUE

LathinspSocieacuteteacutethinspcanadiennethinspdesthinspanestheacutesiologistesthinsp(SCA)thinspindiquethinspquethinsplesthinspthinspdirectivesthinspgeacuteneacuteralesthinspdethinspsoinsthinsp(ythinspcompristhinsplethinspmonitorage)thinsppourthinsplathinspseacutedationthinspconscientethinspsontthinsplesthinspmecircmesthinspquethinsppourthinsplesthinspautresthinspformesthinspdrsquoanestheacutesiethinsp[]thinsp(Merchantthinspetthinspcollabthinsp2014b)thinspDethinspplusthinspellethinspindiquethinspquethinsplethinspcapnographethinspthinspestthinsprequisthinsplorsthinspdethinspseacutedation-analgeacutesiethinspdethinspniveauthinspplusthinspeacuteleveacutethinsp(pthinspexthinspthinspRamsaythinspthinsp4-6)thinsp(Merchantthinspetthinspcollabthinsp2014athinspop cit)

CMQ - OIIQ - OPIQ 29

thinsp16thinspPOSTSEacuteDATION-ANALGEacuteSIEthinsp

Lethinsppatientthinspestthinspagravethinsprisquethinspdethinspdeacutevelopperthinspdesthinspcomplicationsthinspagravethinsplathinspsuitethinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspsurtoutthinspsithinspcettethinspproceacutedurethinspestthinspdethinspcourtethinspdureacuteethinsp(pthinspexthinspthinspdeacutepressionthinsprespiratoirethinsphypotension)thinspEnthinspeffetthinspcertainsthinspmeacutedicamentsthinsptelsthinspquethinsplethinspmidazolamthinspetthinsplethinspfentanylthinspnethinspserontthinsppasthinspcomplegravetementthinspeacutelimineacutesthinspsithinsplathinspdureacuteethinspdethinsplrsquointerventionthinspestthinspmoinsthinspdethinsp30thinspminutesthinspDrsquoautresthinspfacteursthinsptelsthinspquethinsplethinspmanquethinspthinspdethinspstimulationthinspouthinsplrsquoabsorptionthinspretardeacuteethinspdrsquounthinspmeacutedicamentthinsppeuventthinspcontribuerthinspthinspagravethinspunethinspseacutedationthinspprolongeacuteethinspouthinsprebond

Unethinspdeacutepressionthinsprespiratoirethinsppeutthinspsurvenirthinspjusqursquoagravethinspeacuteliminationthinspcomplegravetethinspthinspduthinspmeacutedicamentthinsp

ParthinspconseacutequentthinspjusqursquoagravethinspsonthinspdeacutepartthinsplethinsppatientthinspdoitthinspecirctrethinspsousthinsplathinspsurveillancethinspdrsquounthinspprofessionnelthinsphabiliteacutethinspagravethinspreconnaicirctrethinsplesthinspcomplicationsthinspetthinspagravethinspintervenirthinsprapidementthinspplusthinspparticuliegraverementthinsppourthinspmaintenirthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspetthinspassurerthinsplrsquoassistancethinspventilatoirethinspLethinspmeacutedecinthinspayantthinspproceacutedeacutethinspagravethinsplrsquointerventionthinspsousthinspseacutedation-analgeacutesiethinspouthinspunthinspmeacutedecinthinspdeacutesigneacutethinspdoitthinspecirctrethinspdisponiblethinspenthinsptoutthinsptempsthinspafinthinspdethinsppouvoirthinspintervenirthinspsansthinspdeacutelaithinsplethinspcasthinspeacutecheacuteant

Rappelonsthinspquethinsplesthinspappareilsthinspdethinspmonitoragethinspdoiventthinspecirctrethinspenthinspfonctionthinspmaisthinspthinspenthinspaucunthinsptempsthinspilsthinspnethinspremplacentthinsplathinspsurveillancethinspdirectethinspduthinsppatientthinspparthinspthinsplethinspprofessionnel

Lethinsppatientthinspdoitthinspresterthinspagravethinsplathinspsallethinspdethinspreacutecupeacuterationthinspouthinspdrsquoobservationthinsppendantthinspthinsp30thinspminutesthinspauthinspminimumthinspapregravesthinspavoirthinspreccediluthinsplathinspderniegraverethinspdosethinspdethinspseacutedationthinspouthinspthinspdrsquoanalgeacutesiethinspintraveineusethinsp(Merchantthinspetthinspcollabthinsp2014bthinspop cit)

Sithinspunethinspmeacutedicationthinspantagonistethinspathinspeacuteteacutethinspadministreacuteethinsplethinsppatientthinspserathinspgardeacutethinspsousthinspthinspobservationthinsplethinsptempsthinspneacutecessairethinsp(lethinsptempsthinspserathinspaugmenteacutethinspdethinspgethinsp2thinspheuresthinspthinsp[Merchantthinspetthinspcollabthinsp2014bthinspop cit]thinspenthinspfonctionthinspdethinsplrsquoeacutetatthinspcliniquethinspduthinsppatient)thinsppourthinspsrsquoassurerthinspqursquoilthinspnrsquoythinspathinsppasthinspdethinspseacutedationthinsprebond

Parmithinsplesthinspcritegraveresthinspagravethinsprespecterthinspauthinspmomentthinspduthinspcongeacutethinsp

thinsprsaquo voiesthinspaeacuteriennesthinsppermeacuteablesthinspetthinspventilationthinspadeacutequatethinsprsaquo stabiliteacutethinspcardiovasculairethinspadeacutequatethinsprsaquo niveauthinspdethinspconsciencethinspduthinsppatientthinsprevenuthinspagravethinspsonthinspeacutetatthinspinitialthinsprsaquo douleurthinspreacutesiduellethinsptoleacuterablethinspabsentethinspouthinspcommethinspagravethinspsonthinspeacutetatthinspinitial

CMQ - OIIQ - OPIQ 30

thinsprsaquo mobiliteacutethinsprevenuethinspagravethinspsonthinspeacutetatthinspinitialthinsprsaquo peuthinspouthinsppasthinspdethinspvomissementsthinsprsaquo patientthinspouthinsppersonnethinspresponsablethinspduthinsppatientthinsppeutthinspcomprendrethinsplesthinspdirectivesthinsp

dethinspdeacutepart

thinsprsaquothinsprsaquo Cesthinspcritegraveresthinspdoiventthinspecirctrethinsprespecteacutesthinspdethinspfaccedilonthinspsysteacutematiquethinsp

Lesthinspprofessionnelsthinspdoiventthinspsrsquoassurerthinspquethinspquandthinsplethinsppatientthinspquittethinsplrsquoeacutetablis-sementthinspilthinspestthinspaccompagneacutethinspdrsquounthinspadultethinspresponsablethinspetthinspqursquounthinspdocumentthinsprelatifthinspauthinspcongeacutethinspcomprenantthinspdesthinspconsignesthinspclairesthinsppourthinsplathinspsurveillancethinspagravethinspdomicilethinsp(pthinspexthinspthinspquoithinspfairethinspenthinspcasthinspdrsquourgence)thinspleurthinspsoitthinspremisthinspetthinspexpliqueacutethinsp(annexethinspXII)thinsp

thinspthinsp17thinspDOCUMENTATIONthinspDESthinspSOINSthinspETthinspTENUEthinspthinspDEthinspDOSSIERSthinsp

Commethinsppourthinsptoutethinspautrethinspinterventionthinsplesthinspmecircmesthinspnormesthinspsrsquoappliquentthinsppourthinsplathinspreacutedactionthinspdesthinspnotesthinspenthinspseacutedation-analgeacutesiethinspthinsp

Enthinspplusthinspdesthinspeacuteleacutementsthinspgeacuteneacuteralementthinspverseacutesthinspauthinspdossierthinspcelui-cithinspdoitthinspcontenirthinsptoutesthinsplesthinspinformationsthinsprelativesthinspagravethinsplathinsppeacuteriodethinsppreacutethinspperthinspetthinsppostseacutedation-analgeacutesiethinspAinsithinsplesthinspeacuteleacutementsthinspsuivantsthinspdoiventthinspecirctrethinspdocumenteacutesthinspauthinspdossierthinspduthinsppatientthinsp

(listethinspnonthinsplimitative)thinsp

1 lrsquoidentificationthinspdesthinspfacteursthinspdethinsprisquethinsplieacutesthinspagravethinsplrsquointerventionthinspdiagnostiquethinspthinspouthinsptheacuterapeutiquethinspouthinspagravethinsplathinspseacutedation-analgeacutesie

2 lrsquoheurethinspduthinspdeacutebutthinspetthinspdethinsplathinspfinthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplrsquoheurethinspdrsquoarriveacuteethinspagravethinsplathinspsallethinspdethinspreacutecupeacuterationthinspouthinspdrsquoobservationthinsp(sithinspdiffeacuterente)thinspetthinsplrsquoheurethinspduthinspdeacutepart

3 lesthinspordonnancesthinspmeacutedicalesthinspcomplegravetes4 lathinspmeacutedicationthinspthinspdosagethinspquantiteacutethinspvoiethinspvitessethinspetthinspheurethinspdrsquoadministration5 lathinspconcentrationthinspouthinsplethinspdeacutebitthinspdethinsplrsquooxygegravenethinsp(outhinspduthinspmeacutelangethinspgazeux)thinspadministreacutethinspthinsp

lethinspcasthinspeacutecheacuteant

6 lathinspsurveillancethinspeffectueacuteethinspa lesthinspsignesthinspvitauxthinspavecthinsplrsquoheurethinspdesthinsplecturesb lethinsptauxthinspdethinspsaturationthinspcapillairethinspenthinspoxygegravenethinspavecthinsplrsquoheurethinspdesthinsplecturesc lethinspniveauthinspdethinspCO

2thinspthinsplethinspcasthinspeacutecheacuteantthinspavecthinsplrsquoheurethinspdesthinsplectures

d lathinspdescriptionthinsppeacuteriodiquethinspduthinspniveauthinspdethinspseacutedationagitationthinspetthinspdethinspthinspconsciencethinsplrsquoutilisationthinspdrsquounethinspeacutechellethinspestthinsprecommandeacuteethinsp(annexethinspIX)

e lathinspdescriptionthinsppeacuteriodiquethinspduthinspniveauthinspdethinspdouleurthinsplrsquoutilisationthinspdrsquounethinspeacutechellethinspestthinsprecommandeacuteethinsp(annexethinspX)

CMQ - OIIQ - OPIQ 31

f lathinspdescriptionthinspdethinsptoutethinspreacuteactionthinspdeacutefavorablethinsplethinspcasthinspeacutecheacuteantg lathinspdescriptionthinspdethinsplrsquoeacutetatthinspduthinsppatientthinspagravethinsplathinspfinthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-thinsp

analgeacutesieh lathinspdescriptionthinspdethinsplrsquoeacutetatthinspduthinsppatientthinspauthinspmomentthinspduthinspcongeacutethinspouthinsplathinspreacutefeacuterencethinspthinsp

agravethinspunthinspprotocolethinsp(critegraveresthinspdethinspcongeacute)7 lethinspmonitoragethinspthinspappareilthinspalarmethinspemplacementthinsplethinspcasthinspeacutecheacuteant8 lethinspconsentement9 unethinspcopiethinspdesthinsprecommandationsthinspeacutecritesthinspremisethinspauthinsppatientthinspauthinspmomentthinspduthinsp

congeacutethinsp(annexethinspXII)thinspouthinspagravethinspdeacutefautthinspunethinspnotethinspattestantthinsplathinspremisethinspdethinspcethinspdocumentthinspstandardiseacutethinspdontthinspunethinspcopiethinspestthinspconserveacutee

10 thinsplethinspprotocolethinspopeacuteratoire11 thinsplathinspnotethinspdethinspdeacutepart12 thinsptoutethinspautrethinspinformationthinspjugeacuteethinsppertinentethinsp(pthinspexthinspthinspreacutesultatthinspdrsquoauscultationthinspthinsp

complication)

Enfinthinsptousthinsplesthinspprofessionnelsthinspimpliqueacutesthinspdoiventthinspsrsquoassurerthinspduthinsprespectthinspdethinspleurthinspreacuteglementationthinspouthinspnormesthinsprespectivesthinspenthinspmatiegraverethinspdethinspdocumentationthinspdesthinspsoinsthinspetthinspdethinsptenuethinspdethinspdossiers

CMQ - OIIQ - OPIQ 32

Chapitre 2Patient peacutediatrique

thinspPREacuteAMBULEthinsp

Puisquethinsplrsquoenfantthinsppossegravedethinspdesthinspcaracteacuteristiquesthinspquithinspluithinspsontthinsppropresthinspetthinspquithinspeacutevoluentthinspenthinspfonctionthinspdethinspsonthinspstadethinspdethinspdeacuteveloppementthinspilthinspestthinspdoncthinspopportunthinspdrsquoeacutetablirthinspdesthinsplignesthinspdirectricesthinspparticuliegraveresthinspagravethinspcettethinspclientegravelethinsp

Cesthinsplignesthinspdirectricesthinspvisentthinsplesthinspenfantsthinspacircgeacutesthinspdethinspplusthinspdethinsp3thinspansthinsp

Unethinspseacutedation-analgeacutesiethinspreacuteussiethinspameacuteliorethinsplathinspqualiteacutethinspdesthinspexamensthinspdemandeacutesthinspdiminuethinsplathinspneacutecessiteacutethinspdethinsprecourirthinspagravethinspdesthinspcontentionsthinspphysiquesthinspameacuteliorethinsplathinspcollaborationthinspetthinsplathinspconfiancethinspdethinsplrsquoenfantthinspetthinspdesthinspparentsthinspquantthinspauxthinspsoinsthinspprodigueacutesthinspetthinspauxthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspreacutealiseacuteesthinsp

Lathinspseacutedation-analgeacutesiethinsp(tousthinspniveaux)thinspenthinsppeacutediatriethinspdoitthinspecirctrethinspreacuteserveacuteethinspauthinspmilieuthinsphospitalierthinspouthinspauxthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacuteces-sairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspetthinspcethinspenthinspraisonthinspduthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquithinspestthinspgeacuteneacuteralementthinspneacutecessairethinspEllethinspcomportethinspdesthinsprisquesthinspseacuterieuxthinsppeuthinspimportethinsplrsquoeacutetatthinspdethinspsanteacutethinspdethinsplrsquoenfantthinspLesthinspcomplicationsthinsplesthinspplusthinspfreacutequentesthinspsontthinsplrsquoobstructionthinspdesthinspvoiesthinspaeacuteriennesthinsplrsquoapneacuteethinsplrsquoaspirationthinspdethinspseacutecreacutetionsthinspthinspetthinsplesthinspvomissements

thinsp21thinspOBJECTIFSthinspETthinspCLIENTEgraveLEthinspCIBLEthinsp

OBJECTIFS

Outrethinsplesthinspobjectifsthinspdethinspseacutedation-analgeacutesiethinspdeacutefinisthinsppourthinsplathinspclientegravelethinspadultethinsp(pthinsp8)thinspthinsp

lathinspseacutedation-analgeacutesiethinsppourthinsplathinspclientegravelethinsppeacutediatriquethinspvisethinspeacutegalementthinspagravethinspthinsp

thinsprsaquo eacuteviterthinspunthinsptraumatismethinsppsychologiquethinsprsaquo diminuerthinsplrsquoanxieacuteteacutethinspetthinsplathinsppeurthinspdethinsplrsquoenfantthinspetthinspdesthinspparentsthinsprsaquo obtenirthinsplathinspcollaborationthinspdethinsplrsquoenfant

CMQ - OIIQ - OPIQ 33

CLIENTEgraveLEthinspCIBLE

EnthinsppeacutediatriethinsplethinspniveauthinspdethinspseacutedationthinsprequisthinspestthinsptributairethinspdethinsplrsquoacircgethinspduthinspstadethinspdethinspdeacuteveloppementthinspdethinsplathinspcapaciteacutethinspcognitivethinspetthinspdethinsplathinspcollaborationthinspdethinsplrsquoenfantthinspAinsithinspchezthinsplrsquoenfantthinspdethinsp

thinsprsaquo 3thinspagravethinsp6thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspmodeacutereacutethinspsrsquoavegraverethinsprarementthinspsuffisantethinspLathinspplupartthinspdesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspneacutecessitentthinspunthinspniveauthinspprofondthinsp(voirethinspunethinspanestheacutesiethinspgeacuteneacuterale)thinsp

thinsprsaquo 7thinspagravethinsp13thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspmodeacutereacutethinspsrsquoavegraverethinspgeacuteneacuteralementthinspsuffisantethinspToutefoisthinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinsppeuventthinspneacutecessiterthinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspprofondthinsp

thinsprsaquo gethinsp14thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspleacutegerthinspouthinspmodeacutereacutethinspsrsquoavegraverethinspsuffisantethinspToutefoisthinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinsppeuventthinspneacutecessiterthinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspprofond

Chezthinsplrsquoenfantthinspdethinspmoinsthinspdethinsp3thinspansthinspouthinspdansthinsplethinspcasthinspdrsquounethinspseacutedationthinspprofondethinspviseacuteethinsplethinspmeacutedecinthinspdoitthinspsrsquoassurerthinspdethinsplathinspcollaborationthinspdrsquounthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespira-toirethinsppeacutediatriquethinspavanceacutee

Dethinspplusthinspilthinspestthinsprecommandeacutethinspdrsquoutiliserthinsplathinspclassificationthinspdethinsplrsquoeacutetatthinspphysiquethinspduthinspthinsppatientthinspquethinsplrsquoonthinsptrouvethinspdansthinsplethinsptableauthinspdethinsplathinsppagethinspsuivante

CMQ - OIIQ - OPIQ 34

Tableau 4 Classification de lrsquoeacutetat physique du patient selon lrsquoAmerican Society of Anesthesiologists (ASA) (ASA Physical Status Classification System [En ligne]) (Notre traduction)

Classification Eacutetatthinspdethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp1 Patientthinspenthinspbonnethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp2Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspleacutegegravere

ASAthinspPhysicalthinspStatusthinsp3Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgrave

ASAthinspPhysicalthinspStatusthinsp4Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgravethinspquithinsprepreacutesentethinspunethinspmenacethinspconstantethinsppourthinspsathinspvie

ASAthinspPhysicalthinspStatusthinsp5Patientthinspmoribondthinspquithinspnethinspsurvivrathinsppasthinspthinspagravethinspmoinsthinspdrsquounethinspinterventionthinsp

ASAthinspPhysicalthinspStatusthinsp6Patientthinspdeacuteclareacutethinspenthinspeacutetatthinspdethinspmortthinspceacutereacutebralethinspdontthinsplesthinsporganesthinspontthinspeacuteteacutethinsppreacuteleveacutesthinspagravethinspdesthinspfinsthinspdethinspdon

CMQ - OIIQ - OPIQ 35

Volet organisationnelthinsp22thinspCOMPEacuteTENCESthinspPROFESSIONNELLESthinsp

Outrethinsplesthinspcompeacutetencesthinspprofessionnellesthinspmentionneacuteesthinsppourthinsplethinsppatientthinspadultethinspthinsp(pthinsp11)thinsptousthinsplesthinspprofessionnelsthinspdethinsplathinspsanteacutethinsp(meacutedecinthinspinfirmiegraverethinspetthinspinhalotheacutera-peute)thinspquithinspprocegravedentthinspagravethinspunethinspseacutedation-analgeacutesiethinspaupregravesthinspdethinsppatientsthinsppeacutediatriquesthinspdoiventthinspposseacutederthinsp

athinsp lesthinspconnaissancesthinspetthinsplesthinspcompeacutetences73neacutecessairesthinspagravethinsplathinspreacuteanimationthinspthinspcardiorespiratoirethinsppeacutediatrique84(dethinsppreacutefeacuterencethinspenthinspsoinsthinspavanceacutes)thinspcrsquoest-agrave-direthinspmaicirctriserthinspenthinspprioriteacutethinsplesthinsptechniquesthinspdethinsplathinspprisethinspenthinspchargethinspdethinsplathinspventilationthinspduthinspmassagethinspcardiaquethinspetthinspdethinsplathinspmeacutedicationthinspassocieacutee

bthinspunethinspexpertisethinspcliniquethinspspeacutecifiquethinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspagravethinspreacutealiserthinspthinsp

thinspthinsp23thinspRESSOURCESthinspMATEacuteRIELLESthinsp

Sithinsplesthinspressourcesthinspmateacuteriellesthinspdethinspbasethinspetthinsplrsquoemplacementthinspsontthinspessentiellementthinsplesthinspmecircmesthinspquethinspchezthinsplrsquoadultethinsp(pthinsp11)thinspcelles-cithinspdoiventthinsptoutefoisthinspecirctrethinspadapteacuteesthinspauthinsp

patientthinsppeacutediatriquethinsp(crsquoest-agrave-direthinsptaillethinsppoidsthinspetthinspparticulariteacutes)thinsp

Agravethinsptitrethinspdrsquoexemplethinsp(listethinspnonthinsplimitative)thinsp

thinsprsaquo capteurthinspduthinspsaturomegravetrethinspdethinspmodegravelethinsppeacutediatriquethinsprsaquo reacuteanimateurthinspautogonflantthinsp(Ambuthinspbag)thinspetthinspmasquesthinspdethinspdiffeacuterentesthinsptaillesthinspthinsprsaquo lamesthinspdethinsplaryngoscopethinspsondesthinspendotracheacutealesthinsp(avecthinspouthinspsansthinspballonnet)thinspdethinsp

taillesthinspdiffeacuterentesthinsprsaquo canulesthinsporonasopharyngeacuteesthinspdethinspdiffeacuterentesthinsptaillesthinsprsaquo tubulurethinspagravethinspsoluteacutethinspdethinsptypethinspmicrogouttesthinspavecthinspouthinspsansthinspburettethinsprsaquo outilsthinspsupraglottiquesthinsp(pthinspexthinspthinspmasquethinsplaryngeacute)thinspdethinspdiffeacuterentesthinsptaillesthinsprsaquo deacutefibrillateurthinspavecthinspeacutelectrodesthinsppeacutediatriquesthinsprsaquo steacutethoscopethinspdethinsptaillethinsppeacutediatriquethinsp(preacutecordialthinspouthinsppreacutetracheacutealthinsppourthinspeacutecoutethinspenthinsp

continuethinspsrsquoilthinspythinspathinsplieu)thinsprsaquo appareilthinspagravethinspaspirationthinsppouvantthinspgeacuteneacutererthinspunethinsppressionthinspneacutegativethinspdethinsp40thinspagravethinsp60thinspmmthinsp

Hgthinspouthinspunethinspcapaciteacutethinspdethinspflotthinspdethinsp100thinsplitresthinspparthinspminutethinspetthinsplethinspmateacuterielthinspneacutecessairethinspdethinsptaillethinspadapteacutee

7thinsp Onthinspentendthinspparthinspconnaissancesthinspetthinspcompeacutetencesthinspqursquoellesthinspsoientthinspmisesthinspagravethinspjourthinspselonthinsplesthinsprecommandationsthinspenthinspvigueur

8thinsp Onthinspentendthinspparthinspcertificationthinspenthinspreacuteanimationthinspcardiorespiratoirethinsplesthinspformationsthinspsuivantesthinspthinsp rsaquothinspReacuteanimationthinspcardiorespiratoirethinspdethinspbasethinspthinspSoinsthinspimmeacutediatsthinspenthinspreacuteanimationthinsp(SIR)thinsppourthinspprofessionnelsthinspdethinsplathinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspsanteacutethinspouthinsplrsquoeacutequivalentthinsp rsaquothinspReacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspSoinsthinspavanceacutesthinspenthinspreacuteanimationthinsppeacutediatriquethinsp(SARP)thinspouthinsplrsquoeacutequivalent

CMQ - OIIQ - OPIQ 36

Volet professionnelthinsp24thinspPREacuteSEacuteDATION-ANALGEacuteSIEthinsp

SEacuteLECTIONthinspDESthinspPATIENTS

Sithinspunethinspseacutelectionthinsprigoureusethinspdesthinsppatientsthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinspattentionthinspquethinspchezthinsplrsquoadultethinsp(pthinsp15)thinspcertainesthinspparticulariteacutesthinsppropresthinspagravethinsplrsquoenfantthinspdoiventthinsp

toutefoisthinspecirctrethinspprisesthinspenthinspcomptethinsp

LorsthinspdethinspsituationsthinspparticuliegraveresthinspouthinspcomplexesthinspapregravesthinsplrsquoeacutevaluationthinspduthinsppatientthinsplethinspmeacutedecinthinspdevraitthinspconsulterthinspunthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspCitonsthinspagravethinsptitrethinspdrsquoexemplethinspmaisthinspsansthinspsrsquoythinsplimiterthinsp

thinsprsaquo preacutesencethinspdethinspcertainsthinspsyndromesthinspdontthinsplathinsptrisomiethinsp21thinsprsaquo anomaliethinspdesthinspvoiesthinspaeacuteriennesthinsprsaquo anomaliethinspcranio-facialethinsprsaquo infectionthinsprespiratoirethinspasthmethinsprsaquo maladiethinspneuromusculairethinsprsaquo maladiethinspcardiaquethinsprsaquo troublethinsprespiratoirethinspduthinspsommeilthinspetthinsplathinsptheacuterapiethinspassocieacuteethinsprsaquo obeacutesiteacutethinspimportantethinsprsaquo refluxthinspgastro-œsophagienthinsprsaquo eacutetatthinspdethinspconsciencethinspalteacutereacutethinsprsaquo troublethinspenvahissantthinspduthinspdeacuteveloppementthinsp(pthinspexthinspthinspautisme)

Dethinspmecircmethinsptoutthinspcommethinspchezthinsplrsquoadultethinsplesthinspinterventionsthinspeffectueacuteesthinspsousthinspseacutedation-analgeacutesiethinspdoiventthinspecirctrethinspreacuteserveacuteesthinspprincipalementthinspauxthinsppatientsthinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp1thinspouthinspauxthinsppatientsthinspatteintsthinspdrsquounethinspaffectionthinsp

systeacutemiquethinspleacutegegraverethinspclasseacuteethinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp2thinsp

Notonsthinspquethinsplorsquethinspcestthinspjustifieacutethinspauthinspdossierthinspmeacutedicalthinsplathinspseacutedation-analgeacutesiethinsppeutthinspecirctrethinspeffectueacuteethinspchezthinsplesthinsppatientsthinspstablesthinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp3thinspetthinspexceptionnellementthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp4thinspToutefoisthinspellethinspdoitthinsplrsquoecirctrethinspdansthinspdesthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspDethinspplusthinspcesthinsppatientsthinspdoiventthinsp

fairethinsplrsquoobjetthinspdrsquounethinspeacutevaluationthinspindividualiseacuteethinspetthinspplusthinspapprofondiethinspEacuteVALUATIONthinspDESthinspPATIENTSthinsp

CMQ - OIIQ - OPIQ 37

EacuteVALUATIONthinspDESthinspPATIENTS

Sithinspunethinspeacutevaluationthinsprigoureusethinspdesthinsppatientsthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinspatten-tionthinspquethinspchezthinspladultethinsp(pthinsp15)thinspcettethinspeacutevaluationthinspdoitthinspaussithinspinclurethinspsansthinspsrsquoythinsplimiterthinsplrsquoacircgethinsplathinsptaillethinsplethinsppoidsthinsplethinspstadethinspdethinspdeacuteveloppementthinsplathinspcapaciteacutethinspcognitivethinsplesthinspallergiesthinsplesthinspproblegravemesthinspmeacutedicauxthinspouthinspfamiliauxthinsppertinentsthinsplesthinspmeacutedicamentsthinsp(outhinspautrethinspsubstancethinspnonthinspprescrite)thinsppristhinspreacuteguliegraverementthinspouthinspreacutecemmentthinspetthinsplrsquoheurethinspduthinspdernierthinspingestathinspainsithinspquethinsplethinsptypethinspetthinsplathinspquantiteacutethinspconsommeacutee

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsplrsquoeacutevaluationthinsp(anamnegravesethinspetthinspexamenthinspphysique)thinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinspthinsp

CONSENTEMENTthinsp(REacuteSUMEacute)

LethinsplecteurthinspdoitthinspsethinspreacutefeacutererthinspagravethinsplrsquoannexethinspVIIIthinsppourthinsplethinsptextethinspcomplet

ToutthinspcommethinspchezthinsplrsquoadultethinspilthinspestthinspobligatoirethinspauthinspQueacutebecthinspdrsquoobtenirthinsplethinspconsente-mentthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspinterventionthinspCelathinspditthinsppourthinsplathinspclientegravelethinsppeacutediatriquethinspilthinspfautthinspajouterthinspunethinsppreacutecisionthinspextraitethinspduthinsp

Code civil du QueacutebecthinspthinspSithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsp(traitementsthinspdethinspmeacutedecinethinspetthinspdethinspchirurgiethinspestheacutetiquethinspexpeacuterimentationthinspetthinspdonsthinspdrsquoorganes)thinsplethinsppatientthinspdoitthinspecirctrethinspinformeacutethinspdethinsptousthinsplesthinsprisquesthinsppossiblesthinspmecircmethinspsrsquoilsthinspsontthinspraresthinspthinspetthinsplethinspconsentementthinspdoitthinspecirctrethinspdonneacutethinspparthinspeacutecrit

thinsprsaquo Unethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsp(gethinsp14thinspans)thinsppeutthinspconsentirthinspseulethinspthinspagravethinspmoinsthinspqursquoilthinspsrsquoagissethinspdethinspsoinsthinspnonthinsprequisthinspetthinspcomportantthinspdesthinsprisques

thinsprsaquo Pourthinspunethinsppersonnethinspmineurethinspdethinspmoinsthinspdethinsp14thinspansthinsp(ltthinsp14thinspans)thinsplethinspconsentementthinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentale

Srsquoilthinspsrsquoagitthinspdethinspsoins requisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsplrsquoobligationthinspdrsquoinformerthinsp

croicirctthinspenthinspfonctionthinspdethinsplathinsppreacutevalencethinspetthinspdethinsplathinspgraviteacutethinspdesthinspcomplications

thinsprsaquo Lethinspconsentementthinspdrsquounethinsppersonnethinspmineurethinsp(ltthinsp18thinspans)thinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinsp

thinsprsaquo Unethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsp(gethinsp14thinspans)thinsppeutthinspconsentirthinspmaisthinspnethinsppeutthinsppasthinsprefuserthinspseulethinspdesthinspsoinsthinspquithinspseraientthinspjugeacutesthinsprequisthinsp

DIRECTIVESthinspETthinspCONSEILSthinsp

Toutthinspcommethinsppourthinsplrsquoadultethinsp(pthinsp19)thinsplrsquoenfantthinspetthinspsonthinspparentthinsp(outhinspremplaccedilant)thinspdoiventthinsprecevoirthinsplesthinspdirectivesthinspneacutecessairesthinspCelathinspditthinspauxthinspdirectivesthinsprelativesthinspauthinspjeucircnethinsp

CMQ - OIIQ - OPIQ 38

preacute-interventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspnonthinspurgentethinsp(eacutelective)thinspilthinspfautthinspajouterthinspcecithinsp(Merchantthinspetthinspcollabthinsp2014a op cit)thinsp

thinsprsaquo liquidethinspclairthinsp(pthinspexthinspthinspeauthinspjusthinspdethinspfruitthinsp[sansthinsppulpe])thinspthinspjeucircnethinspdethinsp2thinspheuresthinsprsaquo laitthinspmaternelthinspthinspjeucircnethinspdethinsp4thinspheuresthinsprsaquo formulesthinsplacteacuteesthinspnonthinsphumaniseacuteesthinspouthinsppreacuteparationsthinspcommercialesthinsppourthinsp

nourrissonsthinspthinspjeucircnethinspdethinsp6thinspheuresthinspthinspAucunthinspajoutthinspnrsquoestthinsppermisthinspauthinsplaitthinspmaternelthinsptireacutethinsp

thinsp25thinspPERSEacuteDATION-ANALGEacuteSIEthinsp

APPROCHEthinspPHARMACOLOGIQUEthinsp

Sithinsplathinspmeacutedicationthinspgeacuteneacuteralementthinsputiliseacuteethinspestthinsplathinspmecircmethinspquethinspchezthinsplrsquoadultethinsp(pthinsp20)thinsplathinspdosethinspdoitthinspecirctrethinspadapteacuteethinspnotammentthinspenthinspfonctionthinspduthinsppoidsthinspetthinspdethinsplathinspcondi-tionthinspcliniquethinspdethinsplrsquoenfantthinspParthinspailleursthinspilthinspfautthinspretenirthinspquethinsplathinsppharmacocineacutetiquethinspetthinsplathinsppharmacodynamiquethinspdesthinspagentsthinspdethinspseacutedation-analgeacutesiethinspsontthinspinfluenceacuteesthinspparthinsplrsquoacircgethinspduthinsppatientthinspAgravethinsptitrethinspdrsquoexemplethinsppourthinspunthinspenfantthinspacircgeacutethinspdethinspunthinspagravethinspsixthinspansthinsplathinspclairancethinspdesthinspagentsthinspdethinspseacutedation-analgeacutesiethinspestthinspsupeacuterieurethinspagravethinspcellethinspdethinsplrsquoadultethinspIlthinspfaudrathinspdoncthinspajusterthinsplesthinspdosesthinspchezthinspunthinspenfantthinspdrsquoacircgethinsppreacutescolairethinsp(Saunderthinspetthinsp

collabthinsp2008)thinsp

Lrsquoutilisationthinspdrsquounethinsppommadethinspanalgeacutesiquethinsp(pthinspexthinspthinsplathinspcregravemethinspEMLAreg)thinsppeutthinspecirctrethinspavantageusethinsppourthinspcontrerthinsplathinspdouleurthinspassocieacuteethinspagravethinsplathinspposethinspdrsquounthinspcatheacuteterthinspintra-veineuxthinspparthinspexemplethinsp(lethinsptempsthinspdrsquoattentethinspdethinsp60thinspagravethinsp90thinspminutesthinspdoitthinspecirctrethinsppristhinspenthinspconsideacuteration)thinsp

APPROCHEthinspNONthinspPHARMACOLOGIQUE

Pourthinsplrsquoenfantthinspquithinspnethinspbeacuteneacuteficiethinspquethinspdrsquounethinspanalgeacutesiethinsp(aucunethinspseacutedation)thinspilthinspfautthinspretenirthinspquethinsplathinspdistractionthinsp(attirerthinsplrsquoattentionthinspversthinspquelquethinspchosethinspdethinsppositif)thinsppen-dantthinspunthinspsointhinspdouloureuxthinsp(outhinspquithinspinquiegravete)thinsppeutthinspsrsquoaveacutererthinspunthinspmoyenthinspefficacethinsppourthinspdiminuerthinspsonthinspanxieacuteteacutethinspetthinsplathinspperceptionthinspdethinspsathinspdouleurthinsp(AssociationthinspSparadrapthinspthinsp[Enthinspligne])

Agravethinsptitrethinspdrsquoexemplethinspetthinspsansthinspsrsquoythinsplimiterthinsp

thinsprsaquo discuterthinspavecthinsplrsquoenfantthinspouthinsplrsquoadolescentthinspdethinspsesthinsppreacutefeacuterencesthinsprsaquo utiliserthinspunthinspjouetthinspchanterthinspunethinspchansonthinspouthinspraconterthinspunethinsphistoirethinspagravethinsplrsquoenfantthinspthinsp

plusthinspjeunethinsprsaquo lathinsppreacutesencethinspetthinsplathinspcollaborationthinspdrsquounthinspparentthinsppeuventthinspecirctrethinsppertinentes

CMQ - OIIQ - OPIQ 39

SURVEILLANCEthinspCLINIQUE

Lathinspsurveillancethinspcliniquethinspcomprendthinspplusieursthinspeacuteleacutementsthinspquithinspconcernentthinspnotam-mentthinsplesthinspsystegravemesthinsprespiratoirethinspcardiaquethinspetthinspneurologiquethinspetthinspellethinspdoitthinsptenirthinspcomptethinspentrethinspautresthinsp

thinsprsaquo dethinsplathinspconditionthinspduthinsppatientthinspavantthinspetthinsppendantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

thinsprsaquo dethinsplathinspcomplexiteacutethinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinsprsaquo dethinsplathinspmeacutedicationthinsputiliseacuteethinsp(dosethinspdureacuteethinspetthinsppicthinspdrsquoactionthinspvoiethinspetthinspvitessethinsp

drsquoadministrationthinspcombinaisonthinspetthinspantagonistes)thinsprsaquo dethinsplrsquoassistancethinspagravethinspapporterthinspauthinspmeacutedecin

Lethinspmeacutedecinthinspquithinsppratiquethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspchezthinspunthinspenfantthinspsousthinspseacutedation-analgeacutesiethinspdoitthinspcompterthinspsurthinsplathinsppreacutesencethinspdrsquoauthinspmoinsthinspunthinspautrethinspprofessionnelthinsphabiliteacutethinspduthinspmilieuthinspdethinsplathinspsanteacutethinsp(infirmiegraverethinspinhalotheacuterapeutethinspouthinspautrethinspmeacutedecin)thinsp(annexethinspII)thinspEnthinspeacutetroitethinspcollaborationthinspavecthinsplethinspmeacutedecinthinspreacuteali-santthinsplrsquointerventionthinspceux-cithinspassurentthinsplathinspgestionthinspdethinsplathinspseacutedationthinspetthinspdethinsplrsquoanalgeacutesiethinsp

qui comprend entre autres la surveillance clinique de lrsquoenfantthinspresponsabiliteacutethinspthinspagravethinsplaquellethinspilsthinspdoiventthinspenthinsptoutthinsptempsthinspsethinspconsacrerthinspen prioriteacutethinsp

Dansthinspcertainsthinspcasthinsplethinspprofessionnelthinspquithinspassurethinspen prioriteacutethinsplathinspsurveillancethinspthinspcliniquethinspdethinsplrsquoenfantthinsppeutthinspecirctrethinspappeleacutethinspagravethinspassisterthinsplethinspmeacutedecinthinspdansthinsplathinspreacutealisationthinspthinspdethinspsonthinspinterventionthinspCettethinspassistancethinspquithinspdoitthinspsrsquoeffectuerthinspdansthinsplathinspmecircmethinsppiegravecethinspdoitthinspecirctrethinspdethinsptregravesthinspcourtethinspdureacuteethinspDethinspplusthinspellethinspdoitthinsppouvoirthinspecirctrethinspinterrompuethinspagravethinsptoutthinspmomentthinsppourthinspintervenirthinspimmeacutediatementthinspaupregravesthinspdethinsplrsquoenfantthinspenthinspcasthinspdethinspcomplicationsthinspouthinspdethinspbesoin

Parthinspailleursthinsplorsquethinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspneacutecessitentthinspunethinspassistancethinsptechniquethinspcontinuellethinspauthinspmeacutedecinthinsplrsquoajoutthinspdrsquounthinsptroisiegravemethinspprofessionnelthinspdethinsplathinspsanteacutethinsphabiliteacutethinsp(meacutedecinthinspinfirmiegraverethinspouthinspinhalotheacutera-peute)thinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspdethinsplrsquoenfantthinspestthinsprequisthinsp

CMQ - OIIQ - OPIQ 40

Tableau 5 Tableau reacutecapitulatif du nombre de professionnels habiliteacutes requis en seacutedation-analgeacutesie - Clientegravele peacutediatrique

Toutthinspauthinsplongthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinspdoitthinspecirctrethinspcontinuethinspetthinsplathinspcommunicationthinspavecthinspcelui-cithinspmaintenuethinsp

Proceacutederthinspagravethinsplathinspsurveillancethinspcliniquethinspcrsquoestthinspeacutevaluerthinspqualitativementthinspetthinspquanti-tativementthinspdethinspfaccedilonthinspsoutenuethinspetthinspenthinspcontinuthinsplrsquoensemblethinspdesthinspparamegravetresthinspsui-vantsthinsp(listethinspnonthinsplimitative)thinsp(tableauthinsp6)thinsp

thinsprsaquo mesurethinspdethinsplathinsppressionthinsparteacuteriellethinspduthinsppouls95etthinspdethinsplathinsprespiration106

thinsprsaquo lecturethinspdethinsplathinspsaturationthinspcapillairethinspenthinspoxygegraveneLathinsptonaliteacutethinspdethinsppoulsthinspdoitthinspecirctrethinspactiveacuteethinspenthinsptoutthinsptempsthinspetthinspsonthinspniveauthinspdoitthinspecirctrethinspajusteacutethinspdethinspfaccedilonthinspagravethinspecirctrethinspentenduthinspclairement

thinsprsaquo eacutevaluationthinspdethinsplrsquoeacutetatthinspdethinsplathinspcolorationthinspetthinspdethinsplathinsptempeacuteraturethinspdethinsplathinsppeauthinsprsaquo niveauthinspdrsquoO

2thinspdethinspCO

2thinspetthinspmonitoragethinspcardiaquethinspselonthinsplethinspcasthinsp

Enthinspplusthinspdesthinspparamegravetresthinspdethinspmonitoragethinspcliniquethinsp(mentionneacutesthinsppreacuteceacutedemment)thinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsppeacutediatriquethinspdoitthinspcomprendrethinspthinsp

thinsprsaquo lrsquoeacutevaluationthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsp(pthinspexthinspthinspbradycardiethinsphypoxiquethinsppreacutecocethinspsithinspobstruction)

thinsprsaquo lrsquoapportthinspliquidienthinsprsaquo lathinsppertethinspdethinspchaleurthinsp(selonthinsplathinspdureacuteethinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesie)

9thinspthinspthinspthinspthinspLethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp10thinspthinspthinspthinspLathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinspetthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

Nombrethinspdethinspprofessionnelsthinsphabiliteacutesthinsprequis

2 Nombrethinspmimimalthinsprequis

3 Sithinsputilisationthinspdethinsppropofolthinspkeacutetaminethinspouthinspdethinspdexmeacutedeacutetomidine

3 SithinsputilisationthinspconcomitantethinspdethinspN2Othinspetthinspdrsquounthinspagentthinspseacutedatifthinspouthinspthinsp

dunthinspopioiumldethinspouthinspsithinspconcentrationthinspdethinspN2Othinspmodifiable

3 Sithinsplassistancethinsptechniquethinspauthinspmeacutedecinthinspestthinspcontinuelle

CMQ - OIIQ - OPIQ 41

thinsprsaquo lrsquoeacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplrsquoanalgeacutesiethinspetthinspdethinsplathinspseacutedationthinspagravethinsplrsquoaidethinspdrsquooutilsthinspadapteacutesthinspagravethinsplathinspconditionthinspetthinspagravethinsplrsquoacircgethinspdethinsplrsquoenfantthinsp(annexesthinspIXthinspetthinspX)

thinsprsaquo lathinsppositionthinspduthinsppatientthinspetthinsplesthinsppointsthinspdrsquoappuithinsp(compression)

Tableau 6 Surveillance des paramegravetres cliniques en seacutedation-analgeacutesie - Clientegravele peacutediatrique

Paramegravetrethinspdethinspthinspsurveillancethinspclinique

PatientNiveauthinspdethinspthinspseacutedation

MeacutedicationInterventionthinspdiagnostiquethinspouthinsptheacuterapeutique

TAthinspRC11thinspthinspRR12thinspthinspetthinspsaturationthinspdrsquoO

2thinspthinsp

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

Niveauthinspdethinspthinsp-thinspseacutedationagitationthinspthinspthinspthinspconscience-thinspdouleur

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

NiveauthinspdethinspCO2

SelonthinsplesthinspcaracteacuteristiquesthinspAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)thinsp

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspmeacutedication Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire rsaquothinspAccegravesthinspindirectthinspouthinspthinspthinspthinspthinsprestreintthinspauthinsppatientthinspthinspthinsp(pthinspexthinspthinspIRM)

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetaminethinsp

rsaquothinspRecommandeacute rsaquothinspASAthinspgethinsp3thinsprsaquothinspApneacuteethinspobstructivethinspthinspthinspduthinspsommeilthinsprsaquothinspMaladiethinspthinspthinsprespiratoirethinsprsaquothinspObeacutesiteacutethinspmorbide

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

Monitoragethinspcardiaque

SelonthinsplesthinspcaracteacuteristiquesAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspmeacutedication Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire rsaquothinspASAthinspgethinsp3thinsprsaquothinspMaladiethinspcardiaque

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

Interventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspprolongeacuteethinsp(effetthinspcumulatifthinspdethinsplathinspmeacutedication)

rsaquothinspRecommandeacute Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

thinspthinsp IlthinspnethinspsrsquoagitthinsppasthinspdrsquounethinsplistethinsplimiteacuteethinspdesthinspsituationsthinspcliniquesthinspDrsquoautresthinspsituationsthinspcliniquesthinsppeuventthinspneacutecessiterthinspthinsplethinspmonitoragethinspcardiaquethinspouthinspduthinspCO

2thinspIlthinsprevientthinspauxthinspprofessionnelsthinspdethinspjugerthinspdethinsplathinspsituationthinspenthinspfonctionthinspdethinspthinsp

chaquethinsppatient

11thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp12thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

CMQ - OIIQ - OPIQ 42

ILthinspFAUTthinspSAVOIRthinspQUE

LathinspSocieacuteteacutethinspcanadiennethinspdesthinspanestheacutesiologistesthinsp(SCA)thinspindiquethinspquethinsplesthinspthinspdirectivesthinspgeacuteneacuteralesthinspdethinspsoinsthinsp(ythinspcompristhinsplethinspmonitorage)thinsppourthinsplathinspseacutedationthinspthinspconscientethinspsontthinsplesthinspmecircmesthinspquethinsppourthinsplesthinspautresthinspformesthinspdrsquoanestheacutesiethinsp[]thinspthinsp(Merchantthinspetthinspcollabthinsp2014bthinspopthinspcit)thinspDethinspplusthinspellethinspindiquethinspquethinsplethinspthinspcapnographethinspestthinsprequisthinsplorsthinspdethinspseacutedation-analgeacutesiethinspdethinspniveauthinspplusthinspeacuteleveacutethinspthinsp(pthinspexthinspthinspRamsaythinsp4-6)thinsp(Merchantthinspetthinspcollabthinsp2014athinspop cit)

LethinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspimpliqueacutesthinspestthinspprimordialthinspetthinspcethinspmecircmethinspsithinsplrsquoappareillagethinspenthinspplacethinspestthinspcompletthinspetthinspfonctionnelthinspUnethinspbonnethinspcommunica-tionthinspentrethinspcesthinspderniersthinspestthinspdoncthinspessentiellethinspafinthinspdethinspbienthinspcoordonnerthinsplathinspseacutedationthinspetthinsplrsquoanalgeacutesiethinspavecthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspLes alarmes (audibles et visuelles) de chaque appareil doivent ecirctre en fonction et les paramegravetres ajusteacutes agrave lrsquoacircge et agrave la condition clinique de chaque enfant

IlthinspfautthinspsrsquoassurerthinspdethinsplathinsptraccedilabiliteacutethinspdethinsplrsquoeacutevaluationthinspetthinspdethinsplathinspsurveillancethinspcliniquethinspthinspeffectueacuteesthinspparthinspunethinsptenuethinspdethinspdossiersthinspconformethinspauxthinspnormesthinspenthinspvigueurthinspthinspLesthinspoutilsthinspdrsquoeacutevaluationthinsputiliseacutesthinspdoiventthinspecirctrethinspsimplesthinspstandardiseacutesthinspvalideacutesthinspdethinsppreacutefeacuterencethinspetthinspadapteacutesthinspauthinspcontextethinspetthinspauxthinspcaracteacuteristiquesthinspduthinsppatientthinspnotam-mentthinsppourthinsplrsquoeacutevaluationthinspduthinspniveauthinspdethinspseacutedationagitationthinspdethinspconsciencethinspetthinspdethinspdouleurthinsp(annexesthinspIXthinspetthinspX)

Lathinspfreacutequencethinspdethinsplathinspmesurethinspdethinspcesthinspparamegravetresthinspetthinspleurthinspenregistrementthinspdoiventthinspecirctrethinspdeacutetermineacutesthinspentrethinspautresthinspenthinspfonctionthinspdethinsplathinspmeacutedicationthinspetthinspdethinsplathinspconditionthinsp

cliniquethinspduthinsppatientthinsp

Ideacutealementthinsplethinspprofessionnelthinspdoitthinsplesthinspdocumenterthinsp

thinsprsaquo avantthinsplethinspdeacutebutthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsprsaquo apregravesthinsplrsquoadministrationthinspdrsquounthinspagentthinspdethinspseacutedation-analgeacutesiethinspouthinspdrsquounthinspantagonistethinsprsaquo authinsppicthinspdrsquoactionthinspdethinspchacunthinspdesthinspagentsthinspadministreacutesthinspthinsprsaquo agravethinspintervallesthinspreacuteguliersthinsp(pthinspexthinspthinsp5thinspminutes)thinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-

analgeacutesiethinsprsaquo agravethinspintervallesthinspplusthinsprapprocheacutesthinsplorsquethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsplrsquoexigethinsprsaquo durantthinsplathinsppeacuteriodethinspdethinspreacutecupeacuterationthinspetthinspjusqursquoauthinspretourthinspduthinspniveauthinspdethinspconsciencethinsp

initialthinspselonthinsplathinspconditionthinspcliniquethinspduthinsppatientthinsprsaquo authinspmomentthinspduthinspcongeacutethinsp

CMQ - OIIQ - OPIQ 43

thinsp26thinspPOSTSEacuteDATION-ANALGEacuteSIEthinsp

Commethinsppourthinsplethinsppatientthinspadultethinsp(pthinsp29)thinsplathinspsurveillancethinspcliniquethinspdoitthinspecirctrethinspcons-tantethinspetthinsprigoureusethinsptoutthinspauthinsplongthinspdethinsplathinsppeacuteriodethinsppostseacutedation-analgeacutesiethinspetthinspcethinspjusqursquoauthinspretourthinspdethinsplrsquoeacutetatthinspinitialthinspdethinsplrsquoenfantthinspenthinspfonctionthinspdethinspsonthinspstadethinspdethinspdeacutevelop-pement

Rappelonsthinspquethinsplesthinspappareilsthinspdethinspmonitoragethinspdoiventthinspecirctrethinspenthinspfonctionthinspthinspmaisthinspenthinspaucunthinsptempsthinspilsthinspnethinspremplacentthinsplathinspsurveillancethinspdirectethinspduthinsppatientthinspthinspparthinsplethinspprofessionnelthinsp

LathinsppeacuteriodethinspdrsquoobservationthinspenthinspeacutetablissementthinspdoitthinspecirctrethinspsuffisammentthinspprolongeacuteethinsppourthinsppreacutevenirthinsplesthinspproblegravemesthinsppendantthinspetthinspauthinspretourthinspagravethinsplathinspmaisonthinspComptethinsptenuthinspdethinspsonthinspacircgethinspetthinspdethinspsathinspconditionthinsplrsquoenfantthinspdoitthinspecirctrethinspcapablethinspdethinspsrsquoasseoirthinspdethinspboirethinspdethinspparlerthinspetthinspdethinspmarcherthinspavecthinspunethinspaidethinspminimalethinsp

Selonthinsplathinspdistancethinspagravethinspparcourirthinspauthinspretourthinspilthinsppeutthinspecirctrethinspjudicieuxthinspdethinspprolongerthinsplathinsppeacuteriodethinspdrsquoobservation

Unthinspdocumentthinsprelatifthinspauthinspcongeacutethinspcomprenantthinspdesthinspconsignesthinspclairesthinsppourthinsplathinspthinsp

surveillancethinspagravethinspdomicilethinspdoitthinspecirctrethinspremisthinspetthinspexpliqueacutethinspauxthinspparentsthinsp(annexethinspXII)

thinsp27thinspDOCUMENTATIONthinspDESthinspSOINSthinspETthinspTENUEthinspDEthinspDOSSIERSthinsp

Lathinsptenuethinspdethinspdossiersthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinsprigueurthinspetthinsplathinspmecircmethinsppreacutecisionthinspquethinspchezthinsplrsquoadultethinsp(pthinsp30)thinspCertainesthinspinformationsthinsppropresthinspagravethinsplrsquoenfantthinspdoiventthinspecirctrethinspajouteacuteesthinspnotammentthinsp

thinsprsaquo sithinsppreacutesencethinspdrsquounthinspparentthinsprsaquo lethinsppoidsthinspetthinsplrsquoacircgethinspdethinsplrsquoenfantthinsprsaquo lathinsptaillethinspouthinsplrsquoIMCthinspsrsquoilthinspythinspathinsplieu

CMQ - OIIQ - OPIQ 44

CONCLUSION

Lathinspseacutedation-analgeacutesiethinspvisethinspagravethinspalteacutererthinsplethinspniveauthinspdethinspconsciencethinspainsithinspqursquoagravethinspsoulagerthinsplrsquoanxieacuteteacutethinspetthinsplathinspdouleurthinspdrsquounthinsppatientthinspauthinspcoursthinspdrsquounethinspinterventionthinsptheacuterapeutiquethinspouthinspdiagnostiquethinspCettethinspproceacutedurethinspbienthinspquethinspfreacutequemmentthinsputiliseacuteethinspcomportethinspcependantthinspcertainsthinsprisques

On doit y recourir de faccedilon seacutecuritaire pour le patient et en tout temps preacutevenir et reconnaicirctre les complica-tions lieacutees agrave la seacutedation-analgeacutesie afin drsquoeffectuer rapidement et efficace-ment les manœuvres neacutecessaires

LethinsprespectthinspdesthinsplignesthinspdirectricesthinspeacutenonceacuteesthinspdansthinspcethinspdocumentthinspaiderathinsplesthinspprofessionnelsthinspagravethinspmenerthinspadeacutequatementthinspcettethinspproceacutedurethinspCeux-cithinspdemeurentthinsptoutefoisthinspresponsablesthinspdethinsplathinspmisethinspagravethinspjourthinspdethinspleursthinspconnaissancesthinspetthinspduthinspdeacuteveloppementthinspdethinspleursthinspcompeacutetencesthinsprespectivesthinsp

Parthinspailleursthinsplesthinspeacutetablissementsthinspdethinspsanteacutethinspetthinsplesthinspcliniquesthinspouthinspcabinetsthinsppriveacutesthinspdevraientthinspsrsquoinspirerthinspdethinspcesthinsplignesthinspdirectricesthinsppourthinspeacutelaborerthinspthinspdesthinspproceacuteduresthinsprelativesthinspagravethinsplathinspthinspseacutedation-analgeacutesiethinspetthinspenthinspassurerthinsplrsquoeacutevaluationthinsppeacuteriodiquethinspdethinsplathinspqualiteacutethinsp

CMQ - OIIQ - OPIQ 45

mdash Annexe

thinspANNEXEthinspIthinspndashthinspDEacuteFINITIONthinspDEthinspLrsquoANESTHEacuteSIEthinspGEacuteNEacuteRALEthinspETthinspthinsp

DESthinspNIVEAUXthinspDEthinspSEacuteDATION-ANALGEacuteSIEthinspSELONthinspLrsquoAMERICANthinspSOCIETYthinspOFthinsp

ANESTHESIOLOGISTSthinsp(ASA)thinsp(AMERICANthinspSOCIETYthinspOFthinspANESTHESIOLOGISTSthinsp

ASAthinspHOUSEthinspOFthinspDELEGATEthinsp2014AthinspOP CIT)thinsp(NOTREthinspTRADUCTION)

Seacutedationthinspminimalethinspthinspanxiolyse

Seacutedation-thinspthinspanalgeacutesiethinspthinspmodeacutereacutee(consciente)

Seacutedation-thinspanalgeacutesiethinspthinspprofonde

Anestheacutesiethinspthinspgeacuteneacuterale

Reacuteponse Reacuteponsethinspnormalethinspagravethinsplathinspstimulationthinspverbale

Reacuteponsethinspvolontairethinspagravethinsplathinspstimulationthinspverbalethinspouthinsptactile

Reacuteponsethinspvolontairethinspsuivantthinspunethinspstimulationthinspreacutepeacuteteacuteethinspouthinspdouloureuse

Nonthinspeacuteveillablethinspmecircmethinspavecthinspstimulusthinspdouloureux

Voiesthinspthinspaeacuteriennes

Nonthinspaffecteacutees Pasthinspdrsquointerventionthinsprequise

Interventionthinsppeutthinspecirctrethinsprequise

Interventionthinspthinspsouventthinsprequise

Ventilationspontaneacutee

Nonthinspaffecteacuteethinsp Adeacutequate Peutthinspecirctrethinspinadeacutequate

Freacutequemmentthinspinadeacutequate

Fonctionthinspcardio-thinspvasculaire

Nonthinspaffecteacutee Geacuteneacuteralementthinspthinspmaintenue

Geacuteneacuteralementthinspthinspmaintenue

Peutthinspecirctrethinspthinspcompromise

thinspthinspLethinspreacuteflexethinspdethinspretraitthinspagravethinsplathinspsuitethinspdrsquounethinspstimulationthinspdouloureusethinspnrsquoestthinsppasthinspconsideacutereacutethinspcommethinspunethinspreacuteponsethinspvolontaire

Rappelonsthinspquethinsplathinspseacutedation-analgeacutesiethinspprofondethinspchezthinsplrsquoadultethinspetthinsplrsquoanestheacutesiethinspgeacuteneacuteralethinsp(adultethinspetthinsppeacutediatrique)thinspthinspnethinspfontthinsppasthinsplrsquoobjetthinspdethinspcettethinsppublication

CMQ - OIIQ - OPIQ 46

mdash Annexe

thinspANNEXEthinspIIthinspndashthinspINFORMATIONthinspCOMPLEacuteMENTAIREthinsp-thinspLECTURESthinspDrsquoINTEacuteREcircT

COLLEgraveGEthinspDESthinspMEacuteDECINSthinspDUthinspQUEacuteBECthinsp(CMQ)

thinsprsaquo Proceacutedures et interventions en milieu extrahospitalier (2011)thinsprsaquo Code de deacuteontologie des meacutedecinsthinsp(2015)

ORDREthinspDESthinspINFIRMIEgraveRESthinspETthinspINFIRMIERSthinspDUthinspQUEacuteBECthinsp(OIIQ)thinsp

thinsprsaquo EacutediteurthinspofficielthinspduthinspQueacutebec Code de deacuteontologie des infirmiegraveres et infirmiers (2014)

thinsprsaquo Le champ drsquoexercice et les activiteacutes reacuteserveacutees des infirmiegraveresthinsp(2013)thinsp2ethinspeacutedthinspthinsprsaquo Mosaiumlque des compeacutetences cliniques de lrsquoinfirmiegravere Compeacutetences initiales

(2009)thinsp2ethinspeacutedthinspthinsprsaquo Les obligations deacuteontologiques de lrsquoinfirmiegravere et le consentement aux soins

(2005)

ORDREthinspPROFESSIONNELthinspDESthinspINHALOTHEacuteRAPEUTESthinspDUthinspQUEacuteBECthinsp(OPIQ)

thinsprsaquo Profil national des compeacutetencesthinspLrsquoalliancethinspdesthinsporganismesthinspdethinspregraveglementationthinspenthinsptheacuterapiethinsprespiratoirethinsp(2011)

thinsprsaquo Les notes au dossier dans le secteur de lrsquoassistance anestheacutesique et de la seacutedation analgeacutesiethinsp-thinspGuidethinspdethinsppratiquethinsp(2008)

thinsprsaquo Compeacutetences relatives agrave lrsquoentreacutee dans la pratique (2003)thinsprsaquo Regraveglement sur les dossiers les autres effets les cabinets et la cessation

drsquoexercice des membres de lrsquoOrdre professionnel des inhalotheacuterapeutes du Queacutebecthinsp(2002)thinsp

thinsprsaquo Code de deacuteontologie des inhalotheacuterapeutes du Queacutebec

CMQ - OIIQ - OPIQ 47

thinspANNEXEthinspIIIthinspndashthinspPROCEacuteDURESthinspPROTOCOLESthinspOUthinspALGORITHMESthinsp

Dansthinsptousthinsplesthinsplieuxthinspougravethinspsethinsppratiquethinsplathinspseacutedation-analgeacutesiethinspagravethinspdesthinspfinsthinspdiagnos-tiquesthinspouthinsptheacuterapeutiquesthinsplethinspmeacutedecinthinspresponsablethinspdoitthinspeacutelaborerthinspenthinspcollabora-tionthinspavecthinsplesthinspmembresthinspdethinspsonthinspeacutequipethinspsoignantethinsplesthinspproceacuteduresthinspprotocolesthinspouthinsp

algorithmesthinspconcernantthinspnotammentthinsplesthinspsujetsthinspsuivantsthinsp

PARMIthinspLESthinspPROCEacuteDURESthinspOUthinspPROTOCOLESthinsp(ADULTEthinspETthinspPEacuteDIATRIQUE)thinsp

thinsprsaquo allergiethinspauthinsplatexchocthinspanaphylactiquethinsprsaquo antagonistethinsprsaquo bradycardiethinsprsaquo critegraveresthinspcliniquesthinspdethinspcongeacutethinsprsaquo hypertensionthinspmalignethinsprsaquo seacutedation-analgeacutesiethinsprsaquo transfertthinspdrsquourgence

PARMIthinspLESthinspALGORITHMESthinsp(ADULTEthinspETthinspPEacuteDIATRIQUE)thinsp

thinsprsaquo gestionthinspdesthinspvoiesthinspaeacuteriennesthinspdifficilesthinsp(ventilationintubation)thinsprsaquo reacuteanimationthinspcardiorespiratoirethinsp

thinspthinspthinspILthinspFAUTthinspPENSERthinspAgravethinsp

thinsprsaquo Lrsquoaffichagethinspdesthinspproceacuteduresthinspprotocolesthinspouthinspalgorithmesthinspdrsquourgencethinspquithinsppermettrathinspdrsquoythinspavoirthinspaccegravesthinsprapidementthinspenthinspcasthinspdrsquourgencethinspetthinspdethinsplesthinspconsulterthinspreacuteguliegraverementthinspparthinsplathinspmecircmethinspoccasionthinsp

thinsprsaquo Lrsquoeacutelaborationthinspdrsquounthinspprogrammethinsppeacuteriodiquethinspdrsquoexercicethinsp(pthinspexthinspthinspsimulation)thinspquithinsppermettrathinspdethinsprevoirthinsplesthinspdiffeacuterentesthinspproceacuteduresthinspenthinspplacethinspavecthinsptousthinsplesthinspmembresthinspdethinsplrsquoeacutequipethinspsoignantethinspetthinspdrsquoinitierthinsplethinspnouveauthinsppersonnelthinspassurantthinspainsithinspunethinspmeilleurethinsprelegravevethinspDethinspmecircmethinspmettrethinsplethinspplanthinspenthinsppratiquethinsppermetthinspdrsquooptimiserthinsplathinsprapiditeacutethinspetthinsplathinsppreacutecisionthinspdesthinspgestesthinspposeacuteesthinspetthinspdrsquoidentifierthinspdesthinspproblegravemesthinsppotentielsthinsp(avecthinspdethinsplrsquoeacutequipementthinspparthinspexemple)thinspetthinspcethinspavantthinspqursquoilthinspythinspaitthinspurgencethinspdrsquoagirthinsp

mdash Annexe

CMQ - OIIQ - OPIQ 48

thinspANNEXEthinspIVthinspndashthinspEacuteVALUATIONthinspDESthinspVOIESthinspAEacuteRIENNESthinspSUPEacuteRIEURESthinspAUthinsp

thinspMOYENthinspDUthinspSCOREthinspDEthinspMALLAMPATIthinsp(DIEMUNSCHthinspETthinspCOLLABthinsp2008)thinsp

(Agravethinsptitrethinspinformatifthinspseulement)

Objectifthinspthinspthinsp Eacutevaluerthinsplathinspvisibiliteacutethinspdesthinspstructuresthinsporopharyngeacuteesthinspetthinsplathinsptaillethinspthinsp

dethinsplathinsplangue

Lesthinsp4thinspclassesthinspdethinspMallampatithinspmodifieacuteesthinsp(SamsoonthinspandthinspYoung)thinspsontthinsp

thinsprsaquo ClassethinspIthinspthinspluettethinsppiliersthinspduthinspvoilethinspduthinsppalaisthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIIthinspthinsppiliersthinspduthinspvoilethinspduthinsppalaisthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIIIthinspthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIVthinspthinsppalaisthinspdurthinspseulthinsp

LesthinspclassesthinspIthinspetthinspIIthinsppreacutesagentthinspdrsquounethinspintubationthinspathinsppriorithinspfacilethinsplesthinspclassesthinspIIIthinspetthinspIVthinspdrsquounethinspintubationthinspdifficile

ClassesthinspdethinspMallampatithinspmodifieacuteesthinsp(Jmarchnthinsp[Enthinspligne])

LrsquoinsuffisancethinspdethinsplathinspclassificationthinspdethinspMallampatithinspathinspeacuteteacutethinspspeacutecifiquementthinspmon-treacuteethinspchezthinsplrsquoobegravesethinspEllethinspnethinsppeutthinspecirctrethinspconsideacutereacuteethinspcommethinspunthinsppreacutedicteurthinspisoleacute-mentthinspsuffisantthinspdethinsplathinspdifficulteacutethinspdethinsplathinsplaryngoscopiethinspouthinspathinspfortiorithinspdethinsplrsquointuba-tionthinspdifficilethinsp

mdash Annexe

CMQ - OIIQ - OPIQ 49

ANNEXEthinspVthinspndashthinspOUTILthinspDrsquoEacuteVALUATIONthinspDEthinspLrsquoAPNEacuteEthinspOBSTRUCTIVEthinspDUthinspSOMMEILthinsp

(AOS)thinspADAPTEacutethinspAgravethinspLAthinspCONSULTATIONthinspPREacuteANESTHESIQUESEacuteDATION-thinsp

ANALGEacuteSIEthinspthinsp(ADAPTEacutethinspDEthinspCHUNGthinspETthinspSEETthinsp2010)thinsp(NOTREthinspTRADUCTION)

(Agravethinsptitrethinspinformatifthinspseulement)

mdash Annexe

Exemplethinspdethinspquestionnairethinspstop-bang

Question Reacuteponse

Sthinspnore PreacutesencethinspdethinspronflementVosthinspronflementsthinspsont-ilsthinspbruyants(suffisammentthinsppourthinspecirctrethinspentendusthinspagravethinsptraversthinspunethinspportethinspfermeacutee)

OuithinspouthinspNon

Tthinspiredthinspfatiguethinsporthinspsleepy PreacutesencethinspdethinspsomnolencethinspouthinspfatigueVousthinspsentez-vousthinspsouventthinspfatigueacutethinspeacutepuiseacutethinspouthinspsomnolentthinsppendantthinsplathinspjourneacutee

OuithinspouthinspNon

Othinspbservedthinspapnea ApneacuteethinspobserveacuteethinspQuelqursquounthinspa-t-ilthinspdeacutejagravethinspobserveacutethinspquethinspvousthinspthinsparrecirctiezthinspdethinsprespirerthinspenthinspdormant

OuithinspouthinspNon

Pthinspressure PreacutesencethinspdrsquoHTAAvez-vousthinspouthinspecirctes-vousthinsptraiteacutepourthinspunethinsptensionthinsparteacuteriellethinspeacuteleveacutee

OuithinspouthinspNon

BthinspMI IMCthinspgtthinsp35thinspkgm2 OuithinspouthinspNon

Athinspge Acircgethinspgtthinsp50thinspans OuithinspouthinspNon

Nthinspeck Circonfeacuterencethinspduthinspcouthinspgtthinsp40thinspcm OuithinspouthinspNon

Gthinspender Sexethinspmasculin OuithinspouthinspNon

INTERPREacuteTATIONthinspCLINIQUE

ltthinsp3thinspreacuteponsesthinsppositivesthinsp=thinspfaiblethinsprisquethinspdrsquoAOS

ge 3 reacuteponses positives = risque eacuteleveacute drsquoAOS

CMQ - OIIQ - OPIQ 50

thinspANNEXEthinspVIthinspndashthinspANAMNEgraveSEthinspthinspAIDEthinspMNEacuteMOTECHNIQUEthinsp

(Agravethinsptitrethinspinformatifthinspseulement)

ObjectifthinspthinspthinspthinspCetthinspoutilthinspdrsquoaidethinspmneacutemotechniquethinspsertthinspagravethinspstructurerthinsplathinspfaccedilonthinspdontthinspthinsponthinspprocegravedethinspagravethinsplathinspcollectethinspsommairethinspdesthinspdonneacuteesthinspdansthinsplethinspcadrethinspdethinsplrsquoeacutevaluationthinspcliniquethinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinspfacilitethinsplathinspcompreacutehensionthinspetthinsplathinspreacutealisationthinspdethinsplrsquoanamnegravesethinspchezthinsplrsquoadultethinspetthinsplrsquoenfant

SAMPLEthinsp(AdapteacutethinspdethinspAltonthinspetthinspcollabthinsp2007thinsp[Notrethinsptraduction])thinsp(outhinspvariante)

SthinspthinspSignesthinspetthinspsymptocircmes

AthinspthinspAllergiesthinspetthinspreacuteactionthinsp

MthinspthinspMeacutedicamentsthinspetthinspautresthinspsubstancesthinsp(prescritsthinspouthinspnon)thinspetthinsptraitement

PthinspthinspPasseacutethinspmeacutedicalfamilialthinsp

LthinspthinspLastthinspmeallunchthinsp(dernierthinsprepas)

EthinspthinspEnvironnementeacuteveacutenement

thinsp

mdash Annexe

CMQ - OIIQ - OPIQ 51

thinspANNEXEthinspVIIthinsp-thinspEXAMENthinspPHYSIQUEthinspthinspAIDEthinspMNEacuteMOTECHNIQUE

(Agravethinsptitrethinspinformatifthinspseulement)

Objectifthinspthinspthinsp Lrsquoexamenthinspphysiquethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinspcherchethinspagravethinspmettrethinspenthinspeacutevidencethinspcertainsthinspcritegraveresthinspreconnusthinsppourthinspecirctrethinspassocieacutesthinspagravethinspunethinspassis-tancethinspventilatoirethinspdifficilethinspquithinsppeutthinspsurvenirthinspdansthinsplethinspcasthinspdrsquounthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquethinspceluithinspviseacutethinspparthinspexemple

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinspfacilitethinsplathinspcompreacutehensionthinspetthinsplathinspreacutealisationthinspdethinsplrsquoexamenthinspphysiquethinsprelativementthinspauxthinspvoiesthinspaeacuteriennesthinspdethinsplrsquoadulte

1thinspIndicateursthinspdrsquounethinsppossiblethinspventilationthinspdifficilethinsp(MOANSthinsp[AdapteacutethinspdethinspWallsthinspetthinspthinspthinspthinspthinspMurphythinsp2012]thinsp[Notrethinsptraduction]thinspouthinspvariante)

Mthinspthinspmask sealthinsp(eacutetancheacuteiteacutethinspduthinspmasque)thinspthinspeacutetancheacuteiteacutethinspcompromisethinspenthinspraisonthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspdrsquounethinspbarriegraverethinspmeacutecaniquethinsp(barbethinspfourniethinsptraumatismethinspfacialthinspetc)

OthinspthinspobeacutesiteacuteobstructionthinspthinsppatientthinspdontthinsplrsquoIMCthinspestthinspgtthinsp25thinsp(kgm2)thinspfemmethinspenceintethinspthinspthinspthinspthinspthinspthinspthinspgtthinsp6thinspmoisthinsp(2ethinsptrimestre)thinspangio-œdegravemethinspabcegravesthinspetc

Athinspthinspacircgethinspthinsppatientthinspgethinsp55thinspansthinsp(variablethinspselonthinsplesthinspauteurs)thinspenthinspraisonthinspnotammentthinspthinspthinspthinspthinspthinspthinspdethinsplathinsppertethinspdrsquoeacutelasticiteacutethinspdesthinsptissus

Nthinspthinspno teeththinsp(eacutedenteacute)thinspthinspdifficulteacutethinsplorsthinspdethinsplrsquoassistancethinspventilatoire

Sthinspthinspstiffthinsp(rigiditeacute)thinspthinsppathologiesthinspagravethinspconseacutequencesthinspsurthinsplathinspcompliancethinspetthinsplathinspthinspthinspthinspthinspthinspreacutesistancethinsppulmonairethinsp(asthmethinspMPOCthinsppneumoniethinspdethinspstadethinspavanceacutethinspetc)

thinspthinspVentilationthinspdifficilethinsp(masquethinspouthinspoutilthinspextraglottiquethinsptelthinspquethinspmasquethinspthinspthinspthinspthinspthinsplaryngeacute)thinsp(AdapteacutethinspdethinsplrsquoAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinsp[Notrethinspthinspthinspthinspthinspthinsptraduction])thinspImpossiblethinspdrsquoeffectuerthinspunethinspventilationthinspdethinspfaccedilonthinspadeacutequatethinspthinspthinspthinspthinspthinspenthinspraisonthinspdethinsplrsquounethinspetouthinspdethinsplrsquoautrethinspdesthinspsituationsthinspsuivantesthinsp

athinspMauvaisethinspeacutetancheacuteiteacutethinspduthinspmasquethinspouthinspdethinsplrsquooutilthinspextraglottiquebthinspFuitethinspdethinspgazthinspexcessivecthinspReacutesistancethinspexcessivethinspagravethinsplrsquoinspirationthinspouthinspagravethinsplrsquoexpiration

thinsp

mdash Annexe

CMQ - OIIQ - OPIQ 52

2thinspIndicateursthinspdrsquounethinsppossiblethinsplaryngoscopiethinspouthinspintubationthinspdifficilethinsp(thinspLEMONthinspthinspthinspthinspthinspthinsp[WallsthinspetthinspMurphythinsp2012thinspopthinspcit]thinsp[Notrethinsptraduction]thinspouthinspvariante)

Lthinspthinspthinsplook externallythinsp(apparencethinspphysique)thinspthinspmicrognathiethinspmacroglossiethinspdenti-tionthinspirreacuteguliegraverethinspcirconfeacuterencethinspduthinspcouthinspgethinspgrossessethinspetc

thinspEthinspthinspthinspeacutevaluationthinspthinspregraveglethinspduthinsp3-3-2thinsp(variantethinsppossiblethinspselonthinsplesthinspauteurs)thinsp-thinspthinsp

consideacuterationsthinspgeacuteomeacutetriquesthinsp(agravethinsplrsquoaidethinspdesthinspdoigtsthinspduthinsppatient)3thinspthinsp ouverturethinspdethinspbouchethinspthinspinsertionthinspdethinsp3thinspdethinspsesthinspdoigts3thinspthinsp taillethinspduthinsplarynxthinsp(longueurthinspmandibulaire)thinspthinsp3thinspdoigtsthinspsousthinsplethinspmentonthinsp

(boutthinspdethinspsonthinspmentonthinspjusqursquoagravethinsplathinspjonctionthinspduthinspcouthinspauthinspniveauthinspdethinspthinsplrsquoosthinsphyoiumlde)

2thinspthinsp positionthinspduthinsplarynxthinspthinsp2thinspdethinspsesthinspdoigtsthinspentrethinsplathinspjonctionthinspcou-mentonthinsp(osthinspthinsphyoiumlde)thinspetthinsplethinspcartilagethinspthyroiumlde

thinspMthinspthinspthinspMallampatithinsp(annexethinspIV)thinspOthinspthinspthinspobeacutesiteacuteobstructionthinspthinspIMCthinspthinspœdegravemethinspduthinsplarynxthinspneacuteoplasiethinspdethinsplathinspsphegraverethinsp

ORLthinspcompressionthinspextrinsegravequethinspparthinspheacutematomethinspcervicalthinspdifficulteacutethinspagravethinspavalerthinspdyspneacutee

thinspNthinspthinspthinspneck mobilitythinsp(mobiliteacutethinspcervicale)thinspthinspimmobilisationthinspauthinspmoyenthinspdrsquounthinspcol-

lierthinspcervicalthinsppreacutesencethinspdrsquounethinsppathologiethinspouthinspdrsquounethinspsituationthinspcliniquethinspagravethinspconseacutequencethinspsurthinsplrsquoassistancethinspventilatoirethinspouthinspdethinsplrsquointubationthinsp(pthinspexthinspthinspthinsparthrosethinspouthinsparthritethinspimportantethinsptrisomiethinsp21thinspetc)

thinspthinsp Lanryngoscopiethinspdifficilethinspthinspimpossibiliteacutethinspdethinspvisualiserthinspnrsquoimportethinspquellethinsppartiethinspdesthinspcordesthinspvocalesthinspapregravesthinspdethinspmultiplesthinsptentativesthinspavecthinspunthinsplaryngoscopethinspconventionnelthinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinspop citthinsp[Notrethinsptraduction])thinsp

thinspthinspIntubationthinspendotracheacutealethinspdifficilethinspthinspintubationthinspquithinsprequiertthinspdethinspmultiplesthinspthinsptentativesthinspenthinsppreacutesencethinspouthinspenthinsplrsquoabsencethinspdrsquounethinsppathologiethinsptracheacutealethinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinspop citthinspthinsp[Notrethinsptraduction])

IlthinspfautthinspnoterthinspquethinsplrsquoinsuffisancethinspdethinsplathinspclassificationthinspdethinspMallampatithinspathinspeacuteteacutethinspspeacutecifiquementthinspmontreacuteethinspchezthinsplrsquoobegravesethinspellethinspnethinsppeutthinspecirctrethinspconsideacutereacuteethinspcommethinspunthinsppreacutedicteurthinspisoleacutementthinspsuffisantthinspdethinsplathinspdifficulteacutethinspdethinsplathinsplaryngoscopiethinspouthinspathinspfortiorithinspdethinsplrsquointubationthinspdifficile

mdash Annexe

ge

ge

CMQ - OIIQ - OPIQ 53

thinspANNEXEthinspVIIIthinsp-thinspLEthinspCONSENTEMENT

SelonthinsplethinspdroitthinspenthinspvigueurthinspilthinspestthinspobligatoirethinspauthinspQueacutebecthinspdrsquoobtenirthinsplethinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspintervention

LethinspCode civil du Queacutebec eacutetablitthinspdesthinspregraveglesthinspgeacuteneacuteralesthinspconcernantthinsplethinspconsente-mentthinspauxthinspsoinsthinspquithinspsrsquoappliquentthinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspOnthinspythinspfaitthinspcependantthinspcertainesthinspdistinctionsthinspselonthinspquethinsplesthinspsoinsthinspsontthinsprequisthinspouthinspnonthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspetthinspselonthinspquethinsplethinsppatientthinspestthinspaptethinspagravethinspconsentirthinspouthinspnon

Sithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsp(traitementsthinspdethinspmeacutedecinethinspetthinspdethinspchirurgiethinspestheacutetiquethinspexpeacuterimentationthinspetthinspdonsthinspdrsquoorganes)thinsplethinsppatientthinspdoitthinspecirctrethinspinformeacutethinspdethinsptousthinsplesthinsprisquesthinsppossiblesthinspmecircmethinspsrsquoilsthinspsontthinspraresthinspetthinsplethinspconsentementthinspdoitthinspecirctrethinspdonneacutethinspparthinspeacutecritthinspHabituellementthinspilthinspnethinsppeutthinspecirctrethinspdonneacutethinspquethinspparthinspunthinsppatientthinspaptethinspetthinspacircgeacutethinspdethinsp14thinspansthinspetthinspplusthinspparthinsplethinspmandatairethinsplethinsptuteurthinspouthinsplethinspcurateurthinspdrsquounethinsppersonnethinspinaptethinspouthinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinspdrsquounethinsppersonnethinspdethinspmoinsthinspdethinsp14thinspansthinspLrsquoautorisationthinspdethinsplathinspcourthinspestthinspenthinspoutrethinspneacutecessairethinspsithinsplesthinspsoinsthinsppreacutesententthinspunthinsprisquethinspseacuterieuxthinsppourthinsplathinspsanteacutethinspdethinspcesthinsppersonnesthinspouthinspsrsquoilsthinsppeuventthinspcauserthinspdesthinspeffetsthinspgravesthinspetthinsppermanentsthinspUnethinsppersonnethinspmineurethinspdethinspthinsp14thinspansthinspetthinspplusthinsppeutthinspconsentirthinspseulethinspagravethinspmoinsthinspqursquoilthinspsrsquoagissethinspdethinspsoinsthinspnonthinsprequisthinspetthinspthinspcomportantthinspdesthinsprisques

SrsquoilthinspsrsquoagitthinspdethinspsoinsthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsplrsquoobligationthinspdrsquoinformerthinspcroicirctthinspenthinspfonctionthinspdethinsplathinsppreacutevalencethinspetthinspdethinsplathinspgraviteacutethinspdesthinspcomplicationsthinspSithinsplethinsppatientthinspestthinspinaptethinspetthinspqursquoilthinspnrsquoestthinsppasthinsprepreacutesenteacutethinspparthinspunthinspmandatairethinspunthinsptuteurthinspouthinspunthinspcura-teurthinsplethinspconsentementthinsppeutthinspecirctrethinspdonneacutethinspparthinspunthinspconjointthinspouthinspagravethinspdeacutefautthinspduthinspconjointthinspparthinspunthinspprochethinspouthinspunethinsppersonnethinspquithinspdeacutemontrethinspunthinspinteacuterecirctthinspparticulierthinsppourthinsplathinspper-sonnethinspinaptethinspIlthinspnrsquoythinspathinsppasthinspdrsquoobligationthinspagravethinspcethinspquethinspcethinspconsentementthinspsoitthinspdonneacutethinspparthinspeacutecritthinspLethinspconsentementthinspauxthinspsoinsthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspdrsquounethinsppersonnethinspmi-neurethinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinspouthinsplethinsptuteurthinspUnethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsppeutthinspconsentirthinspmaisthinspnethinsppeutthinsppasthinsprefuserthinspseulethinspdesthinspsoinsthinspquithinspseraientthinspjugeacutesthinsprequisthinspEnthinspcasthinspdrsquourgencethinsplethinspconsentementthinspauxthinspsoinsthinspmeacutedicauxthinspnrsquoestthinsppasthinspneacutecessairethinsplorsquethinsplathinsppersonnethinspouthinspsonthinspinteacutegriteacutethinspestthinspmenaceacuteethinspetthinspquethinsplethinspconsentementthinspnethinsppeutthinspecirctrethinspobtenuthinspagravethinsptemps

LathinspLoi sur les servicesthinspdethinspsanteacutethinspetthinsplesthinspservicesthinspsociauxthinsp(LSSS)thinspeacutetablitthinspquantthinspagravethinspellethinspcertainesthinspregraveglesthinspenthinspmatiegraverethinspdethinspconsentementthinspauxthinspinterventionsthinspchirurgicalesthinspetthinspagravethinsplrsquoanestheacutesiethinsp

mdash Annexe

CMQ - OIIQ - OPIQ 54

Selonthinspcettethinsploithinsplethinspconsentementthinspagravethinspunethinspanestheacutesiethinspouthinspagravethinspunethinspinterventionthinspchirurgi-calethinspdoitthinspecirctrethinspattesteacutethinspparthinspunthinspdocumentthinspeacutecritthinspsigneacutethinspparthinsplethinsppatientthinspouthinspsonthinsprepreacutesen-tantthinspetthinspcethinspdocumentthinspdoitthinspfairethinspeacutetatthinspdesthinspinformationsthinspapproprieacuteesthinspconcernantthinspnotammentthinsplesthinsprisquesthinspouthinsplesthinspeffetsthinsppossiblesthinspCetthinspeacutecritthinspdoitthinspecirctrethinspcontresigneacutethinspparthinsplethinspmeacutedecinthinspouthinsplethinspdentistethinsptraitantthinspetthinspconserveacutethinspdansthinsplethinspdossierthinspduthinsppatientthinspLethinspdossierthinspdoitthinspcontenirthinspunthinspdocumentthinspattestantthinsplethinspconsentementthinsppourthinsplesthinspsoinsthinspetthinsplesthinspservicesthinspdispenseacutesthinspdansthinspunthinspcentrethinsphospitalierthinsp(CH)thinspunthinspcentrethinspdrsquoheacutebergementthinspetthinspdethinspsoinsthinspdethinsplonguethinspdureacuteethinsp(CHSLD)thinspetthinspunthinspcentrethinsplocalthinspdethinspservicesthinspcommunau-tairesthinsp(CLSC)

CesthinspdispositionsthinspnethinspsrsquoappliquentthinspqursquoauxthinspsoinsthinspdispenseacutesthinspenthinspeacutetablissementthinspthinspMaintenantthinspquethinspplusieursthinspinterventionsthinspautrefoisthinspreacuteserveacuteesthinspauxthinspeacutetablissementsthinsppeuventthinspecirctrethinspeffectueacuteesthinspenthinspdehorsthinspdethinspceux-cithinsplathinspquestionthinspsethinspposethinsptoutefoisthinspdethinspsavoirthinspsithinsplesthinspmecircmesthinspexigencesthinspdevraientthinspsrsquoappliquerthinsppartoutthinsp

Qursquoenthinspest-ilthinspparthinspexemplethinspdethinsplathinspsignaturethinspdrsquounthinspformulairethinspdethinspconsentementthinspEnthinsppratiquethinspetthinspagravethinsplrsquousagethinspilthinspsrsquoestthinspaveacutereacutethinspqursquounthinspformulairethinspdethinspconsentementthinspducircmentthinspsigneacutethinspnethinsppeutthinspagravethinspluithinspseulthinspprouverthinspquethinsplethinspconsentementthinspathinspeacuteteacutethinsplibrethinspetthinspeacuteclaireacutethinspUnethinspcourtethinspnotethinspverseacuteethinspauthinspdossierthinspreacutesumantthinsplesthinspinformationsthinsptransmisesthinspetthinsplesthinspeacutechangesthinspauxquelsthinspellesthinspontthinspdonneacutethinsplieuthinspestthinsppreacutesentementthinspjugeacuteethinspbeaucoupthinspplusthinsppertinentethinspagravethinspcetthinspeacutegardthinspLethinspformulairethinspdethinspconsentementthinspcomplegravetethinsplesthinsprenseigne-mentsthinspfournisthinspverbalementthinspIlthinspsrsquoagitthinspdrsquounthinspajoutthinspagravethinsplrsquoinformationthinspverbalethinsptransmisethinspthinsp

etthinspnonthinspdrsquounethinspmesurethinspvisantthinspagravethinsplathinspremplacer

LethinspCode de deacuteontologiethinspdes meacutedecinsthinsppreacutecisethinsplesthinspobligationsthinspdesthinspmeacutedecinsthinsp

quantthinspauthinspconsentementthinsp

Article 28Le meacutedecin doit sauf urgence avant drsquoentreprendre un examen une investiga-tion un traitement ou une recherche obtenir du patient ou de son repreacutesentant leacutegal un consentement libre et eacuteclaireacute

Article 29Le meacutedecin doit srsquoassurer que le patient ou son repreacutesentant leacutegal a reccedilu les explications pertinentes agrave leur compreacutehension de la nature du but et des conseacutequences possibles de lrsquoexamen de lrsquoinvestigation du traitement ou de la recherche qursquoil srsquoapprecircte agrave effectuer Il doit faciliter la prise de deacutecision du patient et la respecter

mdash Annexe

CMQ - OIIQ - OPIQ 55

DansthinspsesthinspguidesthinspdrsquoexercicethinspportantthinspsurthinsplathinsptenuethinspdesthinspdossiersthinsplethinspCollegravegethinspestimethinspdrsquoailleursthinspquethinsplethinspdossierthinspdrsquounthinsppatientthinspdoitthinspcontenirthinspunethinspnotethinspattestantthinspquethinsplesthinspin-formationsthinspneacutecessairesthinspagravethinspunethinspprisethinspdethinspdeacutecisionthinspeacuteclaireacuteethinspontthinspeacuteteacutethinsptransmisesthinspparthinsplethinspmeacutedecinthinspetthinspcomprisesthinspparthinsplethinsppatientthinspouthinspsonthinsprepreacutesentantthinsplorsquethinsplathinspchosethinspestthinspjugeacuteethinsppertinentethinspathinspfortiorithinsplorsqursquoilthinspsrsquoagitthinspdrsquounethinspinterventionthinspchirurgicalethinspdrsquounethinspinterventionthinspchirurgicalethinspsousthinspseacutedation-analgeacutesiethinspdrsquoanestheacutesiethinspreacutegionalethinspouthinspgeacuteneacuteralethinsp

DansthinsplethinspCode de deacuteontologie des infirmiegraveres et infirmiersthinsponthinsppreacutevoitthinspquethinsp

thinspArticle 40 Lrsquoinfirmiegravere ou lrsquoinfirmier doit fournir agrave son client toutes les explications neacuteces-saires agrave la compreacutehension des soins et des services qursquoil lui prodigue

Article 41Lorsque lrsquoobligation drsquoobtenir un consentement libre et eacuteclaireacute incombe agrave lrsquoin-firmiegravere ou agrave lrsquoinfirmier ce dernier doit fournir au client toutes les informations

requises

LethinspCode de deacuteontologie des inhalotheacuterapeutes du Queacutebecthinspnethinspcontientthinsppasthinspdethinsp

dispositionthinsptouchantthinsppreacuteciseacutementthinsplethinspconsentementthinspOnthinsppreacutecisethinspcependantthinspquethinsp

Article 13En plus des avis et des conseils lrsquoinhalotheacuterapeute doit fournir agrave son client les explications neacutecessaires agrave la compreacutehension et agrave lrsquoappreacuteciation des services qursquoil

lui rend

EnthinspcompleacutementthinspdansthinspsesthinspnormesthinspdethinsppratiquethinspportantthinspsurthinsplathinsptenuethinspdesthinspdossiersthinsplrsquoOrdrethinspprofessionnelthinspdesthinspinhalotheacuterapeutesthinspduthinspQueacutebecthinspdemandethinspquethinsplethinspdos-sierthinspdrsquounthinsppatientthinspcomportethinspunethinspmentionthinspdesthinspsoinsthinspetthinspdesthinspservicesthinspprodigueacutesthinspagravethinspsonthinspeacutegardthinspAgravethinspcetthinspeffetthinsptoutethinspactiviteacutethinspexerceacuteethinspparthinsplrsquoinhalotheacuterapeutethinsptellethinspquethinsplrsquoinformationthinsptransmisethinspauthinsppatientthinspeuthinspeacutegardthinspagravethinsplathinspseacutedation-analgeacutesiethinspdoitthinspecirctrethinspinscritethinspauthinspdossierthinspduthinsppatientthinspetthinspcethinspauthinspfurthinspetthinspagravethinspmesurethinspquethinsplesthinspactiviteacutesthinspsontthinspexerceacutees

EnthinspsommethinsplathinsploithinspexigethinspunthinspconsentementthinspeacutecritthinspsithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspainsithinspquethinsppourthinsplesthinspanestheacutesiesthinsplesthinspinterventionsthinspchirurgicalesthinspetthinsplesthinspsoinsthinspdispenseacutesthinspenthinspeacutetablissementthinspDansthinspsesthinspguidesthinspportantthinspsurthinsplesthinspproceacuteduresthinspetthinspinterventionsthinspenthinspmilieuthinspextrahospitalierthinspnotammentthinsplethinspCollegravegethinsprecommandethinsptoutefoisthinspquethinsplethinspmeacutedecinthinspversethinspunethinspnotethinspexplicativethinspauthinspdossierthinspetthinspobtiennethinspunthinspconsentementthinspeacutecritthinsppourthinsptoutethinspinterventionthinspmeacutedicalethinspouthinsp

mdash Annexe

CMQ - OIIQ - OPIQ 56

chirurgicalethinspeffractivethinspqursquoellethinspsoitthinspeffectueacuteethinspdansthinspunthinspbutthinspdiagnosticthinsptheacuterapeu-tiquethinspouthinspestheacutetiquethinspLorsquethinsplethinspconsentementthinspportethinspagravethinsplathinspfoisthinspsurthinsplathinspseacutedation-thinspthinspanalgeacutesiethinspetthinspsurthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsplrsquoinformationthinsptrans-misethinspdoitthinspinclurethinsplesthinsprisquesthinspdethinsplrsquointerventionthinspetthinspceuxthinspdethinsplathinspseacutedation-analgeacutesiethinspcelle-cithinsppouvantthinspcomporterthinspdesthinsprisquesthinspimportantsthinspmecircmethinspsithinsplrsquointerventionthinspestthinspmineure

Lrsquoobtentionthinspdrsquounthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspdemeurethinspunethinspobligationthinspthinspinheacuterentethinspagravethinsplrsquointerventionthinspmeacutedicalethinspelle-mecircmethinspIlthinsprelegravevethinspdoncthinspdethinsplathinspresponsabiliteacutethinspduthinspmeacutedecinthinspdethinspsrsquoassurerthinspdethinsplathinsptransmissionthinspdethinsplrsquoinformationthinsppertinentethinspauthinsppatientthinspetthinspdethinspsathinspcompreacutehensionthinspdethinsplathinspnaturethinspduthinspbutthinspetthinspdesthinsprisquesthinsprelatifsthinspagravethinsplrsquointerventionthinspToutefoisthinsplathinsptacircchethinspdethinsptransmettrethinspdethinsplrsquoinfor-mationthinspcompleacutementairethinspouthinspdethinspfairethinsplrsquoenseignementthinspauxthinsppatientsthinsppeutthinspecirctrethinspconfieacuteethinspagravethinspdrsquoautresthinspprofessionnelsthinspetthinspcellethinspdethinsprecueillirthinsplathinspsignaturethinspdrsquounthinspthinspformulairethinspdethinspconsentementthinspagravethinspdrsquoautresthinspmembresthinspdethinsplrsquoeacutequipethinspdethinspsoins

mdash Annexe

CMQ - OIIQ - OPIQ 57

mdash Annexe

thinspANNEXEthinspIXthinsp-thinspEacuteVALUATIONthinspDEthinspLrsquoEFFICACITEacutethinspDEthinspLAthinspSEacuteDATIONthinsp(EXEMPLES)thinsp

(Listethinspnonthinsplimitative)thinsp

1 Eacutechelle de seacutedation de Ramsay modifieacuteethinsp(Adapteacute de Merchant et collab 2014b op cit)

Instruction Descriptiondeacutefinition Valeur

thinspObserverthinsplethinsppatientEacuteveilleacutethinspthinsplethinsppatientthinspestthinspanxieuxthinspetthinspagiteacutethinspouthinspnerveuxthinspouthinsplesthinspdeux 1

ObserverthinsplethinsppatientLethinsppatientthinspeacutetablit-ilthinspunthinspcontactthinspvisuelthinspetthinspreacutepond-ilthinspauxthinspordres

Eacuteveilleacutethinspthinsplethinsppatientthinspestthinspcoopeacuteratifthinspthinsporienteacutethinspetthinspcalme 2

ParlerthinspauthinsppatientthinspLethinsppatientthinspeacutetablit-ilthinspunthinspcontactthinspvisuelthinspetthinspreacutepond-t-ilthinspauxthinspordres

Eacuteveilleacutethinspthinsplethinsppatientthinspreacutepondthinspseulementthinspauxthinspordres 3

StimulerthinspphysiquementthinsplethinsppatientthinspenthinspagitantthinspsonthinspeacutepaulethinsptoutthinspenthinspparlantthinspfortthinspLethinsppatientthinspreacuteagit-ilthinspdansthinsplesthinsp10thinspsecon-des

Endormithinspthinsplethinsppatientthinspreacuteagitthinspparthinspunethinspreacuteponsethinspvivethinspagravethinsplathinspstimulationthinspdethinsplathinspgla-bellethinspouthinspagravethinspunthinspstimulusthinspauditifthinspintense 4

StimulerthinspphysiquementthinsplethinsppatientthinspenthinspagitantthinspsonthinspeacutepaulethinsptoutthinspenthinspparlantthinspfortthinspLethinsppatientthinspreacuteagit-ilthinspapregravesthinsp10thinspsecondes

Endormithinspthinsplethinsppatientthinspreacuteagitthinspparthinspunethinspreacuteponsethinspfaiblethinspagravethinsplathinspstimulationthinspdethinsplathinspglabellethinspouthinspagravethinspunthinspstimulusthinspauditifthinspintense

5

UtiliserthinspdesthinspstimulithinspdouloureuxAucunethinspreacuteaction

Endormithinspthinsplethinsppatientthinspnethinspreacuteagitthinsppasthinspagravethinsplathinspdouleur 6

thinsp Peuthinspimportethinsplrsquoeacutechellethinsputiliseacuteethinspcelle-cithinspdoitthinspecirctrethinspchoisiethinspselonthinsplathinspclientegravelethinspetthinsplethinspcontextethinspdonneacutethinspDethinspmecircmethinspsonthinsputilisationthinspdoitthinspecirctrethinspuniformethinspetthinspstandardiseacuteethinspauthinspseinthinspdrsquounethinspmecircmethinspeacutequipethinsp

CettethinspeacutechellethinsppeutthinspecirctrethinsputiliseacuteethinspchezthinsplrsquoenfantthinspToutefoisthinspellethinspserathinspdavantagethinsputilethinspdansthinsplethinspcadrethinspdrsquounethinspeacutevaluationthinsppostseacutedationthinsp(soinsthinsppostproceacutedures)thinspcarthinspilthinsppeutthinspecirctrethinspcliniquementthinspinapproprieacutethinspdethinspstimulerthinspphysiquementthinspunthinspenfantthinspsousthinspseacutedationthinspprofondethinsp

CMQ - OIIQ - OPIQ 58

2 Eacutechelle de vigilance-agitation de Richmond (Richmond Agitation Sedation Scale - RASS) (Tireacute et adapteacute de Chanques et collab 2006)

Lathinsptraductionthinspfranccedilaisethinspdethinspcettethinspeacutechellethinspathinspfaitthinsplrsquoobjetthinspdrsquounethinspvalidationthinspdethinspsathinspthinspreproductibiliteacutethinspinterobservateurthinsp

mdash Annexe

Instruction DescriptionDeacutefinition Niveau

Observerthinsplethinsppatientthinspsansthinspfairethinspdethinspbruit

Srsquoilthinspmanifestethinspunethinspactiviteacutethinspmotricethinspspon-taneacuteethinspquantifierthinsplethinspniveauthinspdrsquoagitationthinsp

Combatifthinspthinspdangerthinspimmeacutediatthinspenversthinsplrsquoeacutequipe + 4Tregraves agiteacutethinspthinsptirethinsparrachethinsptuyauxthinspouthinspcatheacutetersthinspetouthinspagressifthinspenversthinsplrsquoeacutequipe + 3Agiteacutethinspthinspmouvementsthinspfreacutequentsthinspsansthinspbutthinsppreacutecisthinspetouthinspdeacutesadaptationthinspauthinsprespirateur + 2Ne tient pas en placethinspthinspanxieuxthinspouthinspcraintifthinspmaisthinspmouvementsthinsporienteacutesthinsppeuthinspfreacutequentsthinspnonthinspvigoureuxthinspnonthinspagressifs

+ 1

Srsquoilthinspestthinspcalmethinspetthinspreacutepondthinspouthinspnonthinspauxthinspordresthinspsimplesthinsp

Eacuteveilleacute et calmethinspthinspcalmethinspetthinsplesthinspyeuxthinspouvertsConscientthinspthinspRASSthinsp0thinsp+thinspreacutepondthinspauxthinspordresthinspsimples

0

Srsquoilthinspestthinspcalmethinsplesthinspyeuxthinspfermeacutesthinspthinspquan-tifierthinsplethinspniveauthinspdrsquohypovigilancethinsp(outhinspdrsquoendormissement)thinspenthinspsrsquoadressantthinspauthinsppatientthinspparthinspsonthinspnomthinspsansthinsplethinsptoucherthinspenthinsputilisantthinspunethinspvoixthinspdethinspplusthinspenthinspplusthinspfortethinspetthinspdrsquoautantthinspplusthinspfortethinspquethinsplethinsppatientthinspestthinspsusceptiblethinspdrsquoecirctrethinspsourdthinsp(sujetthinspacircgeacutethinspseacutejourthinspprolongeacutethinspenthinspreacuteanimationthinspthinspbouchonthinspdethinspceacuterumenthinsptoxiciteacutethinspdesthinspantibiotiquesthinspetthinspduthinspfuroseacutemide)thinsp

Somnolentthinspthinsppasthinspcomplegravetementthinspeacuteveilleacutethinspmaisthinsprestethinspeacuteveilleacutethinspauthinspcontactthinspvisuelthinspagravethinsplrsquoappelthinspthinsp(gtthinsp10thinsps)

- 1

Diminution leacutegegravere de la vigilancethinspthinsprestethinspeacuteveilleacutethinspbriegravevementthinspavecthinspcontactthinspvisuelthinspagravethinsplrsquoappelthinsp(ltthinsp10thinsps)

- 2

Diminution modeacutereacutee de la vigilancethinspthinspnrsquoimportethinspquelthinspmouvementthinspagravethinsplrsquoappelthinsp(ouverturethinspdesthinspyeux)thinspmaisthinsppasthinspdethinspcon-tactthinspvisuel

- 3

Sithinsplethinsppatientthinspnethinspfaitthinspaucunthinspmouvementthinspythinspcompristhinspenthinsplrsquoappelantthinspdrsquounethinspvoixthinspfortethinspthinspfrictionnerthinspdrsquoabordthinsplrsquoeacutepaulethinsppuisthinsplethinspster-numthinspsansthinspecirctrethinspnociceptifthinsp

Diminution profonde de la vigilancethinspthinspau-cunthinspmouvementthinspagravethinsplrsquoappelthinspnrsquoimportethinspquelthinspmouvementthinspagravethinsplathinspstimulationthinspphysiquethinsp(frictionthinspnonthinspnociceptivethinspdethinsplrsquoeacutepaulethinspouthinspduthinspsternum)

- 4

Non reacuteveillablethinspthinspaucunethinspmouvementthinspnithinspagravethinsplrsquoappelthinspnithinspagravethinsplathinspstimulationthinspphysiquethinsp(frictionthinspnonthinspnociceptivethinspdethinsplrsquoeacutepaulethinspouthinspduthinspsternum)

- 5

CMQ - OIIQ - OPIQ 59

thinspANNEXEthinspXthinsp-thinspEacuteVALUATIONthinspDEthinspLrsquoEFFICACITEacutethinspDEthinspLrsquoANALGEacuteSIEthinsp(EXEMPLES)

(Listethinspnonthinsplimitative)thinsp

Selonthinsplrsquoacircgethinspduthinsppatientthinspsathinspconditionthinspetthinsplethinspcontextethinspcliniquethinspdeuxthinspstrateacutegiesthinspdrsquoeacuteva-luationthinsppeuventthinspecirctrethinsputiliseacuteesthinspsoitthinsplrsquoauto-eacutevaluationthinsp(parthinspdesthinspmotsthinspdesthinspchiffresthinspthinspouthinspdesthinspdessins)thinspouthinsplrsquoheacuteteacutero-eacutevaluationthinspcomportementalethinspCelathinspditthinspsithinsplrsquoauto-thinspeacutevaluationthinspestthinspagravethinspprivileacutegierthinspcrsquoestthinsptoutefoisthinsplrsquoacircgethinspduthinsppatientthinsp(patientthinsppeacutediatrique)thinspetthinspsathinspcapaciteacutethinspcognitivethinspquithinspguiderontthinsplethinspchoixthinspduthinspclinicienthinspdansthinsplathinspseacutelectionthinspduthinspmeilleurthinspoutilthinsp

Pourthinsplethinsppatientthinspnrsquoayantthinsppasthinsplathinspcapaciteacutethinsp(pthinspexthinspthinsphabiliteacutethinspverbalethinspouthinspcognitivethinsplimiteacutee)thinspdrsquoeacutevaluerthinsplui-mecircmethinsplrsquointensiteacutethinspdethinsplathinspdouleurthinspunethinspreacuteponsethinspverbalethinsp(ouinon)thinspouthinspgestuellethinspsignifiantthinsplathinsppreacutesencethinspouthinsplrsquoabsencethinspdethinspdouleurthinspconstituethinspunethinspformethinspdrsquoauto-eacutevaluationthinspacceptablethinspenthinsppratiquethinspcliniquethinspaupregravesthinspdethinspcertainesthinsppopulationsthinsptellesthinspquethinsplethinspjeunethinspenfantthinsplethinsppatientthinspdeacutementthinspouthinspceluithinspvivantthinspavecthinspunethinspdeacuteficiencethinspintellectuellethinsp(McCafferythinspciteacutethinspdansthinspHerrthinspetthinspcollabthinsp2011thinsp[Notrethinsptraduc-

tion])

thinspthinsp Peuthinspimportethinsplrsquoeacutechellethinsputiliseacuteethinspcelle-cithinspdoitthinspecirctrethinspchoisiethinspselonthinsplathinspclientegravelethinspetthinsplethinspcontextethinspdonneacutethinspDethinspmecircmethinspsonthinsputilisationthinspdoitthinspecirctrethinspuniformethinspetthinspstandardiseacuteethinspauthinspseinthinspdrsquounethinspmecircmethinspeacutequipethinspsoignantethinsp

ADULTE-AIcircNEacutethinsp

AUTO-EacuteVALUATIONthinsp(DOULEURthinspAIGUEuml)

thinsprsaquo Eacutechellethinspnumeacuteriquethinsp(0thinspagravethinsp10)thinsp(EN)thinsprsaquo Eacutechellethinspverbalethinspsimplethinsp(EVS)thinsprsaquo Eacutechellethinspvisuellethinspanalogiquethinsp(EVA)

HEacuteTEacuteRO-EacuteVALUATIONthinspCOMPORTEMENTALEthinsp(DOULEURthinspAIGUEuml)

thinsprsaquo ALGOPLUSthinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspdesthinsptroublesthinspdethinsplathinspcommunicationthinspverbale)

thinsprsaquo PACSLACthinspouthinspPACSLAC-Fthinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspunethinspcapaciteacutethinsplimiteacuteethinspagravethinspcommuniquer

thinsprsaquo PAINADthinsp(anglais)thinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspunethinspdeacutemencethinspouthinspautrethinsptroublethinspcognitifthinspetthinspquithinspnethinsppeutthinspcommuniquerthinspdethinspmaniegraverethinspfiable

Les hyperliens concernant ces eacutechelles sont fournis agrave titre informatif seulement

mdash Annexe

CMQ - OIIQ - OPIQ 07

Puisquethinsplrsquoenfantthinsppossegravedethinspdesthinspcaracteacuteristiquesthinspquithinspluithinspsontthinsppropresthinspunethinspsectionthinspparticuliegraverethinspluithinspestthinspconsacreacuteethinsp

Enthinsptoutthinsptempsthinspnousthinspdevonsthinsprecourirthinspagravethinsplathinspseacutedation-analgeacutesiethinspavecthinspthinspcirconspectionthinspetthinspprudencethinspLrsquoeacutevaluationthinspduthinsppatientthinsplrsquoadministrationthinspthinspdethinsplathinspmeacutedicationthinspetthinsplathinspsurveillancethinspcliniquethinspdoiventthinspecirctrethinspeffectueacuteesthinspthinspavecthinsplathinspmecircmethinsprigueurthinspquethinsppourthinsplrsquoanestheacutesiethinspgeacuteneacuteralethinsp

CMQ - OIIQ - OPIQ 08

Chapitre 1 Patient adulte

thinsp11thinspDEacuteFINITIONthinspOBJECTIFSthinspETthinspCLIENTEgraveLEthinspCIBLEthinsp

Lathinspseacutedation-analgeacutesiethinspestthinspunethinspproceacutedurethinspquithinspsethinspdeacutefinitthinspcommethinspeacutetantthinsplrsquoadmi-nistrationthinspdethinspmeacutedicamentsthinspouthinspdethinspsubstancesthinspservantthinspagravethinspalteacutererthinsplethinspniveauthinspdethinspconsciencethinspdrsquounethinsppersonnethinspsathinspperceptionthinspdethinsplathinspdouleurthinspetthinspsathinsptoleacuterancethinspagravethinsplrsquoen-vironnementthinsptoutthinspenthinspluithinsppermettantthinspunethinspreacuteponsethinspagravethinsplathinspstimulationthinspverbalethinspouthinsptactilethinspetthinsplethinspmaintienthinspdrsquounethinspfonctionthinspcardiaquethinspetthinspventilatoirethinspadeacutequatethinspenthinsptousthinsppointsthinsp(OPIQthinsp2009)

Ellethinsppermetthinspdoncthinspdethinspmieuxthinsptoleacutererthinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspdethinspfaccedilonthinspseacutecuritairethinspCertainsthinsppatientsthinsprequerrontthinspsurtoutthinspunethinspseacutedationthinspdrsquoautresthinspunethinspanalgeacutesiethinspetthinsplathinspplupartthinsplesthinspdeuxthinspagravethinsplathinspfoisthinspLesthinspmeacutedicamentsthinspetthinsplathinspproceacutedurethinsputiliseacutesthinspdeacutependrontthinspprincipalementthinspduthinspniveauthinspdethinspseacutedationthinspetthinspdrsquoanal-geacutesiethinspdeacutesireacutethinspselonthinsplathinspnaturethinspetthinsplathinspdureacuteethinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacutera-peutiquethinspetthinspselonthinsplesthinspcaracteacuteristiquesthinspduthinsppatientthinspDrsquoailleursthinsplesthinspbesoinsthinspparticu-liersthinspduthinsppatientthinspdoiventthinspecirctrethinsppristhinspenthinspconsideacuteration

Lesthinspobjectifsthinspviseacutesthinspparthinsplathinspseacutedation-analgeacutesiethinsplorsthinspdrsquounethinspinterventionthinspdiagnos-tiquethinspouthinsptheacuterapeutiquethinspsontthinspdrsquoassurerthinsplathinspseacutecuriteacutethinspetthinsplethinspbien-ecirctrethinspduthinsppatientthinspetthinspdethinsppermettrethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspdethinspqualiteacutethinspenthinsp

a fournissantthinspunethinspanalgeacutesiethinspunethinspseacutedationthinspetthinspunethinspamneacutesiethinspadapteacutees

b controcirclantthinsplesthinspcomportementsthinspmoteursthinspnuisiblesthinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

c minimisantthinsplesthinspreacuteponsesthinsppsychologiquesthinspdeacutefavorablesthinspassocieacuteesthinspauxthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspdouloureusesthinspouthinspanxiogegravenesthinsp

Lathinspseacutelectionthinspdesthinsppatientsthinsppourthinsplathinspseacutedation-analgeacutesiethinspestthinspfondeacuteethinspsurthinsplrsquoeacutevaluationthinspcliniquethinspdethinspleurthinspeacutetatthinspdethinspsanteacutethinspAgravethinspcettethinspfinthinspilthinspestthinsprecommandeacutethinspdrsquoutiliserthinsplathinspclassi-ficationthinspdethinsplrsquoeacutetatthinspphysiquethinspduthinsppatientthinspquethinsplrsquoonthinsptrouvethinspdansthinsplethinsptableauthinspdethinsplathinsppagethinspsuivante

CMQ - OIIQ - OPIQ 09

Classification Eacutetatthinspdethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp1 Patientthinspenthinspbonnethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp2Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspleacutegegravere

ASAthinspPhysicalthinspStatusthinsp3Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgrave

ASAthinspPhysicalthinspStatusthinsp4Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgravethinspquithinsprepreacutesentethinspthinspunethinspmenacethinspconstantethinsppourthinspsathinspvie

ASAthinspPhysicalthinspStatusthinsp5Patientthinspmoribondthinspquithinspnethinspsurvivrathinsppasthinspthinspagravethinspmoinsthinspdrsquounethinspinterventionthinsp

ASAthinspPhysicalthinspStatusthinsp6Patientthinspdeacuteclareacutethinspenthinspeacutetatthinspdethinspmortthinspceacutereacutebralethinspdontthinsplesthinsporganesthinspontthinspeacuteteacutethinsppreacuteleveacutesthinspagravethinspdesthinspfinsthinspdethinspdon

Tableau 1Classification de lrsquoeacutetat physique du patient selon lrsquoAmerican Society of Anesthesiologists (ASA) (ASA Physical Status Classification System) [En ligne] (Notre traduction)

Ainsithinsplorsquethinsplathinspseacutedation-analgeacutesiethinspestthinspreacutealiseacuteethinspparthinspunthinspmeacutedecinthinspsansthinsplathinspcolla-borationthinspdirectethinspdrsquounthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesio-logiethinspouthinspenthinspreacuteanimationthinspcardiorespiratoirethinspavanceacuteethinsplesthinspinterventionsthinspdiagnos-tiquesthinspouthinsptheacuterapeutiquesthinspdoiventthinspecirctrethinspreacuteserveacuteesthinspprincipalementthinspauxthinsppatientsthinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp1thinspouthinspauxthinsppatientsthinspatteintsthinspdrsquounethinspaffectionthinspsysteacutemiquethinspleacutegegraverethinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp2thinsp

CMQ - OIIQ - OPIQ 10

Notonsthinspquethinspdansthinspdesthinspsituationsthinspparticuliegraveresthinspetthinspjustifieacuteesthinspauthinspdossierthinspmeacutedi-calthinsplathinspseacutedation-analgeacutesiethinsppeutthinspecirctrethinspeffectueacuteethinspchezthinsplesthinsppatientsthinspstablesthinspdethinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp3thinspetthinspexceptionnellementthinspdethinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp4thinspToutefoisthinspellethinspdoitthinsplrsquoecirctrethinspdansthinspdesthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspopti-malethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespira-toirethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspDethinspplusthinspcesthinsppatientsthinspdoiventthinspfairethinsplrsquoobjetthinspdrsquounethinspeacutevaluationthinspindividualiseacuteethinspetthinspplusthinspapprofondiethinsp

Lathinspprofondeurthinspdethinsplathinspseacutedationthinspetthinsplethinspniveauthinspdrsquoanalgeacutesiethinsprechercheacutethinspenthinspseacutedation-analgeacutesiethinspdoiventthinspcorrespondrethinspauxthinspniveauxthinsppermettantthinsplrsquoatteintethinspdesthinspobjectifsthinspviseacutesthinspetthinspecirctrethinspmesureacutesthinspagravethinsplrsquoaidethinspdrsquoeacutechellesthinspstandardiseacuteesthinspvalideacuteesthinspdethinsppreacutefeacuterencethinspetthinspadapteacuteesthinspauthinspcontextethinspetthinspagravethinsplathinspconditionthinspduthinsppatientthinspLesthinspniveauxthinspdethinspseacutedation-analgeacutesiethinspviseacutesthinsptelsthinspquethinspdeacutefinisthinspdansthinsplathinspclassificationthinspdethinsplrsquoASAthinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinspASAthinspHousethinspofthinspDelegatethinsp2014a)thinsp(annexethinspI)thinspdoiventthinspcorrespondentthinspagravethinsplrsquounthinspouthinsplrsquoautrethinspdesthinspdeuxthinspniveauxthinspsuivantsthinsp(CMQthinsp2009)thinsp

thinsprsaquo seacutedationthinspminimalethinspouthinsplaquothinspanxiolysethinspraquothinspougravethinsplrsquoappreacutehensionthinspduthinsppatientthinspestthinspdiminueacuteethinspsansthinspchangementthinspdethinspsonthinspniveauthinspdethinspconsciencethinspetthinspsansthinspalteacutererthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsplathinspventilationthinspetthinsplathinspfonctionthinspcardiovasculaire

thinsprsaquo seacutedationthinspmodeacutereacuteethinspougravethinsplathinspreacuteponsethinspauxthinspstimulithinspverbauxthinspouthinsptactilesthinspleacutegersthinspestthinspvolontairethinspsansthinspaffecterthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsplathinspventilationthinspspontaneacuteethinspetthinsplathinspfonctionthinspcardiovasculaire

Notonsthinsptoutefoisthinspquethinsplrsquoeacutequipethinspsoignantethinspparticipantthinspagravethinsplathinspproceacutedurethinspdoitthinspconnaicirctrethinsplethinspniveauthinspdethinspseacutedation-analgeacutesiethinspgeacuteneacuteralementthinspneacutecessairethinsppourthinspunethinspinterventionthinspdonneacuteethinspDethinspmecircmethinspellethinspdoitthinspecirctrethinsppreacutepareacuteethinspagravethinspgeacutererthinsplethinsppassagethinspmomentaneacutethinspagravethinspunthinspniveauthinspdethinspseacutedationthinspsupeacuterieurthinspagravethinspceluithinspquithinspathinspeacuteteacutethinspplanifieacutethinsp(crsquoest-agrave-direthinspplusthinspprofondthinspquethinsppreacutevu)thinspcethinspquithinsppeutthinspsurvenirthinspenthinsptoutthinsptempsthinsplorsthinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsp

CMQ - OIIQ - OPIQ 11

Volet organisationnel

thinsp12thinspCOMPEacuteTENCESthinspPROFESSIONNELLESthinsp

Consideacuterantthinspquethinsplathinspseacutedation-analgeacutesiethinspsrsquoinscritthinspdansthinspunethinsppratiquethinspdethinspcollabo-rationthinspentrethinsplethinspmeacutedecinthinspetthinspdrsquoautresthinspprofessionnelsthinspdethinsplathinspsanteacutethinsp(infirmiegraveresthinspetthinspinhalotheacuterapeutes)thinspilthinspimportethinspdethinsppreacuteciserthinspqursquounethinsputilisationthinspjudicieusethinspdethinspleursthinspcompeacutetencesthinspestthinspdethinspmisethinsppourthinspassurerthinsplathinspqualiteacutethinspetthinsplrsquoefficiencethinspdesthinspsoinsthinspAinsithinsptousthinspdoiventthinspavoirthinsplesthinspqualificationsthinsprequisesthinspdansthinsplethinspdomainethinspdethinsplathinspseacutedation-thinspanalgeacutesie

Dethinspplusthinsplrsquoeacutequipethinspsoignantethinspquithinspreacutealisethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacutera-peutiquethinspsousthinspseacutedation-analgeacutesiethinspdoitthinsp

a ecirctrethinspenthinspmesurethinspdrsquoeacutevaluerthinspadeacutequatementthinsplathinspconditionthinspdethinspsanteacutethinspduthinsppatientthinspetthinspdrsquoenthinspassurerthinsplathinspsurveillancethinspclinique

b connaicirctrethinspetthinsputiliserthinspjudicieusementthinsplathinspmeacutedicationthinspainsithinspquethinspsesthinspantagonistes

c posseacutederthinsplesthinspconnaissancesthinspetthinsplesthinspcompeacutetences1thinspneacutecessairesthinsppourthinspintervenirthinspenthinspsituationthinspdrsquourgencethinsptellethinspquethinsplathinspreacuteanimationthinspcardiorespiratoire2thinsp(dethinsppreacutefeacuterencethinspenthinspsoinsthinspavanceacutes)thinspcrsquoest-agrave-direthinspmaicirctriserthinspenthinspprioriteacutethinsplesthinsptechniquesthinspdethinsplathinspprisethinspenthinspchargethinspdethinsplathinspventilationthinspduthinspmassagethinspcardiaquethinspetthinspdethinsplathinspmeacutedicationthinspassocieacutee

d avoirthinsplrsquoexpertisethinsprequisethinspselonthinsplathinspclientegravelethinspviseacuteethinspetthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspagravethinspreacutealiserthinsp

thinsp13thinspRESSOURCESthinspMATEacuteRIELLESthinsp

1thinspLOCAUX

LrsquoameacutenagementthinspdesthinsplocauxthinspdoitthinsppermettrethinspdethinspreacutealiserthinspdethinspfaccedilonthinspadeacutequatethinspetthinspenthinsptoutthinsptempsthinspunethinspreacuteanimationthinspcardiorespiratoirethinspainsithinspqursquounethinspeacutevacuationthinspdrsquourgencethinsplethinspcasthinspeacutecheacuteantthinspEntrethinspautresthinsplathinspsuperficiethinspdoitthinsppermettrethinspauthinsppersonnelthinspdethinspcircu-lerthinsplibrementthinsplrsquoeacuteclairagethinspdoitthinspecirctrethinspsuffisantthinsplethinspmateacuterielthinspdrsquourgencethinsp(pthinspexthinspthinspdethinspreacuteani-mation)thinspdoitthinspecirctrethinspfacilementthinspaccessiblethinspetthinspentreposeacutethinspdansthinspunthinsplieuthinspconnuthinspdethinsptousthinsp

Selonthinsplesthinspmodaliteacutesthinspdethinspfonctionnementthinspetthinsplethinsptypethinspdrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsppratiqueacutethinspilthinspestthinspdrsquousagethinspdethinspdisposerthinspdrsquounethinspsallethinspdethinspreacutecupeacutera-tionthinspouthinspdrsquoobservation

1thinspthinspthinspthinspOnthinspentendthinspparthinspconnaissancesthinspetthinspcompeacutetencesthinspqursquoellesthinspsoientthinspmisesthinspagravethinspjourthinspselonthinsplesthinsprecommandationsthinspenthinspvigueur2thinspthinspthinspOnthinspentendthinspparthinspcertificationthinspenthinspreacuteanimationthinspcardiorespiratoirethinsplesthinspformationsthinspsuivantesthinspthinsp thinsprsaquothinspReacuteanimationthinspcardiorespiratoirethinspdethinspbasethinspthinspSoinsthinspimmeacutediatsthinspenthinspreacuteanimationthinsp(SIR)thinsppourthinspprofessionnelsthinspdethinsplathinspsanteacutethinspthinspthinspthinspthinspthinspthinspthinspthinspouthinsplrsquoeacutequivalentthinsp thinsprsaquothinspReacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspSoinsthinspavanceacutesthinspenthinspreacuteanimationthinspcardiovasculairethinsp(SARC)thinspouthinsplrsquoeacutequivalent

CMQ - OIIQ - OPIQ 12

Pourthinspinformationthinspcompleacutementairethinsp(annexethinspII)thinspProceacutedures et interventions en milieu extrahospitalierthinsp(CMQthinsp2011)

2thinspEacuteQUIPEMENTthinsp(INTRAthinspETthinspEXTRAHOSPITALIER)

OBLIGATOIRE

Enthinspplusthinspduthinspmateacuterielthinspdirectementthinsplieacutethinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspjustifiantthinsplathinspseacutedation-analgeacutesiethinsponthinspdoitthinsptrouverthinspminimalementthinsplrsquoeacutequipe-

mentthinspsuivant

Dansthinsplathinspsallethinsp

thinsprsaquo tablethinspdrsquoexamenthinspciviegraverethinspouthinsptablethinspdethinspchirurgiethinsprsaquo tablethinsppourthinsplesthinspinstrumentsthinsprsaquo soluteacutesthinspetthinspmateacuterielthinspneacutecessairethinsppourthinsplrsquoinstallationthinspetthinsplethinspmaintienthinspdrsquounethinspvoiethinsp

endoveineusethinsprsaquo saturomegravetrethinsp(oxymegravetrethinspdethinsppouls)thinsp

Lethinspmonitoragethinspdethinsplathinspsaturationthinspenthinspoxygegravenethinsppermetthinsplrsquoeacutevaluationthinspdethinsplrsquooxy-geacutenationthinsp(deacutetectionthinsppreacutecocethinspdrsquounethinsphypoxeacutemie)thinspmaisthinspilthinspnethinsppeutthinsppasthinspdeacutetecterthinsppreacutecocementthinspunethinspobstructionthinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(AmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2012)thinspthinsp

thinsprsaquo steacutethoscopethinspthinsprsaquo sphygmomanomegravetrethinspouthinspappareilthinspautomatiseacutethinspnonthinspinvasifthinsppourthinsplathinspprisethinspdethinsplathinsp

pressionthinsparteacuteriellethinsprsaquo sourcethinspdrsquooxygegravenethinspcomprimeacutethinspenthinspquantiteacutethinspsuffisantethinsppourthinspenthinsppermettrethinsp

llsquoadministrationthinspagravethinspunthinspdeacutebitthinspdethinsp15thinsplitresthinspparthinspminutethinsppendantthinsp60thinspminutesthinspetthinspthinsplethinspmateacuterielthinspneacutecessairethinspagravethinsplrsquooxygeacutenotheacuterapie

thinsprsaquo appareilthinspagravethinspaspirationthinsppouvantthinspgeacuteneacutererthinspunethinsppressionthinspneacutegativethinspdethinsp40ndash60thinspmmthinspHgthinspouthinspunethinspcapaciteacutethinspdethinspflotthinspdethinsp100thinsplitresthinspparthinspminutethinspetthinsplethinspmateacuterielthinspneacutecessairethinspthinspagravethinsplrsquoaspiration

thinsprsaquo lethinspmateacuterielthinspneacutecessairethinspagravethinsplathinspprisethinspenthinspchargethinspventilatoirethinspentrethinspautresthinspreacuteanimateurthinspmanuelthinspautogonflablethinsp(Ambuthinspbag)thinspmasquethinspcanulesthinspnasothinspthinspetthinsporopharyngeacuteesthinspdethinsptaillesthinspvarieacutees

Ce mateacuteriel doit ecirctre disponible agrave porteacutee de la main

CMQ - OIIQ - OPIQ 13

thinsprsaquo appareilthinspdrsquoalimentationthinspeacutelectriquethinspdethinspsecoursthinsppourthinsplethinspfonctionnementthinspdesthinspeacutequipementsthinspdrsquourgence

Peutthinspecirctrethinspagravethinsplrsquoexteacuterieurthinspdethinsplathinspsallethinsp(maisthinspfacilethinspdrsquoaccegravesthinspetthinsprapidementthinspdisponible)thinsp

thinsprsaquo thinsparmoirethinspfermeacuteethinsppourthinspentreposerthinspsousthinspcleacutethinspauthinspbesointhinsplethinspmateacuterielthinspetthinsplesthinspsubstancesthinspcontrocircleacuteesthinspainsithinspquethinsplesthinspbenzodiazeacutepines

thinsprsaquo mateacuterielthinspneacutecessairethinspagravethinsplrsquointubationthinspendotracheacutealethinspentrethinspautresthinspsondesthinspendotracheacutealesthinspetthinsplamesthinspdethinsplaryngoscopethinspdethinsptaillesthinspvarieacuteesthinspainsithinspquethinspdesthinspalternativesthinspagravethinsplrsquointubationthinspdifficilethinsp(pthinspexthinspthinspoutilsthinspextraglottiquesthinsptelsthinspquethinspmasquesthinsplaryngeacutes)

thinsprsaquo deacutefibrillateurthinspcardiaquethinsp(dethinsppreacutefeacuterencethinspunthinspdeacutefibrillateurthinspexternethinspautomatiseacutethinsp[DEA])

thinsprsaquo pharmaciethinsp(troussethinspouthinspchariot)thinspcontenantthinsplesthinspmeacutedicamentsthinspneacutecessairesthinspauthinsptraitementthinspdesthinspsituationsthinspdrsquourgencethinsptellesthinspquethinspthinspsurdosagethinspauxthinspopioiumldesthinspouthinspauxthinspbenzodiazeacutepinesthinspurgencethinspcardiaquethinspreacuteactionthinspallergiquethinspcrisethinspdrsquoasthmethinspcrisethinspconvulsivethinspchocthinspvagalthinsphypoglyceacutemiethinspetc

RECOMMANDEacutethinspSELONthinspLAthinspSITUATION

thinsprsaquo moniteurthinspcardiaquethinspthinspdansthinspcertainsthinspcasthinspbienthinspdeacutefinisthinsplethinspmonitoragethinspcardiaquethinsppeutthinspecirctrethinsprecommandeacutethinspouthinspobligatoirethinsp(tableauthinsp3)

thinsprsaquo capnographethinspthinspdansthinspcertainsthinspcasthinspbienthinspdeacutefinisthinsplethinspmonitoragethinspduthinspCO2thinsppeutthinspecirctrethinsp

recommandeacutethinspouthinspobligatoirethinsp(tableauthinsp3)thinspthinspLethinspmonitoragethinspduthinspCO

2thinsppermetthinspdrsquoidentifierthinsppreacutecocementthinsplesthinspcomplicationsthinsp

tellesthinsplathinspseacutedationthinspexcessivethinsplrsquohypoventilationthinspetthinsplrsquoapneacuteethinspenthinspplusthinspdethinsppermettrethinspdethinspmieuxthinspcontrocirclerthinsplethinspniveauthinspdethinspseacutedationthinspenthinspfonctionthinspdethinsplrsquointerventionthinspthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinspSonthinsputilisationthinsppermetthinspeacutegalementthinspthinspdethinspsuivrethinsplethinspmonitoragethinspventilatoirethinspCelathinspestthinspparticuliegraverementthinspapproprieacutethinspthinsplorsqursquoilthinspnrsquoexistethinsppasthinspdrsquoantagonistesthinspagravethinsplathinspmeacutedicationthinsputiliseacuteethinsp(pthinspexthinspthinsppropofol)thinsp

OPTIONNEL

thinsprsaquo moniteurthinspdethinsptempeacuteraturethinspetthinspdispositifthinspdethinspreacutechauffementthinspduthinsppatientthinspselonthinsplethinsppatientthinspetthinsplathinspdureacuteethinspdethinsplrsquointerventionthinsp

thinsprsaquo systegravemethinspdrsquoantipollutionthinsp(eacutevacuationthinspduthinspprotoxydethinspdrsquoazote)thinspsrsquoilthinspythinspathinsplieuthinsprsaquo analyseurthinspdrsquooxygegravenethinsplorsqursquounthinspmeacutelangethinspestthinsputiliseacutethinsp(pthinspexthinspthinspO

2thinspetthinspprotoxydethinsp

drsquoazote)thinsprsaquo steacutethoscopethinsppreacutecordialthinspouthinsppreacutetracheacutealthinsppourthinspeacutecoutethinspenthinspcontinu

CMQ - OIIQ - OPIQ 14

LrsquoensemblethinspdethinspcesthinspeacutequipementsthinspdoitthinspecirctrethinspadapteacutethinspauthinsppatientthinspIlsthinspdoiventthinspecirctrethinspenthinspeacutetatthinspdethinspfonctionnerthinspetthinsplesthinspattestationsthinspdesthinspveacuterificationsthinsppeacuteriodiquesthinspdoiventthinspecirctrethinspconserveacuteesthinspdansthinspunthinspregistrethinsppreacutevuthinspagravethinspcettethinspfin

Pendantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplesthinspprofessionnelsthinspdoiventthinspthinsprespecterthinsplesthinspregraveglesthinspdethinsppreacuteventionthinspetthinspdethinspcontrocirclethinspdesthinspinfections

Unethinspproceacutedurethinsprelativethinspauxthinspsituationsthinspdrsquourgencethinsp(annexethinspIII)thinspagravethinsplrsquoaccegravesthinspauxthinspser-vicesthinspdrsquourgencethinsppreacutehospitaliersthinspetthinspdethinsptransfertthinspselonthinspunethinspententethinspintereacutetablisse-mentsthinspdoitthinspecirctrethinspeacutelaboreacuteethinspmaintenuethinspagravethinspjourthinspfacilementthinspdisponiblethinspenseigneacuteethinspagravethinsptoutthinsplethinsppersonnelthinspetthinspfairethinsplrsquoobjetthinspdrsquounthinsprappelthinspaupregravesthinspdethinspcethinspdernierthinspsurthinspunethinspbasethinsp

peacuteriodiquethinsp

CMQ - OIIQ - OPIQ 15

Volet professionnel

thinsp14thinspPREacuteSEacuteDATION-ANALGEacuteSIEthinsp

SEacuteLECTIONthinspDESthinspPATIENTS

Lathinspseacutelectionthinspdesthinsppatientsthinspdoitthinsptenirthinspcomptethinspnotammentthinspdethinsplrsquoeacutevaluationthinspdesthinspvoiesthinspaeacuteriennesthinspetthinspdethinsplrsquoeacutetatthinspdethinspsanteacutethinspgeacuteneacuteralthinspduthinsppatientthinspquithinspaurontthinspmisthinspenthinspeacutevi-dencethinsplathinsppreacutesencethinspouthinsplrsquoabsencethinspdrsquoindicateursthinspdethinsppossiblesthinspcomplicationsthinsplorsthinspdethinsplathinspseacutedation-analgeacutesiethinspIlthinspexistethinspdeuxthinsptypesthinspdethinsprisquesthinspenthinspseacutedation-analgeacutesiethinspthinsplesthinsprisquesthinsppreacutevisiblesthinsp(difficulteacutethinsppotentiellethinsplieacuteethinspagravethinsplathinspgestionthinspdesthinspvoiesthinspaeacuteriennesthinspouthinspinstabiliteacutethinspduthinsppatient)thinspetthinsplesthinsprisquesthinspimpreacutevisiblesthinsp(incidentaccidentthinsperreurthinsphu-mainethinspetc)thinspUnethinspeacutevaluationthinspinitialethinsp(histoirethinspexamenthinspphysique)thinspadeacutequatethinspavantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspdiminuethinspdethinsptelsthinsprisques

Agravethinsppartirthinspdethinsplrsquoensemblethinspdesthinspeacutevaluationsthinspeffectueacuteesthinsplethinspmeacutedecinthinspseacutelectionnethinsplesthinsppatientsthinspaptesthinspagravethinsprecevoirthinspunethinspseacutedation-analgeacutesiethinspselonthinspnotammentthinsp

thinsprsaquo lesthinspfacteursthinspdethinsprisquethinspidentifieacutesthinspagravethinsplathinspsuitethinspdethinsplrsquoeacutevaluationthinsp(cardiovasculairethinsprespiratoirethinspheacutepatiquethinspneurologique)thinspdethinsplathinsppossibiliteacutethinspdethinspgrossessethinspchezthinsplathinspfemmethinspenthinspacircgethinspdethinspprocreacuteerthinspouthinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspenvisageacutee

thinsprsaquo lrsquoeacutevaluationthinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(annexethinspIV)thinspafinthinspdethinsppreacuteciserthinsplethinsprisquethinspdrsquoassistancethinspventilatoirethinspetthinspdrsquointubationthinspdifficilethinsp

thinsprsaquo lesthinspanteacuteceacutedentsthinspanestheacutesiquesthinspetthinspchirurgicauxthinspafinthinspdrsquoidentifierthinsplesthinspcomplicationsthinsppotentielles

thinsprsaquo lesthinspcomorbiditeacutesthinspdontthinsplesthinsptroublesthinsprespiratoiresthinspduthinspsommeilthinsp(annexethinspV)thinsprsaquo lathinspmeacutedicationthinspouthinspautresthinspsubstancesthinsp(prescritesthinspouthinspenthinspventethinsplibre)thinspafinthinsp

drsquoidentifierthinsplesthinsprisquesthinspdrsquointeractionsthinspavecthinsplesthinspmeacutedicamentsthinsputiliseacutesthinsplorsthinspdethinsplrsquointerventionthinspouthinspdethinsplathinspseacutedation-analgeacutesie

thinsprsaquo lrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspquithinsppourraitthinspneacutecessiterthinspunethinspseacutedation-analgeacutesiethinspdrsquounthinspniveauthinspsupeacuterieurthinspagravethinspceluithinspdontthinspilthinspestthinspquestionthinspdansthinspcesthinsplignesthinspdirectrices

thinsprsaquo lesthinspcaracteacuteristiquesthinsppropresthinspauthinsppatientthinsp(fonctionsthinspcognitivesthinspisolementthinspsocialthinspautonomiethinspetc)

EacuteVALUATIONthinspDESthinspPATIENTS

Cettethinspeacutevaluationthinspdoitthinspsethinspfairethinsppeuthinspdethinsptempsthinsp(moinsthinspdethinsp3thinspmoisthinspenthinsplrsquoabsencethinspdethinspchangementthinspnotablethinspdansthinsplathinspconditionthinspcliniquethinspduthinsppatient)thinspavantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspetthinspdoitthinspnotammentthinsppreacuteciserthinspcethinspquithinspsuit

CMQ - OIIQ - OPIQ 16

AgravethinspLrsquoANAMNEgraveSEthinspthinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsp

lrsquoeacutevaluationthinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinsp(annexethinspVI)thinsp

thinsprsaquo raison(s)thinspdethinspconsultationthinspetthinsphistoirethinspdethinsplathinspmaladiethinspactuellethinsprsaquo anteacuteceacutedentsthinsprsaquo reacuteactionthinspanteacuterieurethinspagravethinsplathinspseacutedation-analgeacutesiethinspagravethinsplrsquoanestheacutesiethinspetthinspagravethinsplathinspchirurgiethinsprsaquo allergiesthinsprsaquo momentthinspduthinspdernierthinspingestathinsp(preacuteciserthinsplethinsptypethinspetthinsplathinspquantiteacute)thinsprsaquo meacutedicationthinspetthinspautresthinspsubstancesthinsp(prescritesthinspouthinspnon)thinsprsaquo preacutemeacutedicationthinspreccediluethinsp(pthinspexthinspthinspadministrationthinspdethinspmorphinethinspchezthinspunthinsppatientthinspenthinsp

attentethinspdrsquounethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutique)thinsprsaquo habitudesthinspdethinspviethinsp(tabacthinspalcoolthinspouthinspdrogues)thinsprsaquo troublethinsprespiratoirethinspduthinspsommeilthinspetthinsplathinsptheacuterapiethinspassocieacutee

AgravethinspLrsquoEXAMENthinspPHYSIQUEthinsp

Lrsquoexamenthinspphysiquethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinspcherchethinspagravethinspmettrethinspenthinspeacutevi-dencethinspcertainsthinspcritegraveresthinspreconnusthinsppourthinspecirctrethinspassocieacutesthinspagravethinspunethinspassistancethinspventila-toirethinspdifficilethinspquithinsppeutthinspsurvenirthinspdansthinsplethinspcasthinspdrsquounthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquethinspceluithinspviseacutethinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsplrsquoeacutevaluationthinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinsp(annexethinspVII)thinsp

Lrsquoexamenthinspphysiquethinspdoitthinspecirctrethinspadapteacutethinspagravethinspchaquethinsppatientthinspetthinspporterthinspnotammentthinspsurthinspdesthinspeacuteleacutementsthinsptelsthinspquethinspceux-cithinsp

thinsprsaquo preacutesencethinspdrsquoobeacutesiteacutethinsprsaquo tecirctethinspetthinspcouthinsp

thinsprsaquo mobiliteacutethinspcervicalethinspcompromisethinsprsaquo couthinspcourtthinspouthinsplargethinsp(circonfeacuterencethinsp )thinsprsaquo pathologiethinspouthinspanomaliethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(pthinspexthinspthinspmassethinsp

cervicale)thinspthinsprsaquo bouchethinsp

thinsprsaquo petitethinspouverturethinsprsaquo dentitionthinsp(pthinspexthinspthinspbouchethinspeacutedenteacuteethinspdentsthinspinstablesthinspincisivesthinspproeacuteminentesthinsp

outhinspappareilthinspdentairethinspmalocclusionthinspimportante)thinsp

LethinspscorethinspdethinspMallampatithinspmodifieacutethinspestthinspunthinspoutilthinspagravethinspprivileacutegierthinsp(annexethinspIV)

CMQ - OIIQ - OPIQ 17

UnethinspbonnethinspeacutevaluationthinspdethinsptousthinsplesthinspaspectsthinsprelatifsthinspauthinspmaintienthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspestthinspessentiellethinspDethinspplusthinspchezthinsplethinsppatientthinspsymptomatiquethinspthinsp(pthinspexthinspthinspdyspneacutee)thinspcettethinspeacutevaluationthinspdoitthinspecirctrethinspcompleacuteteacuteethinspparthinsplrsquoauscultation cardiorespiratoirethinspFinalementthinspsithinspdrsquoautresthinspexamensthinspdoiventthinspecirctrethinspfaitsthinspleurthinspchoixthinspserathinspguideacutethinspparthinsplesthinspproblegravemesthinspmeacutedicauxthinspsous-jacents

Bienthinspquethinsplathinspseacutedation-analgeacutesiethinspnethinsppreacutevoitthinspnormalementthinsppasthinspdethinspprisethinspenthinspchargethinspcomplegravetethinspdethinsplathinspventilationthinsp(assistancethinspventilatoirethinspouthinspintubationthinspthinspendotracheacuteale)thinspilthinspestthinspimportantthinspdrsquoeffectuerthinspcettethinspeacutevaluationthinsppuisqursquoagravethinspthinsptoutthinspmomentthinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspunethinspventilationthinspthinspassisteacuteethinspavecthinspouthinspsansthinspintubationthinspendotracheacutealethinsppeutthinspsrsquoaveacutererthinspneacutecessairethinspthinspsithinsplathinsprespirationthinspestthinspcompromisethinsp

Lorsthinspdethinspsituationsthinspparticuliegraveresthinspouthinspcomplexesthinsplethinspmeacutedecinthinspdevraitthinspconsulterthinspunthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinsp

cardiorespiratoirethinspavanceacutee

CONSENTEMENTthinsp(REacuteSUMEacute)

LethinsplecteurthinspdoitthinspsethinspreacutefeacutererthinspagravethinsplrsquoannexethinspVIIIthinsppourthinsplethinsptextethinspcomplet

SelonthinsplethinspdroitthinspenthinspvigueurthinspauthinspQueacutebecthinspilthinspestthinspobligatoirethinspdrsquoobtenirthinsplethinspconsentementthinspdrsquounthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspintervention

LethinspCode civil du QueacutebecthinspeacutetablitthinspdesthinspregraveglesthinspgeacuteneacuteralesthinspconcernantthinsplethinspconsentementthinspauxthinspsoinsthinspquithinspsrsquoappliquentthinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspdispenseacutesthinspOnthinspythinspfaitthinspcependantthinspcertainesthinspdistinctionsthinspselonthinspquethinsplethinsppatientthinspestthinspaptethinspouthinspnonthinspagravethinspconsentirthinspetthinspselonthinspquethinsplesthinspsoinsthinspsontthinsprequisthinspouthinspnonthinsp

parthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspLathinspLoi sur les services de santeacute et les services sociaux (LSSSS)thinspeacutetablitthinspquantthinspagravethinspellethinsplesthinspregraveglesthinspapplicablesthinspenthinspeacutetablissementthinspenthinspmatiegraverethinspdethinspconsentementthinspauxthinspinterventionsthinspchirurgicalesthinspetthinspagravethinsplrsquoanestheacutesiethinsp

LethinspCode de deacuteontologie des meacutedecinsthinspstipulethinspquethinsplethinspmeacutedecinthinspdoitthinspobtenirthinspunthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspavantthinsptoutethinspinterventionthinspilthinspestthinsppreacuteciseacutethinspquethinsplethinspmeacutedecinthinspdoitthinspsrsquoassurerthinspquethinsplrsquoinformationthinsppertinentethinspathinspeacuteteacutethinsptransmisethinspfaciliterthinsplathinspprisethinspdethinspdeacutecisionthinspduthinsppatientthinspetthinsplathinsprespecterthinspLethinspCode de deacuteontologie

des infirmiegraveres et infirmiersthinspstipulethinspquantthinspagravethinspluithinspquethinsplrsquoinfirmiegraverethinspouthinsplrsquoinfirmierthinspdoitthinspfournirthinspauthinspclientthinsptoutesthinsplesthinspinformationsthinsprequisesthinsplorsquethinsplrsquoobligationthinspdrsquoobtenirthinspunthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspincombethinspagravethinsplrsquoinfirmiegraverethinspouthinspagravethinsplrsquoinfirmierthinspIlthinspnrsquoythinspathinsppasthinspdethinspdispositionthinsptouchantthinsppreacuteciseacutementthinsplethinspconsentementthinspdansthinsplethinspCode de

CMQ - OIIQ - OPIQ 18

deacuteontologie des inhalotheacuterapeutes du QueacutebecthinspCependantthinspilthinspestthinsppreacuteciseacutethinspqursquoenthinspplusthinspdesthinspavisthinspetthinspdesthinspconseilsthinsplrsquoinhalotheacuterapeutethinspdoitthinspfournirthinspagravethinspsonthinspclientthinsplesthinspexplicationsthinspneacutecessairesthinspagravethinsplathinspcompreacutehensionthinspetthinspagravethinsplrsquoappreacuteciationthinspdesthinspservicesthinspqursquoilthinspluithinsprend

TousthinsplesthinspprofessionnelsthinspsontthinspeacutevidemmentthinsptenusthinspdethinsprespecterthinsplesthinspdispositionsthinspleacutegalesthinspexistantesthinspndashthinspincluantthinspleurthinspcodethinspdethinspdeacuteontologiethinsprespectifthinspndashthinspetthinsplesthinspnormesthinspdethinsppratiquethinspeacutetabliesthinspparthinspleurthinspordrethinspprofessionnelthinspToutefoisthinsplathinspquestionthinspsethinspposethinspdethinspsavoirthinspcommentthinspcesthinspexigencesthinspdoiventthinspsrsquoappliquerthinspmaintenantthinspquethinspplusieursthinspinterventionsthinspreacutealiseacuteesthinspautrefoisthinspenthinspeacutetablissementthinspsontthinspeffectueacuteesthinspenthinspdehorsthinspthinspdethinspceux-cithinspetthinspquethinsplesthinspprofessionnelsthinsppartagentthinspcertainesthinspactiviteacutesthinspetthinsptravaillentthinsp

enthinspeacutetroitethinspcollaboration

Mecircmethinspsithinsplathinsploithinspnethinsplrsquoexigethinsppasthinsptoujoursthinspilthinspestthinsprecommandeacutethinsp

thinsprsaquo quethinsplethinsppatientthinspdonnethinspunthinspconsentementthinspeacutecritthinsplorsqursquoilthinspythinspathinspseacutedation-analgeacutesiethinspthinspetthinspcethinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspprodigueacutes

thinsprsaquo quethinsplethinspconsentementthinspportethinspagravethinsplathinspfoisthinspsurthinsplathinspseacutedation-analgeacutesiethinspetthinspsurthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspquethinspcettethinspderniegraverethinsppermet

thinsprsaquo quethinsplrsquoinformationthinsptransmisethinspauthinsppatientthinspverbalementthinspouthinspparthinspeacutecritthinspcomprennethinsplesthinsprisquesthinspdethinsplathinspseacutedation-analgeacutesiethinspetthinsplesthinsprisquesthinspdethinsplrsquointerventionthinspelle-mecircme

thinsprsaquo quethinsplethinspmeacutedecinthinspouthinsplethinspprofessionnelthinspagravethinspquithinspilthinspathinspconfieacutethinsplathinsptacircchethinspversethinspauthinspdossierthinspduthinsppatientthinspunethinspnotethinspexplicativethinspsurthinsplesthinspinformationsthinspfourniesthinspetthinsplethinspconsentementthinspobtenu

Lrsquoobtentionthinspdrsquounthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspdemeurethinspunethinspobligationthinspthinspinheacuterentethinspagravethinsplrsquointerventionthinspmeacutedicalethinspelle-mecircmethinspIlthinsprelegravevethinspdoncthinspdethinsplathinspresponsabiliteacutethinspduthinspmeacutedecinthinspdethinspsrsquoassurerthinspdethinsplathinsptransmissionthinspdethinsplrsquoinformationthinsppertinentethinspauthinsppatientthinspetthinspdethinspsathinspcompreacutehensionthinspdethinsplathinspnaturethinspduthinspbutthinspetthinspdesthinsprisquesthinsprelatifsthinspagravethinsplrsquointerventionthinspToutefoisthinsplathinsptacircchethinspdethinsptransmettrethinspdethinsplrsquoinformationthinspcompleacutementairethinsppeutthinspecirctrethinspconfieacuteethinspagravethinspdrsquoautresthinspprofessionnelsthinspthinspetthinspcellethinspdethinsprecueillirthinsplathinspsignaturethinspdrsquounthinspformulairethinspdethinspconsentementthinspagravethinspdrsquoautresthinspmembresthinspdethinsplrsquoeacutequipethinspdethinspsoins

CMQ - OIIQ - OPIQ 19

DIRECTIVESthinspETthinspCONSEILSthinsp

Avantthinspdethinspsubirthinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspsousthinspseacutedationthinsp-analgeacutesiethinsplethinsppatientthinspdoitthinsprecevoirthinsplesthinspdirectivesthinspneacutecessairesthinspdethinsppreacutefeacuterencethinspdansthinsp

unthinspdocumentthinspcontenantthinspentrethinspautresthinsplesthinsprecommandationsthinspsuivantesthinsp

a eacuteviterthinspdethinspconsommerthinsptoutethinspboissonthinspalcooliseacuteethinspdroguethinspouthinspsubstancethinspenthinspventethinsplibrethinsp(agravethinspmoinsthinspqursquoellethinspsoitthinspprescrite)thinsppouvantthinspalteacutererthinsplethinspniveauthinspdethinspconsciencethinspthinsp24thinspheuresthinspavantthinspetthinspapregravesthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

b observerthinspunethinsppeacuteriodethinspdethinspjeucircnethinspquithinspsrsquoappliquethinspagravethinsptoutthinspacircgethinspauxthinspcasthinspeacutelectifsthinsp(nonthinspurgents)thinspetthinspselonthinsplrsquoeacutevaluationthinspduthinsplaquothinsprapportthinsprisquebeacuteneacuteficethinspraquothinsppourthinsplesthinspcasthinspurgents

c suivrethinsplesthinsprecommandationsthinspduthinspmeacutedecinthinspquithinsppreacutecisethinspsithinsplesthinspmeacutedicamentsthinspprescritsthinspsurthinspunethinspbasethinspreacuteguliegraverethinsppeuventthinspecirctrethinspadministreacutesthinspcommethinspagravethinsplrsquoaccoutumeacuteethinspetthinspquithinspfaitthinsppartthinspdesthinspexceptionsthinsp(pthinspexthinspthinspanticoagulantthinsppsychotropethinspetc)thinspsrsquoilthinspythinspathinsplieuthinsp

Unethinspseacutedation-analgeacutesiethinspleacutegegraverethinspougravethinsplesthinspreacuteflexesthinspdethinspprotectionthinspdesthinspvoiesthinspthinspaeacuteriennesthinspsontthinsppreacuteserveacutesthinspestthinsppeuthinspsusceptiblethinspdrsquoinduirethinspunethinspaspirationthinspduthinspcon-tenuthinspgastriquethinspcontrairementthinspagravethinspunethinspseacutedationthinspplusthinspprofondethinspIlthinspestthinsptoutthinspdethinspmecircmethinspraisonnablethinspdethinsppenserthinspquethinsplethinsprisquethinspdrsquoaspirationthinspestthinspdiminueacutethinsplorsquethinsplrsquoestomacthinspestthinspvidethinspetthinspqursquounethinsppeacuteriodethinspdethinspjeucircnethinspavantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacutera-peutiquethinspestthinsppreacutefeacuterablethinspToutefoisthinspdansthinsptousthinsplesthinspcasthinsplrsquourgencethinspdethinsplrsquointerventionthinspetthinsplethinspniveauthinspdeacutesireacutethinspdethinspseacutedation-analgeacutesiethinspdoiventthinspecirctrethinspsoupeseacutesthinspauthinspregardthinspdesthinsprisquesthinspassocieacutesthinspagravethinspunthinspjeucircnethinspinadeacutequatthinspAinsithinsplethinspdeacutelaithinspentrethinsplrsquoheurethinspduthinspdernierthinsprepasthinspetthinsplethinspmomentthinspdethinsplathinspblessureaccidentthinspdoitthinspecirctrethinsppristhinspenthinspconsideacuterationthinsppourthinspestimerthinsplrsquoeacutetatthinspdethinspjeucircnethinspetthinspcethinspenthinspraisonthinspdethinsplrsquoileacuteusthinspreacuteflexethinsp

Avantthinsplathinspseacutedation-analgeacutesiethinspdrsquounethinspinterventionthinspnonthinspurgentethinsp(eacutelective)thinsplethinsppatientthinspdoitthinsprespecterthinsplesthinspdeacutelaisthinspsuivantsthinspselonthinsplathinspnaturethinspetthinsplathinspquantiteacutethinspingeacutereacuteethinspdethinspthinsp(Merchantthinspetthinspcollabthinsp2014a)thinsp

thinsprsaquo liquidethinspclairthinsp(pthinspexthinspthinspeauthinspjusthinspdethinspfruitthinsp[sansthinsppulpe]thinsptheacutethinspetthinspcafeacutethinspnoir)thinspthinspjeucircnethinspdethinsp2thinspheures

thinsprsaquo repasthinspleacutegerthinsp(pthinspexthinspthinsppainthinspgrilleacutethinsp+thinspliquidethinspclair)thinspthinspjeucircnethinspdethinsp6thinspheuresthinsprsaquo repasthinspcomposeacutethinspdethinspviandethinspouthinspdrsquoalimentsthinspfritsthinspouthinspgrasthinspthinspjeucircnethinspdethinsp8thinspheuresthinsp

CMQ - OIIQ - OPIQ 20

15thinspPERSEacuteDATION-ANALGEacuteSIEthinsp

APPROCHEthinspPHARMACOLOGIQUE

Lrsquoadministrationthinspdethinsptoutthinspmeacutedicamentthinspneacutecessitethinsplrsquoobtentionthinspdrsquounethinspordonnancethinsp

faitethinspenthinspvertuthinspdethinsplrsquoarticlethinsp393thinspduthinspCode des professions du QueacutebecthinspDrsquoailleursthinspthinsplathinspmeilleurethinspfaccedilonthinspdrsquoencadrerthinsplathinsppratiquethinspdethinsplrsquoinfirmiegraverethinspetthinspdethinsplrsquoinhalotheacuterapeutethinspestthinsplrsquoadoptionthinspdrsquounthinspprotocoleordonnancethinspcollectivethinspcomprenantthinspunthinspeacuteventailthinsptheacuterapeutiquethinspquithinsplaissethinspplacethinspauthinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspthinspUnthinsptelthinspdocumentthinspdoitthinspparthinspcontrethinspecirctrethinspenteacuterineacutethinspparthinsplesthinspresponsablesthinspmeacutedicauxthinspthinspdethinsplrsquoeacutetablissementthinspqursquoilthinspsoitthinsppublicthinspouthinsppriveacutethinsp

Soulignonsthinsplrsquoimportancethinspdrsquounthinspaccegravesthinspveineuxthinspfonctionnelthinspquithinspfaciliterathinsplrsquoadmi-nistrationthinspdesthinspagentsthinspseacutedatifsthinspetthinspanalgeacutesiquesthinspainsithinspquethinsplesthinsptraitementsthinsppharma-cologiquesthinspdesthinspcomplications

LethinspmeacutedecinthinsplrsquoinfirmiegraverethinspetthinsplrsquoinhalotheacuterapeutethinspdoiventthinsputiliserthinspunethinspmeacutedicationthinspqursquoilsthinspconnaissentthinspetthinspquithinspestthinspreconnuethinspRappelonsthinspqursquoilsthinspdoiventthinspecirctrethinspenthinspmesurethinspdethinspprendrethinspenthinspchargethinsptoutethinspcomplicationthinsppotentiellethinspythinspcompristhinsplathinspgestionthinspdrsquounthinsppassagethinspmomentaneacutethinspagravethinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspsupeacuterieurthinspagravethinspceluithinspquithinspthinspathinspeacuteteacutethinspplanifieacute

LethinspchoixthinspdethinsplathinspmeacutedicationthinsppeutthinspvarierthinspselonthinsplathinspsituationthinspcliniquethinspetthinsplesthinspfacteursthinsppropresthinspauthinsppatientthinspParthinspexemplethinspcertainsthinsppatientsthinspnethinsptolegraverentthinsppasthinsplesthinspdosagesthinsphabituelsthinspouthinsppreacutesententthinspdesthinspcontre-indications

Ilthinspestthinspimportantthinspdethinspretenirthinspquethinsplethinsptitragethinspdethinsptoutethinspmeacutedicationthinspdoitthinspecirctrethinspthinspprivileacutegieacutethinspetthinspquethinspsonthinspadministrationthinspdoitthinspsethinspfairethinspparthinsppetitesthinspdosesthinspdethinspthinspfaccedilonthinspprogressivethinspjusqursquoagravethinsplrsquoobtentionthinspduthinspniveauthinspdethinspseacutedationthinspetthinspdrsquoanalgeacutesiethinspthinspdeacutesireacutethinsptoutthinspenthinsplaissantthinspsrsquoeacutecoulerthinspsuffisammentthinspdethinsptempsthinspentrethinspdeuxthinspdosesthinsppourthinspquethinsplethinspmeacutedicamentthinspproduisethinspsesthinspeffetsthinsp

Lesthinspmeacutedicamentsthinsputiliseacutesthinspenthinspseacutedation-analgeacutesiethinspontthinspunthinspeffetthinspsynergiquethinspthinspParthinspexemplethinsplrsquoassociationthinspdrsquounethinspbenzodiazeacutepinethinspavecthinspunthinspopioiumldethinspaugmentethinspthinsplesthinsprisquesthinspdethinspdeacutepressionthinsprespiratoirethinspLeurthinspdosagethinspdoitthinspdoncthinspecirctrethinspajusteacutethinspenthinspconseacutequencethinspSithinsplrsquoobstructionthinspdesthinspvoiesthinspaeacuteriennesthinsplrsquoapneacuteethinspetthinsplrsquohypotensionthinspthinspsontthinsplesthinspcomplicationsthinsplesthinspplusthinspfreacutequentesthinspenthinspseacutedation-analgeacutesiethinspilthinspfautthinspretenirthinspquethinspcertainesthinspcomplicationsthinsppeuventthinspecirctrethinspparticuliegraveresthinspagravethinsplathinspmeacutedicationthinsputiliseacuteethinspthinspCitonsthinspagravethinsptitrethinspdrsquoexemplethinsplrsquoassociationthinsplaryngospasmethinspetthinspkeacutetaminethinsp

CMQ - OIIQ - OPIQ 21

Lorsquethinspdesthinspbenzodiazeacutepinesthinspouthinspdesthinspopioiumldesthinspsontthinspadministreacutesthinspparthinspvoiethinspthinspintraveineusethinspleursthinspantagonistesthinsprespectifsthinsp(pthinspexthinspthinspflumazeacutenilthinsp[Anexatereg]thinspthinspnaloxonethinsp[Narcanreg])thinspdoiventthinspecirctrethinsprapidementthinspdisponiblesthinspIlsthinspserontthinsputiliseacutesthinspthinspauthinspmomentthinspdrsquounethinspdeacutepressionthinsprespiratoirethinspinduitethinspparthinsplathinspmeacutedicationthinspet non en prophylaxiethinspchezthinsplethinsppatientthinspstablethinspIlthinspestthinsphabituellementthinsppreacutefeacuterablethinspdethinspthinsprenverserthinspdrsquoabordthinsplrsquoagentthinspseacutedatifthinspafinthinspdethinspmaintenirthinspintactthinsplrsquoeffetthinspanalgeacutesiquethinspthinspSithinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspdemeurethinspcompromisethinspilthinspserathinspalorsthinspthinspneacutecessairethinspdethinsprenverserthinsplrsquoeffetthinspanalgeacutesique

IlthinspfautthinspsethinsprappelerthinspquethinsplathinspdureacuteethinspdrsquoactionthinspdesthinspantagonistesthinspestthinspbienthinspinfeacuterieurethinspthinspagravethinsplathinspdureacuteethinspdrsquoactionthinspduthinspmeacutedicamentthinspdevantthinspecirctrethinspneutraliseacutethinspParthinspconseacutequentthinspthinsplathinspreacuteapparitionthinspdethinsplrsquoeffetthinspindeacutesirablethinspestthinspagravethinspsurveillerthinspchezthinsplethinsppatientthinspquithinspreccediloitthinspunthinspantagonistethinsp

VousthinsptrouverezthinspunethinspfichethinspinformativethinspsurthinsplrsquoutilisationthinspdethinsplathinspnaloxonethinspetthinspduthinspflumazeacutenilthinspagravethinsplrsquoannexethinspXI

Lesthinspdirectivesthinspeacutenonceacuteesthinspdansthinspcesthinsplignesthinspdirectricesthinspnrsquoontthinsppasthinsppourthinspobjectifthinspdethinspdeacutecrirethinspdansthinsplethinspdeacutetailthinsplathinspmeacutedicationthinsputiliseacuteethinspenthinspseacutedation-analgeacutesiethinspleursthinspagentsthinsp

antagonistesthinspetthinsplesthinspmeacutedicamentsthinspdrsquourgencethinspIlthinsprevientthinspauthinspmeacutedecinthinspdethinspbienthinsp

connaicirctrethinsplathinspmeacutedicationthinspetthinspdethinspchoisirthinspunethinspmeacutedicationthinspouthinspunethinspcombinaisonthinspdethinspmeacutedicamentsthinspreconnuethinspEtthinspilthinsprevientthinspauxthinspprofessionnelsthinspquithinsplesthinspadministrentthinsp

dethinspbienthinsplesthinspconnaicirctrethinspeacutegalementthinsp(eacuteleacutementsthinspdethinspsurveillancethinspcliniquethinsptechniquethinspdrsquoadministrationthinspeffetsthinspsecondairesthinspinteractionsthinspcontre-indicationsthinspseuilsthinspthinsptoxiquesthinspetc)thinspetthinspdethinspmaintenirthinspagravethinspjourthinspleursthinspconnaissancesthinspdansthinspcethinspdomaine

thinspPRINCIPALESthinspCLASSESthinspPHARMACOTHEacuteRAPEUTIQUESthinspUTILISEacuteESthinspthinspthinspENthinspSEacuteDATION-ANALGEacuteSIEthinsp

Lathinsplistethinspdesthinspmeacutedicamentsthinspabordeacutesthinspci-dessousthinspnrsquoestthinsppasthinsplimitativethinsp

a BenzodiazeacutepinesthinspProprieacuteteacutesthinspthinspanxiolytiquethinspamneacutesiquethinsphypnotiquethinsprelaxantthinspmusculairethinspetthinspanticonvulsivantthinspthinspIlthinspfautthinspprivileacutegierthinsplesthinspmoleacuteculesthinspagravethinspcourtethinspdemi-viethinsp(pthinspexthinspthinspmidazolamthinsp[Versedreg])thinspenthinspretenantthinspqursquoilthinspfautthinspajusterthinsplethinspdosagethinspchezthinspcertainsthinsppatientsthinsp(pthinspexthinspthinspacircgeacutesthinspouthinspaffaiblis)thinspetthinsplorsthinspdethinsplrsquoutilisationthinspconcomitantethinspdrsquoautresthinspmeacutedicamentsthinspaffectantthinsplethinspsystegravemethinspnerveuxthinspcentralthinspDethinspplusthinsplathinspdemi-viethinsp

CMQ - OIIQ - OPIQ 22

dethinspcesthinspmeacutedicamentsthinsppeutthinspecirctrethinspaugmenteacuteethinsplorsthinspdethinspleurthinspadministrationthinspenthinspperfusionthinspcontinuethinsp(context sensitive half-life)thinsp

b OpioiumldesthinspProprieacuteteacutesthinspthinspanalgeacutesiquethinspetthinspseacutedativethinspLathinspmorphinethinspconstituethinspunthinspopioiumldethinspdontthinsplrsquoefficaciteacutethinspestthinspreconnuethinspCependantthinspellethinspfavorisethinsplathinsplibeacuterationthinspdrsquohistaminethinspcethinspquithinsppeutthinspcauserthinspduthinsppruritthinspetthinspdethinsplrsquohypotensionthinspUnethinspdysfonctionthinspreacutenalethinspseacutevegraverethinspentraicircnethinsplrsquoaccumulationthinspdethinspsesthinspmeacutetabolitesthinspactifsthinsp

thinsprsaquo lethinspfentanylthinsp(Sublimazereg)thinspestthinspunthinspopioiumldethinspsyntheacutetiquethinsppuissantthinspetthinspdethinspcourtethinspdureacuteethinspdrsquoactionthinspIlthinspnethinspdeacuteclenchethinsppasthinspdethinsplibeacuterationthinspdrsquohistaminethinsp(doncthinsppeuthinspdrsquoeffetthinspheacutemodynamique)thinspIlthinspfautthinspcependantthinspsethinspmeacutefierthinspdesthinspdosesthinspeacuteleveacuteesthinspetthinspdesthinspinjectionsthinsprapidesthinspquithinsppeuventthinspprovoquerthinspunethinsprigiditeacutethinspmusculairethinspthinspetthinspunethinspdeacutepressionthinsprespiratoire

thinsprsaquo lrsquohydromorphonethinsp(Dilaudidreg)thinspestthinspunthinspopioiumldethinspsemi-syntheacutetiquethinspdontthinsplesthinspmeacutetabolitesthinspconnusthinspsontthinsprarementthinspprobleacutematiquesthinspMoinsthinsputiliseacuteethinspenthinspthinspseacutedation-analgeacutesiethinspellethinspestthinspauthinspmoinsthinsp5thinspfoisthinspplusthinsppuissantethinspquethinsplathinspmorphinethinspthinspcethinspquithinspestthinspparfoisthinspsous-estimeacute

thinsprsaquo lathinspmeacutepeacuteridinethinsp(Demerolreg)thinspestthinspunthinspopioiumldethinspsyntheacutetiquethinspposseacutedantthinspunthinspmeacuteta-bolitethinspactifthinspneurotoxiquethinspEllethinspnrsquoestthinsphabituellementthinsppasthinsprecommandeacuteethinsp

c Anestheacutesiques geacuteneacuterauxthinspLethinspmeacutedecinthinspquithinspprocegravedethinspagravethinspunethinspinterventionthinspsousthinspseacutedation-analgeacutesiethinspenthinsputilisantthinspunthinspouthinspdesthinspanestheacutesiquesthinspgeacuteneacuterauxthinspdoitthinspecirctrethinspexpeacuterimenteacutethinspenthinspseacutedation-analgeacutesiethinspetthinspenthinspreacuteanimationthinspcardiorespiratoirethinspDansthinsplethinspcasthinspcontrairethinspilthinspdoitthinspsrsquoassurerthinspdethinsplathinspcollaborationthinspdrsquounthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspParthinspailleursthinsplethinspmeacutedecinthinspdoitthinspenthinsptoutthinsptempsthinspecirctrethinspsoutenuthinspparthinspunthinspouthinspdesthinspprofessionnelsthinspqualifieacutesthinsp

thinsprsaquo propofolthinsp(Diprivanreg)thinspProprieacuteteacutesthinspseacutedativethinsphypnotiquethinspamneacutesiquethinspanxiolytiquethinspAgravethinspnoterthinspqursquoilthinspnrsquoathinspaucune proprieacuteteacute analgeacutesiquethinsp

thinspIlthinsppossegravedethinspunethinspdemi-viethinspcourtethinsppeutthinspecirctrethinspcumulatifthinspetthinspnrsquoathinsppas drsquoantago-nistethinspIlthinspnrsquoestthinsppasthinsprecommandeacutethinspchezthinsplathinspfemmethinspenceintethinspouthinspquithinspallaitethinspEnthinspregraveglethinspgeacuteneacuteralethinspetthinspselonthinsplethinsptypethinspdrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspilthinsppeutthinspecirctrethinspplusthinspjudicieuxthinspdethinsplrsquoadministrerthinspenthinspinfusionthinspIVthinspplutocirctthinspthinspqursquoenthinspbolusthinspthinspthinspIlthinsppeutthinsprapidementthinspcauserthinspunethinspdiminutionthinspmarqueacuteethinspduthinspniveauthinspdethinspcon-sciencethinspetthinspunethinspdeacutepressionthinsprespiratoirethinsppouvantthinspconduirethinspmomentaneacute-

CMQ - OIIQ - OPIQ 23

mentthinspagravethinspunethinspanestheacutesiethinspgeacuteneacuteralethinspnonthinspdeacutesireacuteethinspLesthinspprofessionnelsthinspenthinspplacethinspdoiventthinspecirctrethinspenthinspmesurethinspdethinspprendrethinspenthinspchargethinspunethinsptellethinspsituationthinspLrsquoASAthinsp(AmericanthinspSocietythinspofthinspAnesthesiologiststhinspASAthinspHousethinspofthinspDelegatesthinsp2004bthinsp[Notrethinsptraduction])thinsprecommandethinspnotammentthinspquethinsplethinsppatientthinspagravethinspquithinsplrsquoonthinspadministrethinspduthinsppropofolthinspreccediloivethinspdesthinspsoinsthinspenthinsplienthinspavecthinspunethinspseacutedationthinsppro-fondethinsp(niveauthinspnonthinspviseacutethinspdansthinspcesthinsplignesthinspdirectrices)thinspetthinspquethinsplethinspprofessionnelthinsp(nonthinspanestheacutesiologiste)thinspadministrantthinsplethinsppropofolthinsppossegravedethinsplathinspformationthinsptheacuteoriquethinspetthinsppratiquethinspneacutecessairethinspagravethinsplrsquoidentificationthinspetthinspagravethinsplathinspprisethinspenthinspchargethinspdesthinspvoiesthinspaeacuteriennesthinspetthinspdesthinspchangementsthinspcardiovasculairesthinspquithinspsurvien-nentthinspchezthinspunthinsppatientthinspeacutevoluantthinspversthinspunthinspeacutetatthinspdrsquoanestheacutesiethinspgeacuteneacuteralethinsp(niveauthinspnonthinspviseacutethinspdansthinspcesthinsplignesthinspdirectrices)thinsp

thinspthinspLorsquethinsplethinsppropofolthinspestthinspadministreacutethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspthinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspthinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspthinspobligatoirethinsp(tableauthinsp3)thinspthinspthinsp

thinsprsaquo keacutetaminethinsp(Ketalarreg)thinspProprieacuteteacutesthinspthinspseacutedativethinspetthinspanalgeacutesiquethinspthinspUtiliseacuteethinspenthinsppeacutediatriethinspetthinspchezthinsplrsquoadultethinspEllethinspproduitthinspaussithinspunethinspbroncho-thinspdilatationthinspparfoisthinspsouhaiteacuteethinsplorsthinspdrsquointerventionsthinspdiagnostiquesthinspouthinsptheacutera-peutiquesthinspchezthinsplesthinsppatientsthinspasthmatiquesthinspEllethinspsrsquoaccompagnethinspdrsquounethinsplibeacutera-tionthinspdethinspcateacutecholaminesthinspetthinspdrsquoeffetsthinspsympathomimeacutetiquesthinsp(augmentationthinspdethinsplathinspsalivation)thinspEllethinsppeutthinspprovoquerthinspdesthinspsymptocircmesthinsppsychotiquesthinspouthinspdesthinspcomportementsthinspanormauxthinspCesthinspsymptocircmesthinsppeuventthinspnuirethinspagravethinsplrsquoeacutevaluationthinspdesthinsppatientsthinspsousthinspseacutedationthinspEllethinspabaissethinsplethinspseuilthinspconvulsifthinsp

Lorsquethinsplathinspkeacutetaminethinspestthinspadministreacuteethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspobligatoirethinsp(tableauthinsp3)thinspthinsp

thinsprsaquo protoxydethinspdrsquoazotethinsp(N2O)thinsp

ProprieacuteteacutesthinspthinspgazthinspseacutedatifthinspetthinspanalgeacutesiquethinspthinspActionthinspanalgeacutesiquethinspsemblablethinspagravethinspcellethinspdethinsplathinspmorphinethinspIlthinsppotentialisethinsplesthinspanalgeacutesiquesthinspcentrauxthinspetthinsplesthinspagentsthinsphypnotiquesthinspetthinsppeutthinspaussithinspdiminuerthinsplesthinspreacuteservesthinspenthinspoxygegravenethinspduthinsppatientthinspUtiliseacutethinspenthinspcombinaisonthinspavecthinsplrsquooxygegravenethinspIlthinsppeutthinsppolluerthinsplrsquoenvironnementthinspdethinsptravailthinsp(voirthinspnormesthinspCSST)thinspIlthinsppeutthinspecirctrethinsp

CMQ - OIIQ - OPIQ 24

utiliseacutethinspenthinsppeacutediatriethinspchezthinsplrsquoadultethinspetthinspchezthinsplathinspfemmethinspenceintethinsp(saufthinspauthinspthinsppremierthinsptrimestre)thinsp

thinspDansthinsplethinspcasthinspougravethinsplethinspprotoxydethinspdrsquoazotethinspestthinsputiliseacutethinspenthinspcombinaisonthinspavecthinspunthinspagentthinspseacutedatifthinspouthinspunthinspopioiumldethinspouthinspsithinsplrsquoappareilthinsputiliseacutethinsppermetthinspdethinspmodifierthinsplathinspconcentrationthinspdrsquooxygegravenethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivement agravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspthinsp

thinsprsaquo dexmeacutedeacutetomidinethinsp(PreacuteceacutedexMC)thinsp(Agonistethinspalpha2-adreacutenergique)thinspProprieacuteteacutesthinspthinspseacutedativethinspanalgeacutesiquethinspetthinspanxiolytiquethinspthinspLathinspdexmeacutedeacutetomidinethinspenthinspperfusionthinspintraveineusethinspcontinuethinspestthinspindiqueacuteethinspnotammentthinsppourthinsplathinspseacutedationthinspdethinsppatientsthinspnonthinspintubeacutesthinspavantthinspetouthinsppendantthinspunethinspinterventionthinspchirurgicalethinspouthinspdrsquoautresthinsptypesthinspdrsquointerventionsthinspthinspNethinspcausethinspaucunethinspdeacutepressionthinsprespiratoirethinspmaisthinsppeutthinspcauserthinspunethinspbradycar-diethinspetthinspunethinsphypotensionthinspthinsp

thinspLrsquoutilisationthinspdethinspdexmeacutedeacutetomidinethinspdevraitthinspecirctrethinspreacuteserveacuteethinspauthinspmilieuthinspthinsphospitalierthinspouthinspauxthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspthinspEllethinspdevraitthinspecirctrethinspadministreacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspthinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspetthinsprapidementthinspdisponiblethinspthinspLorsquethinspdethinsplathinspdexmeacutedeacutetomidinethinspestthinspadministreacuteethinspunthinspprofessionnelthinspthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspthinspduthinsppatientthinsp(tableauthinsp2)thinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspobligatoirethinsp(tableauthinsp3)thinspthinsp

Agravethinspnoterthinspqursquoilthinspestthinspobligatoirethinspdethinsptenirthinspunthinspregistrethinspdesthinspsubstancesthinspcontrocircleacuteesthinspetthinspdesthinspbenzodiazeacutepinesthinspcomportantthinspdesthinspsignatures

thinsp

CMQ - OIIQ - OPIQ 25

SURVEILLANCEthinspCLINIQUEthinspLathinspsurveillancethinspcliniquethinspcomprendthinspplusieursthinspeacuteleacutementsthinspquithinspconcernentthinspthinspnotammentthinsplesthinspsystegravemesthinsprespiratoirethinspcardiaquethinspetthinspneurologiquethinspEllethinspdoitthinspthinsptenirthinspcomptethinspentrethinspautresthinsp

thinsprsaquo dethinsplathinspconditionthinspduthinsppatientthinspavantthinspetthinsppendantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

thinsprsaquo dethinsplathinspcomplexiteacutethinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinsprsaquo dethinsplathinspmeacutedicationthinsputiliseacuteethinsp(dosethinspdureacuteethinspetthinsppicthinspdrsquoactionthinspvoiethinspetthinspvitessethinspthinsp

drsquoadministrationthinspcombinaisonthinspetthinspantagonistes)

thinsprsaquo dethinsplrsquoassistancethinspagravethinspapporterthinspauthinspmeacutedecin

Lethinspmeacutedecinthinspquithinsppratiquethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspchezthinspunthinsppatientthinspsousthinspseacutedation-analgeacutesiethinspdoitthinspcompterthinspsurthinsplathinsppreacutesencethinspdrsquoauthinspmoinsthinspunthinspautrethinspprofessionnelthinsphabiliteacutethinspduthinspmilieuthinspdethinsplathinspsanteacutethinsp(infirmiegraverethinspinhalotheacuterapeutethinspouthinspautrethinspmeacutedecin)thinsp(annexethinspII)thinspEnthinspeacutetroitethinspcollaborationthinspavecthinsplethinspmeacutedecinthinspreacuteali-santthinsplrsquointerventionthinspceux-cithinspassurentthinspthinsplathinspgestionthinspdethinsplathinspseacutedationthinspetthinspdethinsplrsquoanalgeacutesiethinspqui comprend entre autres la surveillance clinique du patientthinspresponsabiliteacutethinspthinspagravethinsplaquellethinspilsthinspdoiventthinspenthinsptoutthinsptempsthinspsethinspconsacrerthinspenthinspprioriteacutethinsp

Dansthinspcertainsthinspcasthinsplethinspprofessionnelthinspquithinspassurethinspen prioriteacutethinsplathinspsurveillancethinspthinspcliniquethinspduthinsppatientthinsppeutthinspecirctrethinspappeleacutethinspagravethinspassisterthinsplethinspmeacutedecinthinspdansthinsplathinspreacutealisationthinspthinspdethinspsonthinspinterventionthinspCettethinspassistancethinspquithinspdoitthinspsrsquoeffectuerthinspdansthinsplathinspmecircmethinsppiegravecethinspdoitthinspecirctrethinspdethinsptregravesthinspcourtethinspdureacuteethinspDethinspplusthinspellethinspdoitthinsppouvoirthinspecirctrethinspinterrompuethinspthinspagravethinsptoutthinspmomentthinsppourthinspintervenirthinspimmeacutediatementthinspaupregravesthinspduthinsppatientthinspenthinspcasthinspdethinsp

complicationsthinspouthinspdethinspbesoin

Parthinspailleursthinsplorsquethinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspthinspneacutecessitentthinspunethinspassistancethinsptechniquethinspcontinuellethinspauthinspmeacutedecinthinsplrsquoajoutthinspdrsquounthinsptroisiegravemethinspprofessionnelthinspdethinsplathinspsanteacutethinsphabiliteacutethinsp(meacutedecinthinspinfirmiegraverethinspouthinspinhalotheacuterapeute)thinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinspestthinsprequisthinsp

CMQ - OIIQ - OPIQ 26

Tableau 2 Tableau reacutecapitulatif du nombre de professionnels habiliteacutes requis en seacutedation-analgeacutesie - Clientegravele adulte

Toutthinspauthinsplongthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplathinspsurveillancethinspcliniquethinspthinspduthinsppatientthinspdoitthinspecirctrethinspcontinuethinspetthinsplathinspcommunicationthinspavecthinspcelui-cithinspmaintenue

Proceacutederthinspagravethinsplathinspsurveillancethinspcliniquethinspcrsquoestthinspeacutevaluerthinspqualitativementthinspetthinspquantitative-mentthinspdethinspfaccedilonthinspsoutenuethinspetthinspenthinspcontinuthinsplrsquoensemblethinspdesthinspparamegravetresthinspsuivantsthinsp(listethinsp

nonthinsplimitative)thinsp(tableauthinsp3)thinsp

thinsprsaquo mesurethinspdethinsplathinsppressionthinsparteacuteriellethinspduthinsppouls3thinspetthinspdethinsplathinsprespiration4thinsprsaquo lecturethinspdethinsplathinspsaturationthinspcapillairethinspenthinspoxygegravene

Ilthinspfautthinspnoterthinspquethinsplathinsptonaliteacutethinspdethinsppoulsthinspdoitthinspecirctrethinspactiveacuteethinspenthinsptoutthinsptempsthinspetthinspsonthinspniveauthinspdoitthinspecirctrethinspajusteacutethinspdethinspfaccedilonthinspagravethinspecirctrethinspentenduthinspclairement

thinsprsaquo eacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplathinspseacutedationthinsp(eacutevaluationthinspdethinsplathinspseacutedationagitationthinspetthinspduthinspniveauthinspdethinspconscience)thinsp(annexethinspIX)thinsp

thinsprsaquo eacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplrsquoanalgeacutesiethinsp(eacutevaluationthinspdethinsplathinspdouleur)thinspdethinsplrsquoanxieacuteteacutethinspetthinspdethinsplathinspreacuteactionthinspduthinsppatientthinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsp(annexethinspX)

thinsprsaquo eacutevaluationthinspdethinsplrsquoeacutetatthinspdethinsplathinspcolorationthinspetthinspdethinsplathinsptempeacuteraturethinspdethinsplathinsppeauthinsprsaquo eacutevaluationthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsprsaquo niveauthinspdrsquoO

2thinspdethinspCO

2thinspetthinspmonitoragethinspcardiaquethinspselonthinsplethinspcas

3thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp4thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

Nombrethinspdethinspprofessionnelsthinsphabiliteacutesthinsprequis

2 Nombrethinspmimimalthinsprequis

3 Sithinsputilisationthinspdethinsppropofolthinspkeacutetaminethinspouthinspdethinspdexmeacutedeacutetomidine

3 SithinsputilisationthinspconcomitantethinspdethinspN2Othinspetthinspdrsquounthinspagentthinspseacutedatifthinspouthinspthinsp

dunthinspopioiumldethinspouthinspsithinspconcentrationthinspdethinspN2Othinspmodifiable

3 Sithinsplassistancethinsptechniquethinspauthinspmeacutedecinthinspestthinspcontinuelle

CMQ - OIIQ - OPIQ 27

Tableau 3 Surveillance des paramegravetres cliniques en seacutedation-analgeacutesie - Clientegravele adulte

Paramegravetrethinspdethinspthinspsurveillancethinspthinspclinique

PatientNiveauthinspdethinspthinspseacutedation

MeacutedicationInterventionthinspdiagnostiquethinspouthinsptheacuterapeutique

TAthinspRC5thinspthinspRR6thinspthinspetthinspsaturationthinspdrsquoO

thinsp2thinspthinsp

rsaquothinspObligatoireChezthinsptousthinsplesthinsppatients

Niveauthinspdethinspthinsp-thinspseacutedationthinspthinspthinspagitationthinspthinspthinspthinspconscience-thinspdouleur

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

NiveauthinspdethinspCO2

SelonthinsplesthinspthinspcaracteacuteristiquesthinspAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspthinspmeacutedication

Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire

rsaquothinspAccegravesthinspindirectthinspthinspthinspthinspthinspouthinsprestreintthinspthinspthinspthinspauthinsppatientthinspthinspthinspthinsp(pthinspexthinspthinspIRM)

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

rsaquothinspRecommandeacute

rsaquothinspASAthinspgethinsp3thinsprsaquothinspApneacuteethinspthinspobstructivethinspthinspthinspthinspduthinspsommeilthinsprsaquothinspMaladiethinspthinspthinspthinsprespiratoirethinsprsaquothinspObeacutesiteacutethinspmorbide

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

Monitoragethinspcardiaque

SelonthinsplesthinspcaracteacuteristiquesAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

SelonthinsplathinspmeacutedicationSelonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoirersaquothinspASAthinspgethinsp3thinsprsaquothinspMaladiethinspthinspthinspthinspcardiaque

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

Interventionthinspdiagnostiquethinspthinspouthinsptheacuterapeutiquethinspprolongeacuteethinsp(effetthinspcumulatifthinspdethinsplathinspmeacutedication)

rsaquothinspRecommandeacute

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

thinspthinspthinspthinspthinspIlthinspnethinspsrsquoagitthinsppasthinspdrsquounethinsplistethinsplimiteacuteethinspdesthinspsituationsthinspcliniquesthinspDrsquoautresthinspsituationsthinspcliniquesthinsppeuventthinspneacutecessiterthinsplethinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspmonitoragethinspcardiaquethinspouthinspduthinspCO

2thinspIlthinsprevientthinspauxthinspprofessionnelsthinspdethinspjugerthinspdethinsplathinspsituationthinspenthinspfonctionthinspdethinspchaquethinspthinspthinsp

thinspthinspthinspthinspthinspthinsppatient5thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp6thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

CMQ - OIIQ - OPIQ 28

LethinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspimpliqueacutesthinspestthinspprimordialthinspetthinspcethinspmecircmethinspsithinsplrsquoappareillagethinspenthinspplacethinspestthinspcompletthinspetthinspfonctionnelthinspUnethinspbonnethinspcommunica-tionthinspentrethinspcesthinspderniersthinspestthinspdoncthinspessentiellethinspafinthinspdethinspbienthinspcoordonnerthinsplathinspseacutedationthinsp

etthinsplrsquoanalgeacutesiethinspavecthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspLes alarmes (audibles et visuelles) de chaque appareil doivent ecirctre en fonction et les paramegravetres ajusteacutes aux caracteacuteristiques du patient et agrave sa condition clinique

IlthinspfautthinspsrsquoassurerthinspdethinsplathinsptraccedilabiliteacutethinspdethinsplrsquoeacutevaluationthinspetthinspdethinsplathinspsurveillancethinspcliniquethinspthinspeffectueacuteesthinspparthinspunethinsptenuethinspdethinspdossiersthinspconformethinspauxthinspnormesthinspenthinspvigueurthinspLesthinspoutilsthinspdrsquoeacutevaluationthinsputiliseacutesthinspdoiventthinspecirctrethinspsimplesthinspstandardiseacutesthinspvalideacutesthinspdethinsppreacutefeacuterencethinspetthinspadapteacutesthinspauthinspcontextethinspetthinspauxthinspcaracteacuteristiquesthinspduthinsppatientthinspnotam-mentthinsppourthinsplrsquoeacutevaluationthinspduthinspniveauthinspdethinspseacutedationagitationthinspdethinspconsciencethinspetthinspdethinspdouleurthinsp(annexesthinspIXthinspetthinspX)

Lathinspfreacutequencethinspdethinsplathinspmesurethinspdethinspcesthinspparamegravetresthinspetthinspleurthinspenregistrementthinspdoiventthinspecirctrethinspdeacutetermineacutesthinspentrethinspautresthinspenthinspfonctionthinspdethinsplathinspmeacutedicationthinspetthinspdethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsp

Ideacutealementthinsplethinspprofessionnelthinspdoitthinsplesthinspdocumenterthinsp

thinsprsaquo avantthinsplethinspdeacutebutthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsprsaquo apregravesthinsplrsquoadministrationthinspdrsquounthinspagentthinspdethinspseacutedation-analgeacutesiethinspouthinspdrsquounthinspantagonistethinsprsaquo authinsppicthinspdrsquoactionthinspdethinspchacunthinspdesthinspagentsthinspadministreacutesthinspthinsprsaquo agravethinspintervallesthinspreacuteguliersthinsp(pthinspexthinspthinsp5thinspminutes)thinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-thinsp

analgeacutesiethinsprsaquo agravethinspintervallesthinspplusthinsprapprocheacutesthinsplorsquethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsplrsquoexigethinsprsaquo durantthinsplathinsppeacuteriodethinspdethinspreacutecupeacuterationthinspetthinspjusqursquoauthinspretourthinspduthinspniveauthinspdethinspconsciencethinsp

initialethinspselonthinsplathinspconditionthinspcliniquethinspduthinsppatientthinsprsaquo authinspmomentthinspduthinspcongeacute

ILthinspFAUTthinspSAVOIRthinspQUE

LathinspSocieacuteteacutethinspcanadiennethinspdesthinspanestheacutesiologistesthinsp(SCA)thinspindiquethinspquethinsplesthinspthinspdirectivesthinspgeacuteneacuteralesthinspdethinspsoinsthinsp(ythinspcompristhinsplethinspmonitorage)thinsppourthinsplathinspseacutedationthinspconscientethinspsontthinsplesthinspmecircmesthinspquethinsppourthinsplesthinspautresthinspformesthinspdrsquoanestheacutesiethinsp[]thinsp(Merchantthinspetthinspcollabthinsp2014b)thinspDethinspplusthinspellethinspindiquethinspquethinsplethinspcapnographethinspthinspestthinsprequisthinsplorsthinspdethinspseacutedation-analgeacutesiethinspdethinspniveauthinspplusthinspeacuteleveacutethinsp(pthinspexthinspthinspRamsaythinspthinsp4-6)thinsp(Merchantthinspetthinspcollabthinsp2014athinspop cit)

CMQ - OIIQ - OPIQ 29

thinsp16thinspPOSTSEacuteDATION-ANALGEacuteSIEthinsp

Lethinsppatientthinspestthinspagravethinsprisquethinspdethinspdeacutevelopperthinspdesthinspcomplicationsthinspagravethinsplathinspsuitethinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspsurtoutthinspsithinspcettethinspproceacutedurethinspestthinspdethinspcourtethinspdureacuteethinsp(pthinspexthinspthinspdeacutepressionthinsprespiratoirethinsphypotension)thinspEnthinspeffetthinspcertainsthinspmeacutedicamentsthinsptelsthinspquethinsplethinspmidazolamthinspetthinsplethinspfentanylthinspnethinspserontthinsppasthinspcomplegravetementthinspeacutelimineacutesthinspsithinsplathinspdureacuteethinspdethinsplrsquointerventionthinspestthinspmoinsthinspdethinsp30thinspminutesthinspDrsquoautresthinspfacteursthinsptelsthinspquethinsplethinspmanquethinspthinspdethinspstimulationthinspouthinsplrsquoabsorptionthinspretardeacuteethinspdrsquounthinspmeacutedicamentthinsppeuventthinspcontribuerthinspthinspagravethinspunethinspseacutedationthinspprolongeacuteethinspouthinsprebond

Unethinspdeacutepressionthinsprespiratoirethinsppeutthinspsurvenirthinspjusqursquoagravethinspeacuteliminationthinspcomplegravetethinspthinspduthinspmeacutedicamentthinsp

ParthinspconseacutequentthinspjusqursquoagravethinspsonthinspdeacutepartthinsplethinsppatientthinspdoitthinspecirctrethinspsousthinsplathinspsurveillancethinspdrsquounthinspprofessionnelthinsphabiliteacutethinspagravethinspreconnaicirctrethinsplesthinspcomplicationsthinspetthinspagravethinspintervenirthinsprapidementthinspplusthinspparticuliegraverementthinsppourthinspmaintenirthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspetthinspassurerthinsplrsquoassistancethinspventilatoirethinspLethinspmeacutedecinthinspayantthinspproceacutedeacutethinspagravethinsplrsquointerventionthinspsousthinspseacutedation-analgeacutesiethinspouthinspunthinspmeacutedecinthinspdeacutesigneacutethinspdoitthinspecirctrethinspdisponiblethinspenthinsptoutthinsptempsthinspafinthinspdethinsppouvoirthinspintervenirthinspsansthinspdeacutelaithinsplethinspcasthinspeacutecheacuteant

Rappelonsthinspquethinsplesthinspappareilsthinspdethinspmonitoragethinspdoiventthinspecirctrethinspenthinspfonctionthinspmaisthinspthinspenthinspaucunthinsptempsthinspilsthinspnethinspremplacentthinsplathinspsurveillancethinspdirectethinspduthinsppatientthinspparthinspthinsplethinspprofessionnel

Lethinsppatientthinspdoitthinspresterthinspagravethinsplathinspsallethinspdethinspreacutecupeacuterationthinspouthinspdrsquoobservationthinsppendantthinspthinsp30thinspminutesthinspauthinspminimumthinspapregravesthinspavoirthinspreccediluthinsplathinspderniegraverethinspdosethinspdethinspseacutedationthinspouthinspthinspdrsquoanalgeacutesiethinspintraveineusethinsp(Merchantthinspetthinspcollabthinsp2014bthinspop cit)

Sithinspunethinspmeacutedicationthinspantagonistethinspathinspeacuteteacutethinspadministreacuteethinsplethinsppatientthinspserathinspgardeacutethinspsousthinspthinspobservationthinsplethinsptempsthinspneacutecessairethinsp(lethinsptempsthinspserathinspaugmenteacutethinspdethinspgethinsp2thinspheuresthinspthinsp[Merchantthinspetthinspcollabthinsp2014bthinspop cit]thinspenthinspfonctionthinspdethinsplrsquoeacutetatthinspcliniquethinspduthinsppatient)thinsppourthinspsrsquoassurerthinspqursquoilthinspnrsquoythinspathinsppasthinspdethinspseacutedationthinsprebond

Parmithinsplesthinspcritegraveresthinspagravethinsprespecterthinspauthinspmomentthinspduthinspcongeacutethinsp

thinsprsaquo voiesthinspaeacuteriennesthinsppermeacuteablesthinspetthinspventilationthinspadeacutequatethinsprsaquo stabiliteacutethinspcardiovasculairethinspadeacutequatethinsprsaquo niveauthinspdethinspconsciencethinspduthinsppatientthinsprevenuthinspagravethinspsonthinspeacutetatthinspinitialthinsprsaquo douleurthinspreacutesiduellethinsptoleacuterablethinspabsentethinspouthinspcommethinspagravethinspsonthinspeacutetatthinspinitial

CMQ - OIIQ - OPIQ 30

thinsprsaquo mobiliteacutethinsprevenuethinspagravethinspsonthinspeacutetatthinspinitialthinsprsaquo peuthinspouthinsppasthinspdethinspvomissementsthinsprsaquo patientthinspouthinsppersonnethinspresponsablethinspduthinsppatientthinsppeutthinspcomprendrethinsplesthinspdirectivesthinsp

dethinspdeacutepart

thinsprsaquothinsprsaquo Cesthinspcritegraveresthinspdoiventthinspecirctrethinsprespecteacutesthinspdethinspfaccedilonthinspsysteacutematiquethinsp

Lesthinspprofessionnelsthinspdoiventthinspsrsquoassurerthinspquethinspquandthinsplethinsppatientthinspquittethinsplrsquoeacutetablis-sementthinspilthinspestthinspaccompagneacutethinspdrsquounthinspadultethinspresponsablethinspetthinspqursquounthinspdocumentthinsprelatifthinspauthinspcongeacutethinspcomprenantthinspdesthinspconsignesthinspclairesthinsppourthinsplathinspsurveillancethinspagravethinspdomicilethinsp(pthinspexthinspthinspquoithinspfairethinspenthinspcasthinspdrsquourgence)thinspleurthinspsoitthinspremisthinspetthinspexpliqueacutethinsp(annexethinspXII)thinsp

thinspthinsp17thinspDOCUMENTATIONthinspDESthinspSOINSthinspETthinspTENUEthinspthinspDEthinspDOSSIERSthinsp

Commethinsppourthinsptoutethinspautrethinspinterventionthinsplesthinspmecircmesthinspnormesthinspsrsquoappliquentthinsppourthinsplathinspreacutedactionthinspdesthinspnotesthinspenthinspseacutedation-analgeacutesiethinspthinsp

Enthinspplusthinspdesthinspeacuteleacutementsthinspgeacuteneacuteralementthinspverseacutesthinspauthinspdossierthinspcelui-cithinspdoitthinspcontenirthinsptoutesthinsplesthinspinformationsthinsprelativesthinspagravethinsplathinsppeacuteriodethinsppreacutethinspperthinspetthinsppostseacutedation-analgeacutesiethinspAinsithinsplesthinspeacuteleacutementsthinspsuivantsthinspdoiventthinspecirctrethinspdocumenteacutesthinspauthinspdossierthinspduthinsppatientthinsp

(listethinspnonthinsplimitative)thinsp

1 lrsquoidentificationthinspdesthinspfacteursthinspdethinsprisquethinsplieacutesthinspagravethinsplrsquointerventionthinspdiagnostiquethinspthinspouthinsptheacuterapeutiquethinspouthinspagravethinsplathinspseacutedation-analgeacutesie

2 lrsquoheurethinspduthinspdeacutebutthinspetthinspdethinsplathinspfinthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplrsquoheurethinspdrsquoarriveacuteethinspagravethinsplathinspsallethinspdethinspreacutecupeacuterationthinspouthinspdrsquoobservationthinsp(sithinspdiffeacuterente)thinspetthinsplrsquoheurethinspduthinspdeacutepart

3 lesthinspordonnancesthinspmeacutedicalesthinspcomplegravetes4 lathinspmeacutedicationthinspthinspdosagethinspquantiteacutethinspvoiethinspvitessethinspetthinspheurethinspdrsquoadministration5 lathinspconcentrationthinspouthinsplethinspdeacutebitthinspdethinsplrsquooxygegravenethinsp(outhinspduthinspmeacutelangethinspgazeux)thinspadministreacutethinspthinsp

lethinspcasthinspeacutecheacuteant

6 lathinspsurveillancethinspeffectueacuteethinspa lesthinspsignesthinspvitauxthinspavecthinsplrsquoheurethinspdesthinsplecturesb lethinsptauxthinspdethinspsaturationthinspcapillairethinspenthinspoxygegravenethinspavecthinsplrsquoheurethinspdesthinsplecturesc lethinspniveauthinspdethinspCO

2thinspthinsplethinspcasthinspeacutecheacuteantthinspavecthinsplrsquoheurethinspdesthinsplectures

d lathinspdescriptionthinsppeacuteriodiquethinspduthinspniveauthinspdethinspseacutedationagitationthinspetthinspdethinspthinspconsciencethinsplrsquoutilisationthinspdrsquounethinspeacutechellethinspestthinsprecommandeacuteethinsp(annexethinspIX)

e lathinspdescriptionthinsppeacuteriodiquethinspduthinspniveauthinspdethinspdouleurthinsplrsquoutilisationthinspdrsquounethinspeacutechellethinspestthinsprecommandeacuteethinsp(annexethinspX)

CMQ - OIIQ - OPIQ 31

f lathinspdescriptionthinspdethinsptoutethinspreacuteactionthinspdeacutefavorablethinsplethinspcasthinspeacutecheacuteantg lathinspdescriptionthinspdethinsplrsquoeacutetatthinspduthinsppatientthinspagravethinsplathinspfinthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-thinsp

analgeacutesieh lathinspdescriptionthinspdethinsplrsquoeacutetatthinspduthinsppatientthinspauthinspmomentthinspduthinspcongeacutethinspouthinsplathinspreacutefeacuterencethinspthinsp

agravethinspunthinspprotocolethinsp(critegraveresthinspdethinspcongeacute)7 lethinspmonitoragethinspthinspappareilthinspalarmethinspemplacementthinsplethinspcasthinspeacutecheacuteant8 lethinspconsentement9 unethinspcopiethinspdesthinsprecommandationsthinspeacutecritesthinspremisethinspauthinsppatientthinspauthinspmomentthinspduthinsp

congeacutethinsp(annexethinspXII)thinspouthinspagravethinspdeacutefautthinspunethinspnotethinspattestantthinsplathinspremisethinspdethinspcethinspdocumentthinspstandardiseacutethinspdontthinspunethinspcopiethinspestthinspconserveacutee

10 thinsplethinspprotocolethinspopeacuteratoire11 thinsplathinspnotethinspdethinspdeacutepart12 thinsptoutethinspautrethinspinformationthinspjugeacuteethinsppertinentethinsp(pthinspexthinspthinspreacutesultatthinspdrsquoauscultationthinspthinsp

complication)

Enfinthinsptousthinsplesthinspprofessionnelsthinspimpliqueacutesthinspdoiventthinspsrsquoassurerthinspduthinsprespectthinspdethinspleurthinspreacuteglementationthinspouthinspnormesthinsprespectivesthinspenthinspmatiegraverethinspdethinspdocumentationthinspdesthinspsoinsthinspetthinspdethinsptenuethinspdethinspdossiers

CMQ - OIIQ - OPIQ 32

Chapitre 2Patient peacutediatrique

thinspPREacuteAMBULEthinsp

Puisquethinsplrsquoenfantthinsppossegravedethinspdesthinspcaracteacuteristiquesthinspquithinspluithinspsontthinsppropresthinspetthinspquithinspeacutevoluentthinspenthinspfonctionthinspdethinspsonthinspstadethinspdethinspdeacuteveloppementthinspilthinspestthinspdoncthinspopportunthinspdrsquoeacutetablirthinspdesthinsplignesthinspdirectricesthinspparticuliegraveresthinspagravethinspcettethinspclientegravelethinsp

Cesthinsplignesthinspdirectricesthinspvisentthinsplesthinspenfantsthinspacircgeacutesthinspdethinspplusthinspdethinsp3thinspansthinsp

Unethinspseacutedation-analgeacutesiethinspreacuteussiethinspameacuteliorethinsplathinspqualiteacutethinspdesthinspexamensthinspdemandeacutesthinspdiminuethinsplathinspneacutecessiteacutethinspdethinsprecourirthinspagravethinspdesthinspcontentionsthinspphysiquesthinspameacuteliorethinsplathinspcollaborationthinspetthinsplathinspconfiancethinspdethinsplrsquoenfantthinspetthinspdesthinspparentsthinspquantthinspauxthinspsoinsthinspprodigueacutesthinspetthinspauxthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspreacutealiseacuteesthinsp

Lathinspseacutedation-analgeacutesiethinsp(tousthinspniveaux)thinspenthinsppeacutediatriethinspdoitthinspecirctrethinspreacuteserveacuteethinspauthinspmilieuthinsphospitalierthinspouthinspauxthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacuteces-sairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspetthinspcethinspenthinspraisonthinspduthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquithinspestthinspgeacuteneacuteralementthinspneacutecessairethinspEllethinspcomportethinspdesthinsprisquesthinspseacuterieuxthinsppeuthinspimportethinsplrsquoeacutetatthinspdethinspsanteacutethinspdethinsplrsquoenfantthinspLesthinspcomplicationsthinsplesthinspplusthinspfreacutequentesthinspsontthinsplrsquoobstructionthinspdesthinspvoiesthinspaeacuteriennesthinsplrsquoapneacuteethinsplrsquoaspirationthinspdethinspseacutecreacutetionsthinspthinspetthinsplesthinspvomissements

thinsp21thinspOBJECTIFSthinspETthinspCLIENTEgraveLEthinspCIBLEthinsp

OBJECTIFS

Outrethinsplesthinspobjectifsthinspdethinspseacutedation-analgeacutesiethinspdeacutefinisthinsppourthinsplathinspclientegravelethinspadultethinsp(pthinsp8)thinspthinsp

lathinspseacutedation-analgeacutesiethinsppourthinsplathinspclientegravelethinsppeacutediatriquethinspvisethinspeacutegalementthinspagravethinspthinsp

thinsprsaquo eacuteviterthinspunthinsptraumatismethinsppsychologiquethinsprsaquo diminuerthinsplrsquoanxieacuteteacutethinspetthinsplathinsppeurthinspdethinsplrsquoenfantthinspetthinspdesthinspparentsthinsprsaquo obtenirthinsplathinspcollaborationthinspdethinsplrsquoenfant

CMQ - OIIQ - OPIQ 33

CLIENTEgraveLEthinspCIBLE

EnthinsppeacutediatriethinsplethinspniveauthinspdethinspseacutedationthinsprequisthinspestthinsptributairethinspdethinsplrsquoacircgethinspduthinspstadethinspdethinspdeacuteveloppementthinspdethinsplathinspcapaciteacutethinspcognitivethinspetthinspdethinsplathinspcollaborationthinspdethinsplrsquoenfantthinspAinsithinspchezthinsplrsquoenfantthinspdethinsp

thinsprsaquo 3thinspagravethinsp6thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspmodeacutereacutethinspsrsquoavegraverethinsprarementthinspsuffisantethinspLathinspplupartthinspdesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspneacutecessitentthinspunthinspniveauthinspprofondthinsp(voirethinspunethinspanestheacutesiethinspgeacuteneacuterale)thinsp

thinsprsaquo 7thinspagravethinsp13thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspmodeacutereacutethinspsrsquoavegraverethinspgeacuteneacuteralementthinspsuffisantethinspToutefoisthinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinsppeuventthinspneacutecessiterthinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspprofondthinsp

thinsprsaquo gethinsp14thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspleacutegerthinspouthinspmodeacutereacutethinspsrsquoavegraverethinspsuffisantethinspToutefoisthinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinsppeuventthinspneacutecessiterthinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspprofond

Chezthinsplrsquoenfantthinspdethinspmoinsthinspdethinsp3thinspansthinspouthinspdansthinsplethinspcasthinspdrsquounethinspseacutedationthinspprofondethinspviseacuteethinsplethinspmeacutedecinthinspdoitthinspsrsquoassurerthinspdethinsplathinspcollaborationthinspdrsquounthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespira-toirethinsppeacutediatriquethinspavanceacutee

Dethinspplusthinspilthinspestthinsprecommandeacutethinspdrsquoutiliserthinsplathinspclassificationthinspdethinsplrsquoeacutetatthinspphysiquethinspduthinspthinsppatientthinspquethinsplrsquoonthinsptrouvethinspdansthinsplethinsptableauthinspdethinsplathinsppagethinspsuivante

CMQ - OIIQ - OPIQ 34

Tableau 4 Classification de lrsquoeacutetat physique du patient selon lrsquoAmerican Society of Anesthesiologists (ASA) (ASA Physical Status Classification System [En ligne]) (Notre traduction)

Classification Eacutetatthinspdethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp1 Patientthinspenthinspbonnethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp2Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspleacutegegravere

ASAthinspPhysicalthinspStatusthinsp3Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgrave

ASAthinspPhysicalthinspStatusthinsp4Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgravethinspquithinsprepreacutesentethinspunethinspmenacethinspconstantethinsppourthinspsathinspvie

ASAthinspPhysicalthinspStatusthinsp5Patientthinspmoribondthinspquithinspnethinspsurvivrathinsppasthinspthinspagravethinspmoinsthinspdrsquounethinspinterventionthinsp

ASAthinspPhysicalthinspStatusthinsp6Patientthinspdeacuteclareacutethinspenthinspeacutetatthinspdethinspmortthinspceacutereacutebralethinspdontthinsplesthinsporganesthinspontthinspeacuteteacutethinsppreacuteleveacutesthinspagravethinspdesthinspfinsthinspdethinspdon

CMQ - OIIQ - OPIQ 35

Volet organisationnelthinsp22thinspCOMPEacuteTENCESthinspPROFESSIONNELLESthinsp

Outrethinsplesthinspcompeacutetencesthinspprofessionnellesthinspmentionneacuteesthinsppourthinsplethinsppatientthinspadultethinspthinsp(pthinsp11)thinsptousthinsplesthinspprofessionnelsthinspdethinsplathinspsanteacutethinsp(meacutedecinthinspinfirmiegraverethinspetthinspinhalotheacutera-peute)thinspquithinspprocegravedentthinspagravethinspunethinspseacutedation-analgeacutesiethinspaupregravesthinspdethinsppatientsthinsppeacutediatriquesthinspdoiventthinspposseacutederthinsp

athinsp lesthinspconnaissancesthinspetthinsplesthinspcompeacutetences73neacutecessairesthinspagravethinsplathinspreacuteanimationthinspthinspcardiorespiratoirethinsppeacutediatrique84(dethinsppreacutefeacuterencethinspenthinspsoinsthinspavanceacutes)thinspcrsquoest-agrave-direthinspmaicirctriserthinspenthinspprioriteacutethinsplesthinsptechniquesthinspdethinsplathinspprisethinspenthinspchargethinspdethinsplathinspventilationthinspduthinspmassagethinspcardiaquethinspetthinspdethinsplathinspmeacutedicationthinspassocieacutee

bthinspunethinspexpertisethinspcliniquethinspspeacutecifiquethinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspagravethinspreacutealiserthinspthinsp

thinspthinsp23thinspRESSOURCESthinspMATEacuteRIELLESthinsp

Sithinsplesthinspressourcesthinspmateacuteriellesthinspdethinspbasethinspetthinsplrsquoemplacementthinspsontthinspessentiellementthinsplesthinspmecircmesthinspquethinspchezthinsplrsquoadultethinsp(pthinsp11)thinspcelles-cithinspdoiventthinsptoutefoisthinspecirctrethinspadapteacuteesthinspauthinsp

patientthinsppeacutediatriquethinsp(crsquoest-agrave-direthinsptaillethinsppoidsthinspetthinspparticulariteacutes)thinsp

Agravethinsptitrethinspdrsquoexemplethinsp(listethinspnonthinsplimitative)thinsp

thinsprsaquo capteurthinspduthinspsaturomegravetrethinspdethinspmodegravelethinsppeacutediatriquethinsprsaquo reacuteanimateurthinspautogonflantthinsp(Ambuthinspbag)thinspetthinspmasquesthinspdethinspdiffeacuterentesthinsptaillesthinspthinsprsaquo lamesthinspdethinsplaryngoscopethinspsondesthinspendotracheacutealesthinsp(avecthinspouthinspsansthinspballonnet)thinspdethinsp

taillesthinspdiffeacuterentesthinsprsaquo canulesthinsporonasopharyngeacuteesthinspdethinspdiffeacuterentesthinsptaillesthinsprsaquo tubulurethinspagravethinspsoluteacutethinspdethinsptypethinspmicrogouttesthinspavecthinspouthinspsansthinspburettethinsprsaquo outilsthinspsupraglottiquesthinsp(pthinspexthinspthinspmasquethinsplaryngeacute)thinspdethinspdiffeacuterentesthinsptaillesthinsprsaquo deacutefibrillateurthinspavecthinspeacutelectrodesthinsppeacutediatriquesthinsprsaquo steacutethoscopethinspdethinsptaillethinsppeacutediatriquethinsp(preacutecordialthinspouthinsppreacutetracheacutealthinsppourthinspeacutecoutethinspenthinsp

continuethinspsrsquoilthinspythinspathinsplieu)thinsprsaquo appareilthinspagravethinspaspirationthinsppouvantthinspgeacuteneacutererthinspunethinsppressionthinspneacutegativethinspdethinsp40thinspagravethinsp60thinspmmthinsp

Hgthinspouthinspunethinspcapaciteacutethinspdethinspflotthinspdethinsp100thinsplitresthinspparthinspminutethinspetthinsplethinspmateacuterielthinspneacutecessairethinspdethinsptaillethinspadapteacutee

7thinsp Onthinspentendthinspparthinspconnaissancesthinspetthinspcompeacutetencesthinspqursquoellesthinspsoientthinspmisesthinspagravethinspjourthinspselonthinsplesthinsprecommandationsthinspenthinspvigueur

8thinsp Onthinspentendthinspparthinspcertificationthinspenthinspreacuteanimationthinspcardiorespiratoirethinsplesthinspformationsthinspsuivantesthinspthinsp rsaquothinspReacuteanimationthinspcardiorespiratoirethinspdethinspbasethinspthinspSoinsthinspimmeacutediatsthinspenthinspreacuteanimationthinsp(SIR)thinsppourthinspprofessionnelsthinspdethinsplathinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspsanteacutethinspouthinsplrsquoeacutequivalentthinsp rsaquothinspReacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspSoinsthinspavanceacutesthinspenthinspreacuteanimationthinsppeacutediatriquethinsp(SARP)thinspouthinsplrsquoeacutequivalent

CMQ - OIIQ - OPIQ 36

Volet professionnelthinsp24thinspPREacuteSEacuteDATION-ANALGEacuteSIEthinsp

SEacuteLECTIONthinspDESthinspPATIENTS

Sithinspunethinspseacutelectionthinsprigoureusethinspdesthinsppatientsthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinspattentionthinspquethinspchezthinsplrsquoadultethinsp(pthinsp15)thinspcertainesthinspparticulariteacutesthinsppropresthinspagravethinsplrsquoenfantthinspdoiventthinsp

toutefoisthinspecirctrethinspprisesthinspenthinspcomptethinsp

LorsthinspdethinspsituationsthinspparticuliegraveresthinspouthinspcomplexesthinspapregravesthinsplrsquoeacutevaluationthinspduthinsppatientthinsplethinspmeacutedecinthinspdevraitthinspconsulterthinspunthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspCitonsthinspagravethinsptitrethinspdrsquoexemplethinspmaisthinspsansthinspsrsquoythinsplimiterthinsp

thinsprsaquo preacutesencethinspdethinspcertainsthinspsyndromesthinspdontthinsplathinsptrisomiethinsp21thinsprsaquo anomaliethinspdesthinspvoiesthinspaeacuteriennesthinsprsaquo anomaliethinspcranio-facialethinsprsaquo infectionthinsprespiratoirethinspasthmethinsprsaquo maladiethinspneuromusculairethinsprsaquo maladiethinspcardiaquethinsprsaquo troublethinsprespiratoirethinspduthinspsommeilthinspetthinsplathinsptheacuterapiethinspassocieacuteethinsprsaquo obeacutesiteacutethinspimportantethinsprsaquo refluxthinspgastro-œsophagienthinsprsaquo eacutetatthinspdethinspconsciencethinspalteacutereacutethinsprsaquo troublethinspenvahissantthinspduthinspdeacuteveloppementthinsp(pthinspexthinspthinspautisme)

Dethinspmecircmethinsptoutthinspcommethinspchezthinsplrsquoadultethinsplesthinspinterventionsthinspeffectueacuteesthinspsousthinspseacutedation-analgeacutesiethinspdoiventthinspecirctrethinspreacuteserveacuteesthinspprincipalementthinspauxthinsppatientsthinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp1thinspouthinspauxthinsppatientsthinspatteintsthinspdrsquounethinspaffectionthinsp

systeacutemiquethinspleacutegegraverethinspclasseacuteethinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp2thinsp

Notonsthinspquethinsplorsquethinspcestthinspjustifieacutethinspauthinspdossierthinspmeacutedicalthinsplathinspseacutedation-analgeacutesiethinsppeutthinspecirctrethinspeffectueacuteethinspchezthinsplesthinsppatientsthinspstablesthinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp3thinspetthinspexceptionnellementthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp4thinspToutefoisthinspellethinspdoitthinsplrsquoecirctrethinspdansthinspdesthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspDethinspplusthinspcesthinsppatientsthinspdoiventthinsp

fairethinsplrsquoobjetthinspdrsquounethinspeacutevaluationthinspindividualiseacuteethinspetthinspplusthinspapprofondiethinspEacuteVALUATIONthinspDESthinspPATIENTSthinsp

CMQ - OIIQ - OPIQ 37

EacuteVALUATIONthinspDESthinspPATIENTS

Sithinspunethinspeacutevaluationthinsprigoureusethinspdesthinsppatientsthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinspatten-tionthinspquethinspchezthinspladultethinsp(pthinsp15)thinspcettethinspeacutevaluationthinspdoitthinspaussithinspinclurethinspsansthinspsrsquoythinsplimiterthinsplrsquoacircgethinsplathinsptaillethinsplethinsppoidsthinsplethinspstadethinspdethinspdeacuteveloppementthinsplathinspcapaciteacutethinspcognitivethinsplesthinspallergiesthinsplesthinspproblegravemesthinspmeacutedicauxthinspouthinspfamiliauxthinsppertinentsthinsplesthinspmeacutedicamentsthinsp(outhinspautrethinspsubstancethinspnonthinspprescrite)thinsppristhinspreacuteguliegraverementthinspouthinspreacutecemmentthinspetthinsplrsquoheurethinspduthinspdernierthinspingestathinspainsithinspquethinsplethinsptypethinspetthinsplathinspquantiteacutethinspconsommeacutee

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsplrsquoeacutevaluationthinsp(anamnegravesethinspetthinspexamenthinspphysique)thinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinspthinsp

CONSENTEMENTthinsp(REacuteSUMEacute)

LethinsplecteurthinspdoitthinspsethinspreacutefeacutererthinspagravethinsplrsquoannexethinspVIIIthinsppourthinsplethinsptextethinspcomplet

ToutthinspcommethinspchezthinsplrsquoadultethinspilthinspestthinspobligatoirethinspauthinspQueacutebecthinspdrsquoobtenirthinsplethinspconsente-mentthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspinterventionthinspCelathinspditthinsppourthinsplathinspclientegravelethinsppeacutediatriquethinspilthinspfautthinspajouterthinspunethinsppreacutecisionthinspextraitethinspduthinsp

Code civil du QueacutebecthinspthinspSithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsp(traitementsthinspdethinspmeacutedecinethinspetthinspdethinspchirurgiethinspestheacutetiquethinspexpeacuterimentationthinspetthinspdonsthinspdrsquoorganes)thinsplethinsppatientthinspdoitthinspecirctrethinspinformeacutethinspdethinsptousthinsplesthinsprisquesthinsppossiblesthinspmecircmethinspsrsquoilsthinspsontthinspraresthinspthinspetthinsplethinspconsentementthinspdoitthinspecirctrethinspdonneacutethinspparthinspeacutecrit

thinsprsaquo Unethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsp(gethinsp14thinspans)thinsppeutthinspconsentirthinspseulethinspthinspagravethinspmoinsthinspqursquoilthinspsrsquoagissethinspdethinspsoinsthinspnonthinsprequisthinspetthinspcomportantthinspdesthinsprisques

thinsprsaquo Pourthinspunethinsppersonnethinspmineurethinspdethinspmoinsthinspdethinsp14thinspansthinsp(ltthinsp14thinspans)thinsplethinspconsentementthinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentale

Srsquoilthinspsrsquoagitthinspdethinspsoins requisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsplrsquoobligationthinspdrsquoinformerthinsp

croicirctthinspenthinspfonctionthinspdethinsplathinsppreacutevalencethinspetthinspdethinsplathinspgraviteacutethinspdesthinspcomplications

thinsprsaquo Lethinspconsentementthinspdrsquounethinsppersonnethinspmineurethinsp(ltthinsp18thinspans)thinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinsp

thinsprsaquo Unethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsp(gethinsp14thinspans)thinsppeutthinspconsentirthinspmaisthinspnethinsppeutthinsppasthinsprefuserthinspseulethinspdesthinspsoinsthinspquithinspseraientthinspjugeacutesthinsprequisthinsp

DIRECTIVESthinspETthinspCONSEILSthinsp

Toutthinspcommethinsppourthinsplrsquoadultethinsp(pthinsp19)thinsplrsquoenfantthinspetthinspsonthinspparentthinsp(outhinspremplaccedilant)thinspdoiventthinsprecevoirthinsplesthinspdirectivesthinspneacutecessairesthinspCelathinspditthinspauxthinspdirectivesthinsprelativesthinspauthinspjeucircnethinsp

CMQ - OIIQ - OPIQ 38

preacute-interventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspnonthinspurgentethinsp(eacutelective)thinspilthinspfautthinspajouterthinspcecithinsp(Merchantthinspetthinspcollabthinsp2014a op cit)thinsp

thinsprsaquo liquidethinspclairthinsp(pthinspexthinspthinspeauthinspjusthinspdethinspfruitthinsp[sansthinsppulpe])thinspthinspjeucircnethinspdethinsp2thinspheuresthinsprsaquo laitthinspmaternelthinspthinspjeucircnethinspdethinsp4thinspheuresthinsprsaquo formulesthinsplacteacuteesthinspnonthinsphumaniseacuteesthinspouthinsppreacuteparationsthinspcommercialesthinsppourthinsp

nourrissonsthinspthinspjeucircnethinspdethinsp6thinspheuresthinspthinspAucunthinspajoutthinspnrsquoestthinsppermisthinspauthinsplaitthinspmaternelthinsptireacutethinsp

thinsp25thinspPERSEacuteDATION-ANALGEacuteSIEthinsp

APPROCHEthinspPHARMACOLOGIQUEthinsp

Sithinsplathinspmeacutedicationthinspgeacuteneacuteralementthinsputiliseacuteethinspestthinsplathinspmecircmethinspquethinspchezthinsplrsquoadultethinsp(pthinsp20)thinsplathinspdosethinspdoitthinspecirctrethinspadapteacuteethinspnotammentthinspenthinspfonctionthinspduthinsppoidsthinspetthinspdethinsplathinspcondi-tionthinspcliniquethinspdethinsplrsquoenfantthinspParthinspailleursthinspilthinspfautthinspretenirthinspquethinsplathinsppharmacocineacutetiquethinspetthinsplathinsppharmacodynamiquethinspdesthinspagentsthinspdethinspseacutedation-analgeacutesiethinspsontthinspinfluenceacuteesthinspparthinsplrsquoacircgethinspduthinsppatientthinspAgravethinsptitrethinspdrsquoexemplethinsppourthinspunthinspenfantthinspacircgeacutethinspdethinspunthinspagravethinspsixthinspansthinsplathinspclairancethinspdesthinspagentsthinspdethinspseacutedation-analgeacutesiethinspestthinspsupeacuterieurethinspagravethinspcellethinspdethinsplrsquoadultethinspIlthinspfaudrathinspdoncthinspajusterthinsplesthinspdosesthinspchezthinspunthinspenfantthinspdrsquoacircgethinsppreacutescolairethinsp(Saunderthinspetthinsp

collabthinsp2008)thinsp

Lrsquoutilisationthinspdrsquounethinsppommadethinspanalgeacutesiquethinsp(pthinspexthinspthinsplathinspcregravemethinspEMLAreg)thinsppeutthinspecirctrethinspavantageusethinsppourthinspcontrerthinsplathinspdouleurthinspassocieacuteethinspagravethinsplathinspposethinspdrsquounthinspcatheacuteterthinspintra-veineuxthinspparthinspexemplethinsp(lethinsptempsthinspdrsquoattentethinspdethinsp60thinspagravethinsp90thinspminutesthinspdoitthinspecirctrethinsppristhinspenthinspconsideacuteration)thinsp

APPROCHEthinspNONthinspPHARMACOLOGIQUE

Pourthinsplrsquoenfantthinspquithinspnethinspbeacuteneacuteficiethinspquethinspdrsquounethinspanalgeacutesiethinsp(aucunethinspseacutedation)thinspilthinspfautthinspretenirthinspquethinsplathinspdistractionthinsp(attirerthinsplrsquoattentionthinspversthinspquelquethinspchosethinspdethinsppositif)thinsppen-dantthinspunthinspsointhinspdouloureuxthinsp(outhinspquithinspinquiegravete)thinsppeutthinspsrsquoaveacutererthinspunthinspmoyenthinspefficacethinsppourthinspdiminuerthinspsonthinspanxieacuteteacutethinspetthinsplathinspperceptionthinspdethinspsathinspdouleurthinsp(AssociationthinspSparadrapthinspthinsp[Enthinspligne])

Agravethinsptitrethinspdrsquoexemplethinspetthinspsansthinspsrsquoythinsplimiterthinsp

thinsprsaquo discuterthinspavecthinsplrsquoenfantthinspouthinsplrsquoadolescentthinspdethinspsesthinsppreacutefeacuterencesthinsprsaquo utiliserthinspunthinspjouetthinspchanterthinspunethinspchansonthinspouthinspraconterthinspunethinsphistoirethinspagravethinsplrsquoenfantthinspthinsp

plusthinspjeunethinsprsaquo lathinsppreacutesencethinspetthinsplathinspcollaborationthinspdrsquounthinspparentthinsppeuventthinspecirctrethinsppertinentes

CMQ - OIIQ - OPIQ 39

SURVEILLANCEthinspCLINIQUE

Lathinspsurveillancethinspcliniquethinspcomprendthinspplusieursthinspeacuteleacutementsthinspquithinspconcernentthinspnotam-mentthinsplesthinspsystegravemesthinsprespiratoirethinspcardiaquethinspetthinspneurologiquethinspetthinspellethinspdoitthinsptenirthinspcomptethinspentrethinspautresthinsp

thinsprsaquo dethinsplathinspconditionthinspduthinsppatientthinspavantthinspetthinsppendantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

thinsprsaquo dethinsplathinspcomplexiteacutethinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinsprsaquo dethinsplathinspmeacutedicationthinsputiliseacuteethinsp(dosethinspdureacuteethinspetthinsppicthinspdrsquoactionthinspvoiethinspetthinspvitessethinsp

drsquoadministrationthinspcombinaisonthinspetthinspantagonistes)thinsprsaquo dethinsplrsquoassistancethinspagravethinspapporterthinspauthinspmeacutedecin

Lethinspmeacutedecinthinspquithinsppratiquethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspchezthinspunthinspenfantthinspsousthinspseacutedation-analgeacutesiethinspdoitthinspcompterthinspsurthinsplathinsppreacutesencethinspdrsquoauthinspmoinsthinspunthinspautrethinspprofessionnelthinsphabiliteacutethinspduthinspmilieuthinspdethinsplathinspsanteacutethinsp(infirmiegraverethinspinhalotheacuterapeutethinspouthinspautrethinspmeacutedecin)thinsp(annexethinspII)thinspEnthinspeacutetroitethinspcollaborationthinspavecthinsplethinspmeacutedecinthinspreacuteali-santthinsplrsquointerventionthinspceux-cithinspassurentthinsplathinspgestionthinspdethinsplathinspseacutedationthinspetthinspdethinsplrsquoanalgeacutesiethinsp

qui comprend entre autres la surveillance clinique de lrsquoenfantthinspresponsabiliteacutethinspthinspagravethinsplaquellethinspilsthinspdoiventthinspenthinsptoutthinsptempsthinspsethinspconsacrerthinspen prioriteacutethinsp

Dansthinspcertainsthinspcasthinsplethinspprofessionnelthinspquithinspassurethinspen prioriteacutethinsplathinspsurveillancethinspthinspcliniquethinspdethinsplrsquoenfantthinsppeutthinspecirctrethinspappeleacutethinspagravethinspassisterthinsplethinspmeacutedecinthinspdansthinsplathinspreacutealisationthinspthinspdethinspsonthinspinterventionthinspCettethinspassistancethinspquithinspdoitthinspsrsquoeffectuerthinspdansthinsplathinspmecircmethinsppiegravecethinspdoitthinspecirctrethinspdethinsptregravesthinspcourtethinspdureacuteethinspDethinspplusthinspellethinspdoitthinsppouvoirthinspecirctrethinspinterrompuethinspagravethinsptoutthinspmomentthinsppourthinspintervenirthinspimmeacutediatementthinspaupregravesthinspdethinsplrsquoenfantthinspenthinspcasthinspdethinspcomplicationsthinspouthinspdethinspbesoin

Parthinspailleursthinsplorsquethinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspneacutecessitentthinspunethinspassistancethinsptechniquethinspcontinuellethinspauthinspmeacutedecinthinsplrsquoajoutthinspdrsquounthinsptroisiegravemethinspprofessionnelthinspdethinsplathinspsanteacutethinsphabiliteacutethinsp(meacutedecinthinspinfirmiegraverethinspouthinspinhalotheacutera-peute)thinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspdethinsplrsquoenfantthinspestthinsprequisthinsp

CMQ - OIIQ - OPIQ 40

Tableau 5 Tableau reacutecapitulatif du nombre de professionnels habiliteacutes requis en seacutedation-analgeacutesie - Clientegravele peacutediatrique

Toutthinspauthinsplongthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinspdoitthinspecirctrethinspcontinuethinspetthinsplathinspcommunicationthinspavecthinspcelui-cithinspmaintenuethinsp

Proceacutederthinspagravethinsplathinspsurveillancethinspcliniquethinspcrsquoestthinspeacutevaluerthinspqualitativementthinspetthinspquanti-tativementthinspdethinspfaccedilonthinspsoutenuethinspetthinspenthinspcontinuthinsplrsquoensemblethinspdesthinspparamegravetresthinspsui-vantsthinsp(listethinspnonthinsplimitative)thinsp(tableauthinsp6)thinsp

thinsprsaquo mesurethinspdethinsplathinsppressionthinsparteacuteriellethinspduthinsppouls95etthinspdethinsplathinsprespiration106

thinsprsaquo lecturethinspdethinsplathinspsaturationthinspcapillairethinspenthinspoxygegraveneLathinsptonaliteacutethinspdethinsppoulsthinspdoitthinspecirctrethinspactiveacuteethinspenthinsptoutthinsptempsthinspetthinspsonthinspniveauthinspdoitthinspecirctrethinspajusteacutethinspdethinspfaccedilonthinspagravethinspecirctrethinspentenduthinspclairement

thinsprsaquo eacutevaluationthinspdethinsplrsquoeacutetatthinspdethinsplathinspcolorationthinspetthinspdethinsplathinsptempeacuteraturethinspdethinsplathinsppeauthinsprsaquo niveauthinspdrsquoO

2thinspdethinspCO

2thinspetthinspmonitoragethinspcardiaquethinspselonthinsplethinspcasthinsp

Enthinspplusthinspdesthinspparamegravetresthinspdethinspmonitoragethinspcliniquethinsp(mentionneacutesthinsppreacuteceacutedemment)thinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsppeacutediatriquethinspdoitthinspcomprendrethinspthinsp

thinsprsaquo lrsquoeacutevaluationthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsp(pthinspexthinspthinspbradycardiethinsphypoxiquethinsppreacutecocethinspsithinspobstruction)

thinsprsaquo lrsquoapportthinspliquidienthinsprsaquo lathinsppertethinspdethinspchaleurthinsp(selonthinsplathinspdureacuteethinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesie)

9thinspthinspthinspthinspthinspLethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp10thinspthinspthinspthinspLathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinspetthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

Nombrethinspdethinspprofessionnelsthinsphabiliteacutesthinsprequis

2 Nombrethinspmimimalthinsprequis

3 Sithinsputilisationthinspdethinsppropofolthinspkeacutetaminethinspouthinspdethinspdexmeacutedeacutetomidine

3 SithinsputilisationthinspconcomitantethinspdethinspN2Othinspetthinspdrsquounthinspagentthinspseacutedatifthinspouthinspthinsp

dunthinspopioiumldethinspouthinspsithinspconcentrationthinspdethinspN2Othinspmodifiable

3 Sithinsplassistancethinsptechniquethinspauthinspmeacutedecinthinspestthinspcontinuelle

CMQ - OIIQ - OPIQ 41

thinsprsaquo lrsquoeacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplrsquoanalgeacutesiethinspetthinspdethinsplathinspseacutedationthinspagravethinsplrsquoaidethinspdrsquooutilsthinspadapteacutesthinspagravethinsplathinspconditionthinspetthinspagravethinsplrsquoacircgethinspdethinsplrsquoenfantthinsp(annexesthinspIXthinspetthinspX)

thinsprsaquo lathinsppositionthinspduthinsppatientthinspetthinsplesthinsppointsthinspdrsquoappuithinsp(compression)

Tableau 6 Surveillance des paramegravetres cliniques en seacutedation-analgeacutesie - Clientegravele peacutediatrique

Paramegravetrethinspdethinspthinspsurveillancethinspclinique

PatientNiveauthinspdethinspthinspseacutedation

MeacutedicationInterventionthinspdiagnostiquethinspouthinsptheacuterapeutique

TAthinspRC11thinspthinspRR12thinspthinspetthinspsaturationthinspdrsquoO

2thinspthinsp

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

Niveauthinspdethinspthinsp-thinspseacutedationagitationthinspthinspthinspthinspconscience-thinspdouleur

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

NiveauthinspdethinspCO2

SelonthinsplesthinspcaracteacuteristiquesthinspAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)thinsp

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspmeacutedication Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire rsaquothinspAccegravesthinspindirectthinspouthinspthinspthinspthinspthinsprestreintthinspauthinsppatientthinspthinspthinsp(pthinspexthinspthinspIRM)

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetaminethinsp

rsaquothinspRecommandeacute rsaquothinspASAthinspgethinsp3thinsprsaquothinspApneacuteethinspobstructivethinspthinspthinspduthinspsommeilthinsprsaquothinspMaladiethinspthinspthinsprespiratoirethinsprsaquothinspObeacutesiteacutethinspmorbide

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

Monitoragethinspcardiaque

SelonthinsplesthinspcaracteacuteristiquesAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspmeacutedication Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire rsaquothinspASAthinspgethinsp3thinsprsaquothinspMaladiethinspcardiaque

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

Interventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspprolongeacuteethinsp(effetthinspcumulatifthinspdethinsplathinspmeacutedication)

rsaquothinspRecommandeacute Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

thinspthinsp IlthinspnethinspsrsquoagitthinsppasthinspdrsquounethinsplistethinsplimiteacuteethinspdesthinspsituationsthinspcliniquesthinspDrsquoautresthinspsituationsthinspcliniquesthinsppeuventthinspneacutecessiterthinspthinsplethinspmonitoragethinspcardiaquethinspouthinspduthinspCO

2thinspIlthinsprevientthinspauxthinspprofessionnelsthinspdethinspjugerthinspdethinsplathinspsituationthinspenthinspfonctionthinspdethinspthinsp

chaquethinsppatient

11thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp12thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

CMQ - OIIQ - OPIQ 42

ILthinspFAUTthinspSAVOIRthinspQUE

LathinspSocieacuteteacutethinspcanadiennethinspdesthinspanestheacutesiologistesthinsp(SCA)thinspindiquethinspquethinsplesthinspthinspdirectivesthinspgeacuteneacuteralesthinspdethinspsoinsthinsp(ythinspcompristhinsplethinspmonitorage)thinsppourthinsplathinspseacutedationthinspthinspconscientethinspsontthinsplesthinspmecircmesthinspquethinsppourthinsplesthinspautresthinspformesthinspdrsquoanestheacutesiethinsp[]thinspthinsp(Merchantthinspetthinspcollabthinsp2014bthinspopthinspcit)thinspDethinspplusthinspellethinspindiquethinspquethinsplethinspthinspcapnographethinspestthinsprequisthinsplorsthinspdethinspseacutedation-analgeacutesiethinspdethinspniveauthinspplusthinspeacuteleveacutethinspthinsp(pthinspexthinspthinspRamsaythinsp4-6)thinsp(Merchantthinspetthinspcollabthinsp2014athinspop cit)

LethinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspimpliqueacutesthinspestthinspprimordialthinspetthinspcethinspmecircmethinspsithinsplrsquoappareillagethinspenthinspplacethinspestthinspcompletthinspetthinspfonctionnelthinspUnethinspbonnethinspcommunica-tionthinspentrethinspcesthinspderniersthinspestthinspdoncthinspessentiellethinspafinthinspdethinspbienthinspcoordonnerthinsplathinspseacutedationthinspetthinsplrsquoanalgeacutesiethinspavecthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspLes alarmes (audibles et visuelles) de chaque appareil doivent ecirctre en fonction et les paramegravetres ajusteacutes agrave lrsquoacircge et agrave la condition clinique de chaque enfant

IlthinspfautthinspsrsquoassurerthinspdethinsplathinsptraccedilabiliteacutethinspdethinsplrsquoeacutevaluationthinspetthinspdethinsplathinspsurveillancethinspcliniquethinspthinspeffectueacuteesthinspparthinspunethinsptenuethinspdethinspdossiersthinspconformethinspauxthinspnormesthinspenthinspvigueurthinspthinspLesthinspoutilsthinspdrsquoeacutevaluationthinsputiliseacutesthinspdoiventthinspecirctrethinspsimplesthinspstandardiseacutesthinspvalideacutesthinspdethinsppreacutefeacuterencethinspetthinspadapteacutesthinspauthinspcontextethinspetthinspauxthinspcaracteacuteristiquesthinspduthinsppatientthinspnotam-mentthinsppourthinsplrsquoeacutevaluationthinspduthinspniveauthinspdethinspseacutedationagitationthinspdethinspconsciencethinspetthinspdethinspdouleurthinsp(annexesthinspIXthinspetthinspX)

Lathinspfreacutequencethinspdethinsplathinspmesurethinspdethinspcesthinspparamegravetresthinspetthinspleurthinspenregistrementthinspdoiventthinspecirctrethinspdeacutetermineacutesthinspentrethinspautresthinspenthinspfonctionthinspdethinsplathinspmeacutedicationthinspetthinspdethinsplathinspconditionthinsp

cliniquethinspduthinsppatientthinsp

Ideacutealementthinsplethinspprofessionnelthinspdoitthinsplesthinspdocumenterthinsp

thinsprsaquo avantthinsplethinspdeacutebutthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsprsaquo apregravesthinsplrsquoadministrationthinspdrsquounthinspagentthinspdethinspseacutedation-analgeacutesiethinspouthinspdrsquounthinspantagonistethinsprsaquo authinsppicthinspdrsquoactionthinspdethinspchacunthinspdesthinspagentsthinspadministreacutesthinspthinsprsaquo agravethinspintervallesthinspreacuteguliersthinsp(pthinspexthinspthinsp5thinspminutes)thinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-

analgeacutesiethinsprsaquo agravethinspintervallesthinspplusthinsprapprocheacutesthinsplorsquethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsplrsquoexigethinsprsaquo durantthinsplathinsppeacuteriodethinspdethinspreacutecupeacuterationthinspetthinspjusqursquoauthinspretourthinspduthinspniveauthinspdethinspconsciencethinsp

initialthinspselonthinsplathinspconditionthinspcliniquethinspduthinsppatientthinsprsaquo authinspmomentthinspduthinspcongeacutethinsp

CMQ - OIIQ - OPIQ 43

thinsp26thinspPOSTSEacuteDATION-ANALGEacuteSIEthinsp

Commethinsppourthinsplethinsppatientthinspadultethinsp(pthinsp29)thinsplathinspsurveillancethinspcliniquethinspdoitthinspecirctrethinspcons-tantethinspetthinsprigoureusethinsptoutthinspauthinsplongthinspdethinsplathinsppeacuteriodethinsppostseacutedation-analgeacutesiethinspetthinspcethinspjusqursquoauthinspretourthinspdethinsplrsquoeacutetatthinspinitialthinspdethinsplrsquoenfantthinspenthinspfonctionthinspdethinspsonthinspstadethinspdethinspdeacutevelop-pement

Rappelonsthinspquethinsplesthinspappareilsthinspdethinspmonitoragethinspdoiventthinspecirctrethinspenthinspfonctionthinspthinspmaisthinspenthinspaucunthinsptempsthinspilsthinspnethinspremplacentthinsplathinspsurveillancethinspdirectethinspduthinsppatientthinspthinspparthinsplethinspprofessionnelthinsp

LathinsppeacuteriodethinspdrsquoobservationthinspenthinspeacutetablissementthinspdoitthinspecirctrethinspsuffisammentthinspprolongeacuteethinsppourthinsppreacutevenirthinsplesthinspproblegravemesthinsppendantthinspetthinspauthinspretourthinspagravethinsplathinspmaisonthinspComptethinsptenuthinspdethinspsonthinspacircgethinspetthinspdethinspsathinspconditionthinsplrsquoenfantthinspdoitthinspecirctrethinspcapablethinspdethinspsrsquoasseoirthinspdethinspboirethinspdethinspparlerthinspetthinspdethinspmarcherthinspavecthinspunethinspaidethinspminimalethinsp

Selonthinsplathinspdistancethinspagravethinspparcourirthinspauthinspretourthinspilthinsppeutthinspecirctrethinspjudicieuxthinspdethinspprolongerthinsplathinsppeacuteriodethinspdrsquoobservation

Unthinspdocumentthinsprelatifthinspauthinspcongeacutethinspcomprenantthinspdesthinspconsignesthinspclairesthinsppourthinsplathinspthinsp

surveillancethinspagravethinspdomicilethinspdoitthinspecirctrethinspremisthinspetthinspexpliqueacutethinspauxthinspparentsthinsp(annexethinspXII)

thinsp27thinspDOCUMENTATIONthinspDESthinspSOINSthinspETthinspTENUEthinspDEthinspDOSSIERSthinsp

Lathinsptenuethinspdethinspdossiersthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinsprigueurthinspetthinsplathinspmecircmethinsppreacutecisionthinspquethinspchezthinsplrsquoadultethinsp(pthinsp30)thinspCertainesthinspinformationsthinsppropresthinspagravethinsplrsquoenfantthinspdoiventthinspecirctrethinspajouteacuteesthinspnotammentthinsp

thinsprsaquo sithinsppreacutesencethinspdrsquounthinspparentthinsprsaquo lethinsppoidsthinspetthinsplrsquoacircgethinspdethinsplrsquoenfantthinsprsaquo lathinsptaillethinspouthinsplrsquoIMCthinspsrsquoilthinspythinspathinsplieu

CMQ - OIIQ - OPIQ 44

CONCLUSION

Lathinspseacutedation-analgeacutesiethinspvisethinspagravethinspalteacutererthinsplethinspniveauthinspdethinspconsciencethinspainsithinspqursquoagravethinspsoulagerthinsplrsquoanxieacuteteacutethinspetthinsplathinspdouleurthinspdrsquounthinsppatientthinspauthinspcoursthinspdrsquounethinspinterventionthinsptheacuterapeutiquethinspouthinspdiagnostiquethinspCettethinspproceacutedurethinspbienthinspquethinspfreacutequemmentthinsputiliseacuteethinspcomportethinspcependantthinspcertainsthinsprisques

On doit y recourir de faccedilon seacutecuritaire pour le patient et en tout temps preacutevenir et reconnaicirctre les complica-tions lieacutees agrave la seacutedation-analgeacutesie afin drsquoeffectuer rapidement et efficace-ment les manœuvres neacutecessaires

LethinsprespectthinspdesthinsplignesthinspdirectricesthinspeacutenonceacuteesthinspdansthinspcethinspdocumentthinspaiderathinsplesthinspprofessionnelsthinspagravethinspmenerthinspadeacutequatementthinspcettethinspproceacutedurethinspCeux-cithinspdemeurentthinsptoutefoisthinspresponsablesthinspdethinsplathinspmisethinspagravethinspjourthinspdethinspleursthinspconnaissancesthinspetthinspduthinspdeacuteveloppementthinspdethinspleursthinspcompeacutetencesthinsprespectivesthinsp

Parthinspailleursthinsplesthinspeacutetablissementsthinspdethinspsanteacutethinspetthinsplesthinspcliniquesthinspouthinspcabinetsthinsppriveacutesthinspdevraientthinspsrsquoinspirerthinspdethinspcesthinsplignesthinspdirectricesthinsppourthinspeacutelaborerthinspthinspdesthinspproceacuteduresthinsprelativesthinspagravethinsplathinspthinspseacutedation-analgeacutesiethinspetthinspenthinspassurerthinsplrsquoeacutevaluationthinsppeacuteriodiquethinspdethinsplathinspqualiteacutethinsp

CMQ - OIIQ - OPIQ 45

mdash Annexe

thinspANNEXEthinspIthinspndashthinspDEacuteFINITIONthinspDEthinspLrsquoANESTHEacuteSIEthinspGEacuteNEacuteRALEthinspETthinspthinsp

DESthinspNIVEAUXthinspDEthinspSEacuteDATION-ANALGEacuteSIEthinspSELONthinspLrsquoAMERICANthinspSOCIETYthinspOFthinsp

ANESTHESIOLOGISTSthinsp(ASA)thinsp(AMERICANthinspSOCIETYthinspOFthinspANESTHESIOLOGISTSthinsp

ASAthinspHOUSEthinspOFthinspDELEGATEthinsp2014AthinspOP CIT)thinsp(NOTREthinspTRADUCTION)

Seacutedationthinspminimalethinspthinspanxiolyse

Seacutedation-thinspthinspanalgeacutesiethinspthinspmodeacutereacutee(consciente)

Seacutedation-thinspanalgeacutesiethinspthinspprofonde

Anestheacutesiethinspthinspgeacuteneacuterale

Reacuteponse Reacuteponsethinspnormalethinspagravethinsplathinspstimulationthinspverbale

Reacuteponsethinspvolontairethinspagravethinsplathinspstimulationthinspverbalethinspouthinsptactile

Reacuteponsethinspvolontairethinspsuivantthinspunethinspstimulationthinspreacutepeacuteteacuteethinspouthinspdouloureuse

Nonthinspeacuteveillablethinspmecircmethinspavecthinspstimulusthinspdouloureux

Voiesthinspthinspaeacuteriennes

Nonthinspaffecteacutees Pasthinspdrsquointerventionthinsprequise

Interventionthinsppeutthinspecirctrethinsprequise

Interventionthinspthinspsouventthinsprequise

Ventilationspontaneacutee

Nonthinspaffecteacuteethinsp Adeacutequate Peutthinspecirctrethinspinadeacutequate

Freacutequemmentthinspinadeacutequate

Fonctionthinspcardio-thinspvasculaire

Nonthinspaffecteacutee Geacuteneacuteralementthinspthinspmaintenue

Geacuteneacuteralementthinspthinspmaintenue

Peutthinspecirctrethinspthinspcompromise

thinspthinspLethinspreacuteflexethinspdethinspretraitthinspagravethinsplathinspsuitethinspdrsquounethinspstimulationthinspdouloureusethinspnrsquoestthinsppasthinspconsideacutereacutethinspcommethinspunethinspreacuteponsethinspvolontaire

Rappelonsthinspquethinsplathinspseacutedation-analgeacutesiethinspprofondethinspchezthinsplrsquoadultethinspetthinsplrsquoanestheacutesiethinspgeacuteneacuteralethinsp(adultethinspetthinsppeacutediatrique)thinspthinspnethinspfontthinsppasthinsplrsquoobjetthinspdethinspcettethinsppublication

CMQ - OIIQ - OPIQ 46

mdash Annexe

thinspANNEXEthinspIIthinspndashthinspINFORMATIONthinspCOMPLEacuteMENTAIREthinsp-thinspLECTURESthinspDrsquoINTEacuteREcircT

COLLEgraveGEthinspDESthinspMEacuteDECINSthinspDUthinspQUEacuteBECthinsp(CMQ)

thinsprsaquo Proceacutedures et interventions en milieu extrahospitalier (2011)thinsprsaquo Code de deacuteontologie des meacutedecinsthinsp(2015)

ORDREthinspDESthinspINFIRMIEgraveRESthinspETthinspINFIRMIERSthinspDUthinspQUEacuteBECthinsp(OIIQ)thinsp

thinsprsaquo EacutediteurthinspofficielthinspduthinspQueacutebec Code de deacuteontologie des infirmiegraveres et infirmiers (2014)

thinsprsaquo Le champ drsquoexercice et les activiteacutes reacuteserveacutees des infirmiegraveresthinsp(2013)thinsp2ethinspeacutedthinspthinsprsaquo Mosaiumlque des compeacutetences cliniques de lrsquoinfirmiegravere Compeacutetences initiales

(2009)thinsp2ethinspeacutedthinspthinsprsaquo Les obligations deacuteontologiques de lrsquoinfirmiegravere et le consentement aux soins

(2005)

ORDREthinspPROFESSIONNELthinspDESthinspINHALOTHEacuteRAPEUTESthinspDUthinspQUEacuteBECthinsp(OPIQ)

thinsprsaquo Profil national des compeacutetencesthinspLrsquoalliancethinspdesthinsporganismesthinspdethinspregraveglementationthinspenthinsptheacuterapiethinsprespiratoirethinsp(2011)

thinsprsaquo Les notes au dossier dans le secteur de lrsquoassistance anestheacutesique et de la seacutedation analgeacutesiethinsp-thinspGuidethinspdethinsppratiquethinsp(2008)

thinsprsaquo Compeacutetences relatives agrave lrsquoentreacutee dans la pratique (2003)thinsprsaquo Regraveglement sur les dossiers les autres effets les cabinets et la cessation

drsquoexercice des membres de lrsquoOrdre professionnel des inhalotheacuterapeutes du Queacutebecthinsp(2002)thinsp

thinsprsaquo Code de deacuteontologie des inhalotheacuterapeutes du Queacutebec

CMQ - OIIQ - OPIQ 47

thinspANNEXEthinspIIIthinspndashthinspPROCEacuteDURESthinspPROTOCOLESthinspOUthinspALGORITHMESthinsp

Dansthinsptousthinsplesthinsplieuxthinspougravethinspsethinsppratiquethinsplathinspseacutedation-analgeacutesiethinspagravethinspdesthinspfinsthinspdiagnos-tiquesthinspouthinsptheacuterapeutiquesthinsplethinspmeacutedecinthinspresponsablethinspdoitthinspeacutelaborerthinspenthinspcollabora-tionthinspavecthinsplesthinspmembresthinspdethinspsonthinspeacutequipethinspsoignantethinsplesthinspproceacuteduresthinspprotocolesthinspouthinsp

algorithmesthinspconcernantthinspnotammentthinsplesthinspsujetsthinspsuivantsthinsp

PARMIthinspLESthinspPROCEacuteDURESthinspOUthinspPROTOCOLESthinsp(ADULTEthinspETthinspPEacuteDIATRIQUE)thinsp

thinsprsaquo allergiethinspauthinsplatexchocthinspanaphylactiquethinsprsaquo antagonistethinsprsaquo bradycardiethinsprsaquo critegraveresthinspcliniquesthinspdethinspcongeacutethinsprsaquo hypertensionthinspmalignethinsprsaquo seacutedation-analgeacutesiethinsprsaquo transfertthinspdrsquourgence

PARMIthinspLESthinspALGORITHMESthinsp(ADULTEthinspETthinspPEacuteDIATRIQUE)thinsp

thinsprsaquo gestionthinspdesthinspvoiesthinspaeacuteriennesthinspdifficilesthinsp(ventilationintubation)thinsprsaquo reacuteanimationthinspcardiorespiratoirethinsp

thinspthinspthinspILthinspFAUTthinspPENSERthinspAgravethinsp

thinsprsaquo Lrsquoaffichagethinspdesthinspproceacuteduresthinspprotocolesthinspouthinspalgorithmesthinspdrsquourgencethinspquithinsppermettrathinspdrsquoythinspavoirthinspaccegravesthinsprapidementthinspenthinspcasthinspdrsquourgencethinspetthinspdethinsplesthinspconsulterthinspreacuteguliegraverementthinspparthinsplathinspmecircmethinspoccasionthinsp

thinsprsaquo Lrsquoeacutelaborationthinspdrsquounthinspprogrammethinsppeacuteriodiquethinspdrsquoexercicethinsp(pthinspexthinspthinspsimulation)thinspquithinsppermettrathinspdethinsprevoirthinsplesthinspdiffeacuterentesthinspproceacuteduresthinspenthinspplacethinspavecthinsptousthinsplesthinspmembresthinspdethinsplrsquoeacutequipethinspsoignantethinspetthinspdrsquoinitierthinsplethinspnouveauthinsppersonnelthinspassurantthinspainsithinspunethinspmeilleurethinsprelegravevethinspDethinspmecircmethinspmettrethinsplethinspplanthinspenthinsppratiquethinsppermetthinspdrsquooptimiserthinsplathinsprapiditeacutethinspetthinsplathinsppreacutecisionthinspdesthinspgestesthinspposeacuteesthinspetthinspdrsquoidentifierthinspdesthinspproblegravemesthinsppotentielsthinsp(avecthinspdethinsplrsquoeacutequipementthinspparthinspexemple)thinspetthinspcethinspavantthinspqursquoilthinspythinspaitthinspurgencethinspdrsquoagirthinsp

mdash Annexe

CMQ - OIIQ - OPIQ 48

thinspANNEXEthinspIVthinspndashthinspEacuteVALUATIONthinspDESthinspVOIESthinspAEacuteRIENNESthinspSUPEacuteRIEURESthinspAUthinsp

thinspMOYENthinspDUthinspSCOREthinspDEthinspMALLAMPATIthinsp(DIEMUNSCHthinspETthinspCOLLABthinsp2008)thinsp

(Agravethinsptitrethinspinformatifthinspseulement)

Objectifthinspthinspthinsp Eacutevaluerthinsplathinspvisibiliteacutethinspdesthinspstructuresthinsporopharyngeacuteesthinspetthinsplathinsptaillethinspthinsp

dethinsplathinsplangue

Lesthinsp4thinspclassesthinspdethinspMallampatithinspmodifieacuteesthinsp(SamsoonthinspandthinspYoung)thinspsontthinsp

thinsprsaquo ClassethinspIthinspthinspluettethinsppiliersthinspduthinspvoilethinspduthinsppalaisthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIIthinspthinsppiliersthinspduthinspvoilethinspduthinsppalaisthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIIIthinspthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIVthinspthinsppalaisthinspdurthinspseulthinsp

LesthinspclassesthinspIthinspetthinspIIthinsppreacutesagentthinspdrsquounethinspintubationthinspathinsppriorithinspfacilethinsplesthinspclassesthinspIIIthinspetthinspIVthinspdrsquounethinspintubationthinspdifficile

ClassesthinspdethinspMallampatithinspmodifieacuteesthinsp(Jmarchnthinsp[Enthinspligne])

LrsquoinsuffisancethinspdethinsplathinspclassificationthinspdethinspMallampatithinspathinspeacuteteacutethinspspeacutecifiquementthinspmon-treacuteethinspchezthinsplrsquoobegravesethinspEllethinspnethinsppeutthinspecirctrethinspconsideacutereacuteethinspcommethinspunthinsppreacutedicteurthinspisoleacute-mentthinspsuffisantthinspdethinsplathinspdifficulteacutethinspdethinsplathinsplaryngoscopiethinspouthinspathinspfortiorithinspdethinsplrsquointuba-tionthinspdifficilethinsp

mdash Annexe

CMQ - OIIQ - OPIQ 49

ANNEXEthinspVthinspndashthinspOUTILthinspDrsquoEacuteVALUATIONthinspDEthinspLrsquoAPNEacuteEthinspOBSTRUCTIVEthinspDUthinspSOMMEILthinsp

(AOS)thinspADAPTEacutethinspAgravethinspLAthinspCONSULTATIONthinspPREacuteANESTHESIQUESEacuteDATION-thinsp

ANALGEacuteSIEthinspthinsp(ADAPTEacutethinspDEthinspCHUNGthinspETthinspSEETthinsp2010)thinsp(NOTREthinspTRADUCTION)

(Agravethinsptitrethinspinformatifthinspseulement)

mdash Annexe

Exemplethinspdethinspquestionnairethinspstop-bang

Question Reacuteponse

Sthinspnore PreacutesencethinspdethinspronflementVosthinspronflementsthinspsont-ilsthinspbruyants(suffisammentthinsppourthinspecirctrethinspentendusthinspagravethinsptraversthinspunethinspportethinspfermeacutee)

OuithinspouthinspNon

Tthinspiredthinspfatiguethinsporthinspsleepy PreacutesencethinspdethinspsomnolencethinspouthinspfatigueVousthinspsentez-vousthinspsouventthinspfatigueacutethinspeacutepuiseacutethinspouthinspsomnolentthinsppendantthinsplathinspjourneacutee

OuithinspouthinspNon

Othinspbservedthinspapnea ApneacuteethinspobserveacuteethinspQuelqursquounthinspa-t-ilthinspdeacutejagravethinspobserveacutethinspquethinspvousthinspthinsparrecirctiezthinspdethinsprespirerthinspenthinspdormant

OuithinspouthinspNon

Pthinspressure PreacutesencethinspdrsquoHTAAvez-vousthinspouthinspecirctes-vousthinsptraiteacutepourthinspunethinsptensionthinsparteacuteriellethinspeacuteleveacutee

OuithinspouthinspNon

BthinspMI IMCthinspgtthinsp35thinspkgm2 OuithinspouthinspNon

Athinspge Acircgethinspgtthinsp50thinspans OuithinspouthinspNon

Nthinspeck Circonfeacuterencethinspduthinspcouthinspgtthinsp40thinspcm OuithinspouthinspNon

Gthinspender Sexethinspmasculin OuithinspouthinspNon

INTERPREacuteTATIONthinspCLINIQUE

ltthinsp3thinspreacuteponsesthinsppositivesthinsp=thinspfaiblethinsprisquethinspdrsquoAOS

ge 3 reacuteponses positives = risque eacuteleveacute drsquoAOS

CMQ - OIIQ - OPIQ 50

thinspANNEXEthinspVIthinspndashthinspANAMNEgraveSEthinspthinspAIDEthinspMNEacuteMOTECHNIQUEthinsp

(Agravethinsptitrethinspinformatifthinspseulement)

ObjectifthinspthinspthinspthinspCetthinspoutilthinspdrsquoaidethinspmneacutemotechniquethinspsertthinspagravethinspstructurerthinsplathinspfaccedilonthinspdontthinspthinsponthinspprocegravedethinspagravethinsplathinspcollectethinspsommairethinspdesthinspdonneacuteesthinspdansthinsplethinspcadrethinspdethinsplrsquoeacutevaluationthinspcliniquethinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinspfacilitethinsplathinspcompreacutehensionthinspetthinsplathinspreacutealisationthinspdethinsplrsquoanamnegravesethinspchezthinsplrsquoadultethinspetthinsplrsquoenfant

SAMPLEthinsp(AdapteacutethinspdethinspAltonthinspetthinspcollabthinsp2007thinsp[Notrethinsptraduction])thinsp(outhinspvariante)

SthinspthinspSignesthinspetthinspsymptocircmes

AthinspthinspAllergiesthinspetthinspreacuteactionthinsp

MthinspthinspMeacutedicamentsthinspetthinspautresthinspsubstancesthinsp(prescritsthinspouthinspnon)thinspetthinsptraitement

PthinspthinspPasseacutethinspmeacutedicalfamilialthinsp

LthinspthinspLastthinspmeallunchthinsp(dernierthinsprepas)

EthinspthinspEnvironnementeacuteveacutenement

thinsp

mdash Annexe

CMQ - OIIQ - OPIQ 51

thinspANNEXEthinspVIIthinsp-thinspEXAMENthinspPHYSIQUEthinspthinspAIDEthinspMNEacuteMOTECHNIQUE

(Agravethinsptitrethinspinformatifthinspseulement)

Objectifthinspthinspthinsp Lrsquoexamenthinspphysiquethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinspcherchethinspagravethinspmettrethinspenthinspeacutevidencethinspcertainsthinspcritegraveresthinspreconnusthinsppourthinspecirctrethinspassocieacutesthinspagravethinspunethinspassis-tancethinspventilatoirethinspdifficilethinspquithinsppeutthinspsurvenirthinspdansthinsplethinspcasthinspdrsquounthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquethinspceluithinspviseacutethinspparthinspexemple

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinspfacilitethinsplathinspcompreacutehensionthinspetthinsplathinspreacutealisationthinspdethinsplrsquoexamenthinspphysiquethinsprelativementthinspauxthinspvoiesthinspaeacuteriennesthinspdethinsplrsquoadulte

1thinspIndicateursthinspdrsquounethinsppossiblethinspventilationthinspdifficilethinsp(MOANSthinsp[AdapteacutethinspdethinspWallsthinspetthinspthinspthinspthinspthinspMurphythinsp2012]thinsp[Notrethinsptraduction]thinspouthinspvariante)

Mthinspthinspmask sealthinsp(eacutetancheacuteiteacutethinspduthinspmasque)thinspthinspeacutetancheacuteiteacutethinspcompromisethinspenthinspraisonthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspdrsquounethinspbarriegraverethinspmeacutecaniquethinsp(barbethinspfourniethinsptraumatismethinspfacialthinspetc)

OthinspthinspobeacutesiteacuteobstructionthinspthinsppatientthinspdontthinsplrsquoIMCthinspestthinspgtthinsp25thinsp(kgm2)thinspfemmethinspenceintethinspthinspthinspthinspthinspthinspthinspthinspgtthinsp6thinspmoisthinsp(2ethinsptrimestre)thinspangio-œdegravemethinspabcegravesthinspetc

Athinspthinspacircgethinspthinsppatientthinspgethinsp55thinspansthinsp(variablethinspselonthinsplesthinspauteurs)thinspenthinspraisonthinspnotammentthinspthinspthinspthinspthinspthinspthinspdethinsplathinsppertethinspdrsquoeacutelasticiteacutethinspdesthinsptissus

Nthinspthinspno teeththinsp(eacutedenteacute)thinspthinspdifficulteacutethinsplorsthinspdethinsplrsquoassistancethinspventilatoire

Sthinspthinspstiffthinsp(rigiditeacute)thinspthinsppathologiesthinspagravethinspconseacutequencesthinspsurthinsplathinspcompliancethinspetthinsplathinspthinspthinspthinspthinspthinspreacutesistancethinsppulmonairethinsp(asthmethinspMPOCthinsppneumoniethinspdethinspstadethinspavanceacutethinspetc)

thinspthinspVentilationthinspdifficilethinsp(masquethinspouthinspoutilthinspextraglottiquethinsptelthinspquethinspmasquethinspthinspthinspthinspthinspthinsplaryngeacute)thinsp(AdapteacutethinspdethinsplrsquoAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinsp[Notrethinspthinspthinspthinspthinspthinsptraduction])thinspImpossiblethinspdrsquoeffectuerthinspunethinspventilationthinspdethinspfaccedilonthinspadeacutequatethinspthinspthinspthinspthinspthinspenthinspraisonthinspdethinsplrsquounethinspetouthinspdethinsplrsquoautrethinspdesthinspsituationsthinspsuivantesthinsp

athinspMauvaisethinspeacutetancheacuteiteacutethinspduthinspmasquethinspouthinspdethinsplrsquooutilthinspextraglottiquebthinspFuitethinspdethinspgazthinspexcessivecthinspReacutesistancethinspexcessivethinspagravethinsplrsquoinspirationthinspouthinspagravethinsplrsquoexpiration

thinsp

mdash Annexe

CMQ - OIIQ - OPIQ 52

2thinspIndicateursthinspdrsquounethinsppossiblethinsplaryngoscopiethinspouthinspintubationthinspdifficilethinsp(thinspLEMONthinspthinspthinspthinspthinspthinsp[WallsthinspetthinspMurphythinsp2012thinspopthinspcit]thinsp[Notrethinsptraduction]thinspouthinspvariante)

Lthinspthinspthinsplook externallythinsp(apparencethinspphysique)thinspthinspmicrognathiethinspmacroglossiethinspdenti-tionthinspirreacuteguliegraverethinspcirconfeacuterencethinspduthinspcouthinspgethinspgrossessethinspetc

thinspEthinspthinspthinspeacutevaluationthinspthinspregraveglethinspduthinsp3-3-2thinsp(variantethinsppossiblethinspselonthinsplesthinspauteurs)thinsp-thinspthinsp

consideacuterationsthinspgeacuteomeacutetriquesthinsp(agravethinsplrsquoaidethinspdesthinspdoigtsthinspduthinsppatient)3thinspthinsp ouverturethinspdethinspbouchethinspthinspinsertionthinspdethinsp3thinspdethinspsesthinspdoigts3thinspthinsp taillethinspduthinsplarynxthinsp(longueurthinspmandibulaire)thinspthinsp3thinspdoigtsthinspsousthinsplethinspmentonthinsp

(boutthinspdethinspsonthinspmentonthinspjusqursquoagravethinsplathinspjonctionthinspduthinspcouthinspauthinspniveauthinspdethinspthinsplrsquoosthinsphyoiumlde)

2thinspthinsp positionthinspduthinsplarynxthinspthinsp2thinspdethinspsesthinspdoigtsthinspentrethinsplathinspjonctionthinspcou-mentonthinsp(osthinspthinsphyoiumlde)thinspetthinsplethinspcartilagethinspthyroiumlde

thinspMthinspthinspthinspMallampatithinsp(annexethinspIV)thinspOthinspthinspthinspobeacutesiteacuteobstructionthinspthinspIMCthinspthinspœdegravemethinspduthinsplarynxthinspneacuteoplasiethinspdethinsplathinspsphegraverethinsp

ORLthinspcompressionthinspextrinsegravequethinspparthinspheacutematomethinspcervicalthinspdifficulteacutethinspagravethinspavalerthinspdyspneacutee

thinspNthinspthinspthinspneck mobilitythinsp(mobiliteacutethinspcervicale)thinspthinspimmobilisationthinspauthinspmoyenthinspdrsquounthinspcol-

lierthinspcervicalthinsppreacutesencethinspdrsquounethinsppathologiethinspouthinspdrsquounethinspsituationthinspcliniquethinspagravethinspconseacutequencethinspsurthinsplrsquoassistancethinspventilatoirethinspouthinspdethinsplrsquointubationthinsp(pthinspexthinspthinspthinsparthrosethinspouthinsparthritethinspimportantethinsptrisomiethinsp21thinspetc)

thinspthinsp Lanryngoscopiethinspdifficilethinspthinspimpossibiliteacutethinspdethinspvisualiserthinspnrsquoimportethinspquellethinsppartiethinspdesthinspcordesthinspvocalesthinspapregravesthinspdethinspmultiplesthinsptentativesthinspavecthinspunthinsplaryngoscopethinspconventionnelthinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinspop citthinsp[Notrethinsptraduction])thinsp

thinspthinspIntubationthinspendotracheacutealethinspdifficilethinspthinspintubationthinspquithinsprequiertthinspdethinspmultiplesthinspthinsptentativesthinspenthinsppreacutesencethinspouthinspenthinsplrsquoabsencethinspdrsquounethinsppathologiethinsptracheacutealethinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinspop citthinspthinsp[Notrethinsptraduction])

IlthinspfautthinspnoterthinspquethinsplrsquoinsuffisancethinspdethinsplathinspclassificationthinspdethinspMallampatithinspathinspeacuteteacutethinspspeacutecifiquementthinspmontreacuteethinspchezthinsplrsquoobegravesethinspellethinspnethinsppeutthinspecirctrethinspconsideacutereacuteethinspcommethinspunthinsppreacutedicteurthinspisoleacutementthinspsuffisantthinspdethinsplathinspdifficulteacutethinspdethinsplathinsplaryngoscopiethinspouthinspathinspfortiorithinspdethinsplrsquointubationthinspdifficile

mdash Annexe

ge

ge

CMQ - OIIQ - OPIQ 53

thinspANNEXEthinspVIIIthinsp-thinspLEthinspCONSENTEMENT

SelonthinsplethinspdroitthinspenthinspvigueurthinspilthinspestthinspobligatoirethinspauthinspQueacutebecthinspdrsquoobtenirthinsplethinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspintervention

LethinspCode civil du Queacutebec eacutetablitthinspdesthinspregraveglesthinspgeacuteneacuteralesthinspconcernantthinsplethinspconsente-mentthinspauxthinspsoinsthinspquithinspsrsquoappliquentthinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspOnthinspythinspfaitthinspcependantthinspcertainesthinspdistinctionsthinspselonthinspquethinsplesthinspsoinsthinspsontthinsprequisthinspouthinspnonthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspetthinspselonthinspquethinsplethinsppatientthinspestthinspaptethinspagravethinspconsentirthinspouthinspnon

Sithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsp(traitementsthinspdethinspmeacutedecinethinspetthinspdethinspchirurgiethinspestheacutetiquethinspexpeacuterimentationthinspetthinspdonsthinspdrsquoorganes)thinsplethinsppatientthinspdoitthinspecirctrethinspinformeacutethinspdethinsptousthinsplesthinsprisquesthinsppossiblesthinspmecircmethinspsrsquoilsthinspsontthinspraresthinspetthinsplethinspconsentementthinspdoitthinspecirctrethinspdonneacutethinspparthinspeacutecritthinspHabituellementthinspilthinspnethinsppeutthinspecirctrethinspdonneacutethinspquethinspparthinspunthinsppatientthinspaptethinspetthinspacircgeacutethinspdethinsp14thinspansthinspetthinspplusthinspparthinsplethinspmandatairethinsplethinsptuteurthinspouthinsplethinspcurateurthinspdrsquounethinsppersonnethinspinaptethinspouthinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinspdrsquounethinsppersonnethinspdethinspmoinsthinspdethinsp14thinspansthinspLrsquoautorisationthinspdethinsplathinspcourthinspestthinspenthinspoutrethinspneacutecessairethinspsithinsplesthinspsoinsthinsppreacutesententthinspunthinsprisquethinspseacuterieuxthinsppourthinsplathinspsanteacutethinspdethinspcesthinsppersonnesthinspouthinspsrsquoilsthinsppeuventthinspcauserthinspdesthinspeffetsthinspgravesthinspetthinsppermanentsthinspUnethinsppersonnethinspmineurethinspdethinspthinsp14thinspansthinspetthinspplusthinsppeutthinspconsentirthinspseulethinspagravethinspmoinsthinspqursquoilthinspsrsquoagissethinspdethinspsoinsthinspnonthinsprequisthinspetthinspthinspcomportantthinspdesthinsprisques

SrsquoilthinspsrsquoagitthinspdethinspsoinsthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsplrsquoobligationthinspdrsquoinformerthinspcroicirctthinspenthinspfonctionthinspdethinsplathinsppreacutevalencethinspetthinspdethinsplathinspgraviteacutethinspdesthinspcomplicationsthinspSithinsplethinsppatientthinspestthinspinaptethinspetthinspqursquoilthinspnrsquoestthinsppasthinsprepreacutesenteacutethinspparthinspunthinspmandatairethinspunthinsptuteurthinspouthinspunthinspcura-teurthinsplethinspconsentementthinsppeutthinspecirctrethinspdonneacutethinspparthinspunthinspconjointthinspouthinspagravethinspdeacutefautthinspduthinspconjointthinspparthinspunthinspprochethinspouthinspunethinsppersonnethinspquithinspdeacutemontrethinspunthinspinteacuterecirctthinspparticulierthinsppourthinsplathinspper-sonnethinspinaptethinspIlthinspnrsquoythinspathinsppasthinspdrsquoobligationthinspagravethinspcethinspquethinspcethinspconsentementthinspsoitthinspdonneacutethinspparthinspeacutecritthinspLethinspconsentementthinspauxthinspsoinsthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspdrsquounethinsppersonnethinspmi-neurethinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinspouthinsplethinsptuteurthinspUnethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsppeutthinspconsentirthinspmaisthinspnethinsppeutthinsppasthinsprefuserthinspseulethinspdesthinspsoinsthinspquithinspseraientthinspjugeacutesthinsprequisthinspEnthinspcasthinspdrsquourgencethinsplethinspconsentementthinspauxthinspsoinsthinspmeacutedicauxthinspnrsquoestthinsppasthinspneacutecessairethinsplorsquethinsplathinsppersonnethinspouthinspsonthinspinteacutegriteacutethinspestthinspmenaceacuteethinspetthinspquethinsplethinspconsentementthinspnethinsppeutthinspecirctrethinspobtenuthinspagravethinsptemps

LathinspLoi sur les servicesthinspdethinspsanteacutethinspetthinsplesthinspservicesthinspsociauxthinsp(LSSS)thinspeacutetablitthinspquantthinspagravethinspellethinspcertainesthinspregraveglesthinspenthinspmatiegraverethinspdethinspconsentementthinspauxthinspinterventionsthinspchirurgicalesthinspetthinspagravethinsplrsquoanestheacutesiethinsp

mdash Annexe

CMQ - OIIQ - OPIQ 54

Selonthinspcettethinsploithinsplethinspconsentementthinspagravethinspunethinspanestheacutesiethinspouthinspagravethinspunethinspinterventionthinspchirurgi-calethinspdoitthinspecirctrethinspattesteacutethinspparthinspunthinspdocumentthinspeacutecritthinspsigneacutethinspparthinsplethinsppatientthinspouthinspsonthinsprepreacutesen-tantthinspetthinspcethinspdocumentthinspdoitthinspfairethinspeacutetatthinspdesthinspinformationsthinspapproprieacuteesthinspconcernantthinspnotammentthinsplesthinsprisquesthinspouthinsplesthinspeffetsthinsppossiblesthinspCetthinspeacutecritthinspdoitthinspecirctrethinspcontresigneacutethinspparthinsplethinspmeacutedecinthinspouthinsplethinspdentistethinsptraitantthinspetthinspconserveacutethinspdansthinsplethinspdossierthinspduthinsppatientthinspLethinspdossierthinspdoitthinspcontenirthinspunthinspdocumentthinspattestantthinsplethinspconsentementthinsppourthinsplesthinspsoinsthinspetthinsplesthinspservicesthinspdispenseacutesthinspdansthinspunthinspcentrethinsphospitalierthinsp(CH)thinspunthinspcentrethinspdrsquoheacutebergementthinspetthinspdethinspsoinsthinspdethinsplonguethinspdureacuteethinsp(CHSLD)thinspetthinspunthinspcentrethinsplocalthinspdethinspservicesthinspcommunau-tairesthinsp(CLSC)

CesthinspdispositionsthinspnethinspsrsquoappliquentthinspqursquoauxthinspsoinsthinspdispenseacutesthinspenthinspeacutetablissementthinspthinspMaintenantthinspquethinspplusieursthinspinterventionsthinspautrefoisthinspreacuteserveacuteesthinspauxthinspeacutetablissementsthinsppeuventthinspecirctrethinspeffectueacuteesthinspenthinspdehorsthinspdethinspceux-cithinsplathinspquestionthinspsethinspposethinsptoutefoisthinspdethinspsavoirthinspsithinsplesthinspmecircmesthinspexigencesthinspdevraientthinspsrsquoappliquerthinsppartoutthinsp

Qursquoenthinspest-ilthinspparthinspexemplethinspdethinsplathinspsignaturethinspdrsquounthinspformulairethinspdethinspconsentementthinspEnthinsppratiquethinspetthinspagravethinsplrsquousagethinspilthinspsrsquoestthinspaveacutereacutethinspqursquounthinspformulairethinspdethinspconsentementthinspducircmentthinspsigneacutethinspnethinsppeutthinspagravethinspluithinspseulthinspprouverthinspquethinsplethinspconsentementthinspathinspeacuteteacutethinsplibrethinspetthinspeacuteclaireacutethinspUnethinspcourtethinspnotethinspverseacuteethinspauthinspdossierthinspreacutesumantthinsplesthinspinformationsthinsptransmisesthinspetthinsplesthinspeacutechangesthinspauxquelsthinspellesthinspontthinspdonneacutethinsplieuthinspestthinsppreacutesentementthinspjugeacuteethinspbeaucoupthinspplusthinsppertinentethinspagravethinspcetthinspeacutegardthinspLethinspformulairethinspdethinspconsentementthinspcomplegravetethinsplesthinsprenseigne-mentsthinspfournisthinspverbalementthinspIlthinspsrsquoagitthinspdrsquounthinspajoutthinspagravethinsplrsquoinformationthinspverbalethinsptransmisethinspthinsp

etthinspnonthinspdrsquounethinspmesurethinspvisantthinspagravethinsplathinspremplacer

LethinspCode de deacuteontologiethinspdes meacutedecinsthinsppreacutecisethinsplesthinspobligationsthinspdesthinspmeacutedecinsthinsp

quantthinspauthinspconsentementthinsp

Article 28Le meacutedecin doit sauf urgence avant drsquoentreprendre un examen une investiga-tion un traitement ou une recherche obtenir du patient ou de son repreacutesentant leacutegal un consentement libre et eacuteclaireacute

Article 29Le meacutedecin doit srsquoassurer que le patient ou son repreacutesentant leacutegal a reccedilu les explications pertinentes agrave leur compreacutehension de la nature du but et des conseacutequences possibles de lrsquoexamen de lrsquoinvestigation du traitement ou de la recherche qursquoil srsquoapprecircte agrave effectuer Il doit faciliter la prise de deacutecision du patient et la respecter

mdash Annexe

CMQ - OIIQ - OPIQ 55

DansthinspsesthinspguidesthinspdrsquoexercicethinspportantthinspsurthinsplathinsptenuethinspdesthinspdossiersthinsplethinspCollegravegethinspestimethinspdrsquoailleursthinspquethinsplethinspdossierthinspdrsquounthinsppatientthinspdoitthinspcontenirthinspunethinspnotethinspattestantthinspquethinsplesthinspin-formationsthinspneacutecessairesthinspagravethinspunethinspprisethinspdethinspdeacutecisionthinspeacuteclaireacuteethinspontthinspeacuteteacutethinsptransmisesthinspparthinsplethinspmeacutedecinthinspetthinspcomprisesthinspparthinsplethinsppatientthinspouthinspsonthinsprepreacutesentantthinsplorsquethinsplathinspchosethinspestthinspjugeacuteethinsppertinentethinspathinspfortiorithinsplorsqursquoilthinspsrsquoagitthinspdrsquounethinspinterventionthinspchirurgicalethinspdrsquounethinspinterventionthinspchirurgicalethinspsousthinspseacutedation-analgeacutesiethinspdrsquoanestheacutesiethinspreacutegionalethinspouthinspgeacuteneacuteralethinsp

DansthinsplethinspCode de deacuteontologie des infirmiegraveres et infirmiersthinsponthinsppreacutevoitthinspquethinsp

thinspArticle 40 Lrsquoinfirmiegravere ou lrsquoinfirmier doit fournir agrave son client toutes les explications neacuteces-saires agrave la compreacutehension des soins et des services qursquoil lui prodigue

Article 41Lorsque lrsquoobligation drsquoobtenir un consentement libre et eacuteclaireacute incombe agrave lrsquoin-firmiegravere ou agrave lrsquoinfirmier ce dernier doit fournir au client toutes les informations

requises

LethinspCode de deacuteontologie des inhalotheacuterapeutes du Queacutebecthinspnethinspcontientthinsppasthinspdethinsp

dispositionthinsptouchantthinsppreacuteciseacutementthinsplethinspconsentementthinspOnthinsppreacutecisethinspcependantthinspquethinsp

Article 13En plus des avis et des conseils lrsquoinhalotheacuterapeute doit fournir agrave son client les explications neacutecessaires agrave la compreacutehension et agrave lrsquoappreacuteciation des services qursquoil

lui rend

EnthinspcompleacutementthinspdansthinspsesthinspnormesthinspdethinsppratiquethinspportantthinspsurthinsplathinsptenuethinspdesthinspdossiersthinsplrsquoOrdrethinspprofessionnelthinspdesthinspinhalotheacuterapeutesthinspduthinspQueacutebecthinspdemandethinspquethinsplethinspdos-sierthinspdrsquounthinsppatientthinspcomportethinspunethinspmentionthinspdesthinspsoinsthinspetthinspdesthinspservicesthinspprodigueacutesthinspagravethinspsonthinspeacutegardthinspAgravethinspcetthinspeffetthinsptoutethinspactiviteacutethinspexerceacuteethinspparthinsplrsquoinhalotheacuterapeutethinsptellethinspquethinsplrsquoinformationthinsptransmisethinspauthinsppatientthinspeuthinspeacutegardthinspagravethinsplathinspseacutedation-analgeacutesiethinspdoitthinspecirctrethinspinscritethinspauthinspdossierthinspduthinsppatientthinspetthinspcethinspauthinspfurthinspetthinspagravethinspmesurethinspquethinsplesthinspactiviteacutesthinspsontthinspexerceacutees

EnthinspsommethinsplathinsploithinspexigethinspunthinspconsentementthinspeacutecritthinspsithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspainsithinspquethinsppourthinsplesthinspanestheacutesiesthinsplesthinspinterventionsthinspchirurgicalesthinspetthinsplesthinspsoinsthinspdispenseacutesthinspenthinspeacutetablissementthinspDansthinspsesthinspguidesthinspportantthinspsurthinsplesthinspproceacuteduresthinspetthinspinterventionsthinspenthinspmilieuthinspextrahospitalierthinspnotammentthinsplethinspCollegravegethinsprecommandethinsptoutefoisthinspquethinsplethinspmeacutedecinthinspversethinspunethinspnotethinspexplicativethinspauthinspdossierthinspetthinspobtiennethinspunthinspconsentementthinspeacutecritthinsppourthinsptoutethinspinterventionthinspmeacutedicalethinspouthinsp

mdash Annexe

CMQ - OIIQ - OPIQ 56

chirurgicalethinspeffractivethinspqursquoellethinspsoitthinspeffectueacuteethinspdansthinspunthinspbutthinspdiagnosticthinsptheacuterapeu-tiquethinspouthinspestheacutetiquethinspLorsquethinsplethinspconsentementthinspportethinspagravethinsplathinspfoisthinspsurthinsplathinspseacutedation-thinspthinspanalgeacutesiethinspetthinspsurthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsplrsquoinformationthinsptrans-misethinspdoitthinspinclurethinsplesthinsprisquesthinspdethinsplrsquointerventionthinspetthinspceuxthinspdethinsplathinspseacutedation-analgeacutesiethinspcelle-cithinsppouvantthinspcomporterthinspdesthinsprisquesthinspimportantsthinspmecircmethinspsithinsplrsquointerventionthinspestthinspmineure

Lrsquoobtentionthinspdrsquounthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspdemeurethinspunethinspobligationthinspthinspinheacuterentethinspagravethinsplrsquointerventionthinspmeacutedicalethinspelle-mecircmethinspIlthinsprelegravevethinspdoncthinspdethinsplathinspresponsabiliteacutethinspduthinspmeacutedecinthinspdethinspsrsquoassurerthinspdethinsplathinsptransmissionthinspdethinsplrsquoinformationthinsppertinentethinspauthinsppatientthinspetthinspdethinspsathinspcompreacutehensionthinspdethinsplathinspnaturethinspduthinspbutthinspetthinspdesthinsprisquesthinsprelatifsthinspagravethinsplrsquointerventionthinspToutefoisthinsplathinsptacircchethinspdethinsptransmettrethinspdethinsplrsquoinfor-mationthinspcompleacutementairethinspouthinspdethinspfairethinsplrsquoenseignementthinspauxthinsppatientsthinsppeutthinspecirctrethinspconfieacuteethinspagravethinspdrsquoautresthinspprofessionnelsthinspetthinspcellethinspdethinsprecueillirthinsplathinspsignaturethinspdrsquounthinspthinspformulairethinspdethinspconsentementthinspagravethinspdrsquoautresthinspmembresthinspdethinsplrsquoeacutequipethinspdethinspsoins

mdash Annexe

CMQ - OIIQ - OPIQ 57

mdash Annexe

thinspANNEXEthinspIXthinsp-thinspEacuteVALUATIONthinspDEthinspLrsquoEFFICACITEacutethinspDEthinspLAthinspSEacuteDATIONthinsp(EXEMPLES)thinsp

(Listethinspnonthinsplimitative)thinsp

1 Eacutechelle de seacutedation de Ramsay modifieacuteethinsp(Adapteacute de Merchant et collab 2014b op cit)

Instruction Descriptiondeacutefinition Valeur

thinspObserverthinsplethinsppatientEacuteveilleacutethinspthinsplethinsppatientthinspestthinspanxieuxthinspetthinspagiteacutethinspouthinspnerveuxthinspouthinsplesthinspdeux 1

ObserverthinsplethinsppatientLethinsppatientthinspeacutetablit-ilthinspunthinspcontactthinspvisuelthinspetthinspreacutepond-ilthinspauxthinspordres

Eacuteveilleacutethinspthinsplethinsppatientthinspestthinspcoopeacuteratifthinspthinsporienteacutethinspetthinspcalme 2

ParlerthinspauthinsppatientthinspLethinsppatientthinspeacutetablit-ilthinspunthinspcontactthinspvisuelthinspetthinspreacutepond-t-ilthinspauxthinspordres

Eacuteveilleacutethinspthinsplethinsppatientthinspreacutepondthinspseulementthinspauxthinspordres 3

StimulerthinspphysiquementthinsplethinsppatientthinspenthinspagitantthinspsonthinspeacutepaulethinsptoutthinspenthinspparlantthinspfortthinspLethinsppatientthinspreacuteagit-ilthinspdansthinsplesthinsp10thinspsecon-des

Endormithinspthinsplethinsppatientthinspreacuteagitthinspparthinspunethinspreacuteponsethinspvivethinspagravethinsplathinspstimulationthinspdethinsplathinspgla-bellethinspouthinspagravethinspunthinspstimulusthinspauditifthinspintense 4

StimulerthinspphysiquementthinsplethinsppatientthinspenthinspagitantthinspsonthinspeacutepaulethinsptoutthinspenthinspparlantthinspfortthinspLethinsppatientthinspreacuteagit-ilthinspapregravesthinsp10thinspsecondes

Endormithinspthinsplethinsppatientthinspreacuteagitthinspparthinspunethinspreacuteponsethinspfaiblethinspagravethinsplathinspstimulationthinspdethinsplathinspglabellethinspouthinspagravethinspunthinspstimulusthinspauditifthinspintense

5

UtiliserthinspdesthinspstimulithinspdouloureuxAucunethinspreacuteaction

Endormithinspthinsplethinsppatientthinspnethinspreacuteagitthinsppasthinspagravethinsplathinspdouleur 6

thinsp Peuthinspimportethinsplrsquoeacutechellethinsputiliseacuteethinspcelle-cithinspdoitthinspecirctrethinspchoisiethinspselonthinsplathinspclientegravelethinspetthinsplethinspcontextethinspdonneacutethinspDethinspmecircmethinspsonthinsputilisationthinspdoitthinspecirctrethinspuniformethinspetthinspstandardiseacuteethinspauthinspseinthinspdrsquounethinspmecircmethinspeacutequipethinsp

CettethinspeacutechellethinsppeutthinspecirctrethinsputiliseacuteethinspchezthinsplrsquoenfantthinspToutefoisthinspellethinspserathinspdavantagethinsputilethinspdansthinsplethinspcadrethinspdrsquounethinspeacutevaluationthinsppostseacutedationthinsp(soinsthinsppostproceacutedures)thinspcarthinspilthinsppeutthinspecirctrethinspcliniquementthinspinapproprieacutethinspdethinspstimulerthinspphysiquementthinspunthinspenfantthinspsousthinspseacutedationthinspprofondethinsp

CMQ - OIIQ - OPIQ 58

2 Eacutechelle de vigilance-agitation de Richmond (Richmond Agitation Sedation Scale - RASS) (Tireacute et adapteacute de Chanques et collab 2006)

Lathinsptraductionthinspfranccedilaisethinspdethinspcettethinspeacutechellethinspathinspfaitthinsplrsquoobjetthinspdrsquounethinspvalidationthinspdethinspsathinspthinspreproductibiliteacutethinspinterobservateurthinsp

mdash Annexe

Instruction DescriptionDeacutefinition Niveau

Observerthinsplethinsppatientthinspsansthinspfairethinspdethinspbruit

Srsquoilthinspmanifestethinspunethinspactiviteacutethinspmotricethinspspon-taneacuteethinspquantifierthinsplethinspniveauthinspdrsquoagitationthinsp

Combatifthinspthinspdangerthinspimmeacutediatthinspenversthinsplrsquoeacutequipe + 4Tregraves agiteacutethinspthinsptirethinsparrachethinsptuyauxthinspouthinspcatheacutetersthinspetouthinspagressifthinspenversthinsplrsquoeacutequipe + 3Agiteacutethinspthinspmouvementsthinspfreacutequentsthinspsansthinspbutthinsppreacutecisthinspetouthinspdeacutesadaptationthinspauthinsprespirateur + 2Ne tient pas en placethinspthinspanxieuxthinspouthinspcraintifthinspmaisthinspmouvementsthinsporienteacutesthinsppeuthinspfreacutequentsthinspnonthinspvigoureuxthinspnonthinspagressifs

+ 1

Srsquoilthinspestthinspcalmethinspetthinspreacutepondthinspouthinspnonthinspauxthinspordresthinspsimplesthinsp

Eacuteveilleacute et calmethinspthinspcalmethinspetthinsplesthinspyeuxthinspouvertsConscientthinspthinspRASSthinsp0thinsp+thinspreacutepondthinspauxthinspordresthinspsimples

0

Srsquoilthinspestthinspcalmethinsplesthinspyeuxthinspfermeacutesthinspthinspquan-tifierthinsplethinspniveauthinspdrsquohypovigilancethinsp(outhinspdrsquoendormissement)thinspenthinspsrsquoadressantthinspauthinsppatientthinspparthinspsonthinspnomthinspsansthinsplethinsptoucherthinspenthinsputilisantthinspunethinspvoixthinspdethinspplusthinspenthinspplusthinspfortethinspetthinspdrsquoautantthinspplusthinspfortethinspquethinsplethinsppatientthinspestthinspsusceptiblethinspdrsquoecirctrethinspsourdthinsp(sujetthinspacircgeacutethinspseacutejourthinspprolongeacutethinspenthinspreacuteanimationthinspthinspbouchonthinspdethinspceacuterumenthinsptoxiciteacutethinspdesthinspantibiotiquesthinspetthinspduthinspfuroseacutemide)thinsp

Somnolentthinspthinsppasthinspcomplegravetementthinspeacuteveilleacutethinspmaisthinsprestethinspeacuteveilleacutethinspauthinspcontactthinspvisuelthinspagravethinsplrsquoappelthinspthinsp(gtthinsp10thinsps)

- 1

Diminution leacutegegravere de la vigilancethinspthinsprestethinspeacuteveilleacutethinspbriegravevementthinspavecthinspcontactthinspvisuelthinspagravethinsplrsquoappelthinsp(ltthinsp10thinsps)

- 2

Diminution modeacutereacutee de la vigilancethinspthinspnrsquoimportethinspquelthinspmouvementthinspagravethinsplrsquoappelthinsp(ouverturethinspdesthinspyeux)thinspmaisthinsppasthinspdethinspcon-tactthinspvisuel

- 3

Sithinsplethinsppatientthinspnethinspfaitthinspaucunthinspmouvementthinspythinspcompristhinspenthinsplrsquoappelantthinspdrsquounethinspvoixthinspfortethinspthinspfrictionnerthinspdrsquoabordthinsplrsquoeacutepaulethinsppuisthinsplethinspster-numthinspsansthinspecirctrethinspnociceptifthinsp

Diminution profonde de la vigilancethinspthinspau-cunthinspmouvementthinspagravethinsplrsquoappelthinspnrsquoimportethinspquelthinspmouvementthinspagravethinsplathinspstimulationthinspphysiquethinsp(frictionthinspnonthinspnociceptivethinspdethinsplrsquoeacutepaulethinspouthinspduthinspsternum)

- 4

Non reacuteveillablethinspthinspaucunethinspmouvementthinspnithinspagravethinsplrsquoappelthinspnithinspagravethinsplathinspstimulationthinspphysiquethinsp(frictionthinspnonthinspnociceptivethinspdethinsplrsquoeacutepaulethinspouthinspduthinspsternum)

- 5

CMQ - OIIQ - OPIQ 59

thinspANNEXEthinspXthinsp-thinspEacuteVALUATIONthinspDEthinspLrsquoEFFICACITEacutethinspDEthinspLrsquoANALGEacuteSIEthinsp(EXEMPLES)

(Listethinspnonthinsplimitative)thinsp

Selonthinsplrsquoacircgethinspduthinsppatientthinspsathinspconditionthinspetthinsplethinspcontextethinspcliniquethinspdeuxthinspstrateacutegiesthinspdrsquoeacuteva-luationthinsppeuventthinspecirctrethinsputiliseacuteesthinspsoitthinsplrsquoauto-eacutevaluationthinsp(parthinspdesthinspmotsthinspdesthinspchiffresthinspthinspouthinspdesthinspdessins)thinspouthinsplrsquoheacuteteacutero-eacutevaluationthinspcomportementalethinspCelathinspditthinspsithinsplrsquoauto-thinspeacutevaluationthinspestthinspagravethinspprivileacutegierthinspcrsquoestthinsptoutefoisthinsplrsquoacircgethinspduthinsppatientthinsp(patientthinsppeacutediatrique)thinspetthinspsathinspcapaciteacutethinspcognitivethinspquithinspguiderontthinsplethinspchoixthinspduthinspclinicienthinspdansthinsplathinspseacutelectionthinspduthinspmeilleurthinspoutilthinsp

Pourthinsplethinsppatientthinspnrsquoayantthinsppasthinsplathinspcapaciteacutethinsp(pthinspexthinspthinsphabiliteacutethinspverbalethinspouthinspcognitivethinsplimiteacutee)thinspdrsquoeacutevaluerthinsplui-mecircmethinsplrsquointensiteacutethinspdethinsplathinspdouleurthinspunethinspreacuteponsethinspverbalethinsp(ouinon)thinspouthinspgestuellethinspsignifiantthinsplathinsppreacutesencethinspouthinsplrsquoabsencethinspdethinspdouleurthinspconstituethinspunethinspformethinspdrsquoauto-eacutevaluationthinspacceptablethinspenthinsppratiquethinspcliniquethinspaupregravesthinspdethinspcertainesthinsppopulationsthinsptellesthinspquethinsplethinspjeunethinspenfantthinsplethinsppatientthinspdeacutementthinspouthinspceluithinspvivantthinspavecthinspunethinspdeacuteficiencethinspintellectuellethinsp(McCafferythinspciteacutethinspdansthinspHerrthinspetthinspcollabthinsp2011thinsp[Notrethinsptraduc-

tion])

thinspthinsp Peuthinspimportethinsplrsquoeacutechellethinsputiliseacuteethinspcelle-cithinspdoitthinspecirctrethinspchoisiethinspselonthinsplathinspclientegravelethinspetthinsplethinspcontextethinspdonneacutethinspDethinspmecircmethinspsonthinsputilisationthinspdoitthinspecirctrethinspuniformethinspetthinspstandardiseacuteethinspauthinspseinthinspdrsquounethinspmecircmethinspeacutequipethinspsoignantethinsp

ADULTE-AIcircNEacutethinsp

AUTO-EacuteVALUATIONthinsp(DOULEURthinspAIGUEuml)

thinsprsaquo Eacutechellethinspnumeacuteriquethinsp(0thinspagravethinsp10)thinsp(EN)thinsprsaquo Eacutechellethinspverbalethinspsimplethinsp(EVS)thinsprsaquo Eacutechellethinspvisuellethinspanalogiquethinsp(EVA)

HEacuteTEacuteRO-EacuteVALUATIONthinspCOMPORTEMENTALEthinsp(DOULEURthinspAIGUEuml)

thinsprsaquo ALGOPLUSthinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspdesthinsptroublesthinspdethinsplathinspcommunicationthinspverbale)

thinsprsaquo PACSLACthinspouthinspPACSLAC-Fthinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspunethinspcapaciteacutethinsplimiteacuteethinspagravethinspcommuniquer

thinsprsaquo PAINADthinsp(anglais)thinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspunethinspdeacutemencethinspouthinspautrethinsptroublethinspcognitifthinspetthinspquithinspnethinsppeutthinspcommuniquerthinspdethinspmaniegraverethinspfiable

Les hyperliens concernant ces eacutechelles sont fournis agrave titre informatif seulement

mdash Annexe

CMQ - OIIQ - OPIQ 08

Chapitre 1 Patient adulte

thinsp11thinspDEacuteFINITIONthinspOBJECTIFSthinspETthinspCLIENTEgraveLEthinspCIBLEthinsp

Lathinspseacutedation-analgeacutesiethinspestthinspunethinspproceacutedurethinspquithinspsethinspdeacutefinitthinspcommethinspeacutetantthinsplrsquoadmi-nistrationthinspdethinspmeacutedicamentsthinspouthinspdethinspsubstancesthinspservantthinspagravethinspalteacutererthinsplethinspniveauthinspdethinspconsciencethinspdrsquounethinsppersonnethinspsathinspperceptionthinspdethinsplathinspdouleurthinspetthinspsathinsptoleacuterancethinspagravethinsplrsquoen-vironnementthinsptoutthinspenthinspluithinsppermettantthinspunethinspreacuteponsethinspagravethinsplathinspstimulationthinspverbalethinspouthinsptactilethinspetthinsplethinspmaintienthinspdrsquounethinspfonctionthinspcardiaquethinspetthinspventilatoirethinspadeacutequatethinspenthinsptousthinsppointsthinsp(OPIQthinsp2009)

Ellethinsppermetthinspdoncthinspdethinspmieuxthinsptoleacutererthinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspdethinspfaccedilonthinspseacutecuritairethinspCertainsthinsppatientsthinsprequerrontthinspsurtoutthinspunethinspseacutedationthinspdrsquoautresthinspunethinspanalgeacutesiethinspetthinsplathinspplupartthinsplesthinspdeuxthinspagravethinsplathinspfoisthinspLesthinspmeacutedicamentsthinspetthinsplathinspproceacutedurethinsputiliseacutesthinspdeacutependrontthinspprincipalementthinspduthinspniveauthinspdethinspseacutedationthinspetthinspdrsquoanal-geacutesiethinspdeacutesireacutethinspselonthinsplathinspnaturethinspetthinsplathinspdureacuteethinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacutera-peutiquethinspetthinspselonthinsplesthinspcaracteacuteristiquesthinspduthinsppatientthinspDrsquoailleursthinsplesthinspbesoinsthinspparticu-liersthinspduthinsppatientthinspdoiventthinspecirctrethinsppristhinspenthinspconsideacuteration

Lesthinspobjectifsthinspviseacutesthinspparthinsplathinspseacutedation-analgeacutesiethinsplorsthinspdrsquounethinspinterventionthinspdiagnos-tiquethinspouthinsptheacuterapeutiquethinspsontthinspdrsquoassurerthinsplathinspseacutecuriteacutethinspetthinsplethinspbien-ecirctrethinspduthinsppatientthinspetthinspdethinsppermettrethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspdethinspqualiteacutethinspenthinsp

a fournissantthinspunethinspanalgeacutesiethinspunethinspseacutedationthinspetthinspunethinspamneacutesiethinspadapteacutees

b controcirclantthinsplesthinspcomportementsthinspmoteursthinspnuisiblesthinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

c minimisantthinsplesthinspreacuteponsesthinsppsychologiquesthinspdeacutefavorablesthinspassocieacuteesthinspauxthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspdouloureusesthinspouthinspanxiogegravenesthinsp

Lathinspseacutelectionthinspdesthinsppatientsthinsppourthinsplathinspseacutedation-analgeacutesiethinspestthinspfondeacuteethinspsurthinsplrsquoeacutevaluationthinspcliniquethinspdethinspleurthinspeacutetatthinspdethinspsanteacutethinspAgravethinspcettethinspfinthinspilthinspestthinsprecommandeacutethinspdrsquoutiliserthinsplathinspclassi-ficationthinspdethinsplrsquoeacutetatthinspphysiquethinspduthinsppatientthinspquethinsplrsquoonthinsptrouvethinspdansthinsplethinsptableauthinspdethinsplathinsppagethinspsuivante

CMQ - OIIQ - OPIQ 09

Classification Eacutetatthinspdethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp1 Patientthinspenthinspbonnethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp2Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspleacutegegravere

ASAthinspPhysicalthinspStatusthinsp3Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgrave

ASAthinspPhysicalthinspStatusthinsp4Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgravethinspquithinsprepreacutesentethinspthinspunethinspmenacethinspconstantethinsppourthinspsathinspvie

ASAthinspPhysicalthinspStatusthinsp5Patientthinspmoribondthinspquithinspnethinspsurvivrathinsppasthinspthinspagravethinspmoinsthinspdrsquounethinspinterventionthinsp

ASAthinspPhysicalthinspStatusthinsp6Patientthinspdeacuteclareacutethinspenthinspeacutetatthinspdethinspmortthinspceacutereacutebralethinspdontthinsplesthinsporganesthinspontthinspeacuteteacutethinsppreacuteleveacutesthinspagravethinspdesthinspfinsthinspdethinspdon

Tableau 1Classification de lrsquoeacutetat physique du patient selon lrsquoAmerican Society of Anesthesiologists (ASA) (ASA Physical Status Classification System) [En ligne] (Notre traduction)

Ainsithinsplorsquethinsplathinspseacutedation-analgeacutesiethinspestthinspreacutealiseacuteethinspparthinspunthinspmeacutedecinthinspsansthinsplathinspcolla-borationthinspdirectethinspdrsquounthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesio-logiethinspouthinspenthinspreacuteanimationthinspcardiorespiratoirethinspavanceacuteethinsplesthinspinterventionsthinspdiagnos-tiquesthinspouthinsptheacuterapeutiquesthinspdoiventthinspecirctrethinspreacuteserveacuteesthinspprincipalementthinspauxthinsppatientsthinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp1thinspouthinspauxthinsppatientsthinspatteintsthinspdrsquounethinspaffectionthinspsysteacutemiquethinspleacutegegraverethinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp2thinsp

CMQ - OIIQ - OPIQ 10

Notonsthinspquethinspdansthinspdesthinspsituationsthinspparticuliegraveresthinspetthinspjustifieacuteesthinspauthinspdossierthinspmeacutedi-calthinsplathinspseacutedation-analgeacutesiethinsppeutthinspecirctrethinspeffectueacuteethinspchezthinsplesthinsppatientsthinspstablesthinspdethinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp3thinspetthinspexceptionnellementthinspdethinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp4thinspToutefoisthinspellethinspdoitthinsplrsquoecirctrethinspdansthinspdesthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspopti-malethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespira-toirethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspDethinspplusthinspcesthinsppatientsthinspdoiventthinspfairethinsplrsquoobjetthinspdrsquounethinspeacutevaluationthinspindividualiseacuteethinspetthinspplusthinspapprofondiethinsp

Lathinspprofondeurthinspdethinsplathinspseacutedationthinspetthinsplethinspniveauthinspdrsquoanalgeacutesiethinsprechercheacutethinspenthinspseacutedation-analgeacutesiethinspdoiventthinspcorrespondrethinspauxthinspniveauxthinsppermettantthinsplrsquoatteintethinspdesthinspobjectifsthinspviseacutesthinspetthinspecirctrethinspmesureacutesthinspagravethinsplrsquoaidethinspdrsquoeacutechellesthinspstandardiseacuteesthinspvalideacuteesthinspdethinsppreacutefeacuterencethinspetthinspadapteacuteesthinspauthinspcontextethinspetthinspagravethinsplathinspconditionthinspduthinsppatientthinspLesthinspniveauxthinspdethinspseacutedation-analgeacutesiethinspviseacutesthinsptelsthinspquethinspdeacutefinisthinspdansthinsplathinspclassificationthinspdethinsplrsquoASAthinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinspASAthinspHousethinspofthinspDelegatethinsp2014a)thinsp(annexethinspI)thinspdoiventthinspcorrespondentthinspagravethinsplrsquounthinspouthinsplrsquoautrethinspdesthinspdeuxthinspniveauxthinspsuivantsthinsp(CMQthinsp2009)thinsp

thinsprsaquo seacutedationthinspminimalethinspouthinsplaquothinspanxiolysethinspraquothinspougravethinsplrsquoappreacutehensionthinspduthinsppatientthinspestthinspdiminueacuteethinspsansthinspchangementthinspdethinspsonthinspniveauthinspdethinspconsciencethinspetthinspsansthinspalteacutererthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsplathinspventilationthinspetthinsplathinspfonctionthinspcardiovasculaire

thinsprsaquo seacutedationthinspmodeacutereacuteethinspougravethinsplathinspreacuteponsethinspauxthinspstimulithinspverbauxthinspouthinsptactilesthinspleacutegersthinspestthinspvolontairethinspsansthinspaffecterthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsplathinspventilationthinspspontaneacuteethinspetthinsplathinspfonctionthinspcardiovasculaire

Notonsthinsptoutefoisthinspquethinsplrsquoeacutequipethinspsoignantethinspparticipantthinspagravethinsplathinspproceacutedurethinspdoitthinspconnaicirctrethinsplethinspniveauthinspdethinspseacutedation-analgeacutesiethinspgeacuteneacuteralementthinspneacutecessairethinsppourthinspunethinspinterventionthinspdonneacuteethinspDethinspmecircmethinspellethinspdoitthinspecirctrethinsppreacutepareacuteethinspagravethinspgeacutererthinsplethinsppassagethinspmomentaneacutethinspagravethinspunthinspniveauthinspdethinspseacutedationthinspsupeacuterieurthinspagravethinspceluithinspquithinspathinspeacuteteacutethinspplanifieacutethinsp(crsquoest-agrave-direthinspplusthinspprofondthinspquethinsppreacutevu)thinspcethinspquithinsppeutthinspsurvenirthinspenthinsptoutthinsptempsthinsplorsthinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsp

CMQ - OIIQ - OPIQ 11

Volet organisationnel

thinsp12thinspCOMPEacuteTENCESthinspPROFESSIONNELLESthinsp

Consideacuterantthinspquethinsplathinspseacutedation-analgeacutesiethinspsrsquoinscritthinspdansthinspunethinsppratiquethinspdethinspcollabo-rationthinspentrethinsplethinspmeacutedecinthinspetthinspdrsquoautresthinspprofessionnelsthinspdethinsplathinspsanteacutethinsp(infirmiegraveresthinspetthinspinhalotheacuterapeutes)thinspilthinspimportethinspdethinsppreacuteciserthinspqursquounethinsputilisationthinspjudicieusethinspdethinspleursthinspcompeacutetencesthinspestthinspdethinspmisethinsppourthinspassurerthinsplathinspqualiteacutethinspetthinsplrsquoefficiencethinspdesthinspsoinsthinspAinsithinsptousthinspdoiventthinspavoirthinsplesthinspqualificationsthinsprequisesthinspdansthinsplethinspdomainethinspdethinsplathinspseacutedation-thinspanalgeacutesie

Dethinspplusthinsplrsquoeacutequipethinspsoignantethinspquithinspreacutealisethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacutera-peutiquethinspsousthinspseacutedation-analgeacutesiethinspdoitthinsp

a ecirctrethinspenthinspmesurethinspdrsquoeacutevaluerthinspadeacutequatementthinsplathinspconditionthinspdethinspsanteacutethinspduthinsppatientthinspetthinspdrsquoenthinspassurerthinsplathinspsurveillancethinspclinique

b connaicirctrethinspetthinsputiliserthinspjudicieusementthinsplathinspmeacutedicationthinspainsithinspquethinspsesthinspantagonistes

c posseacutederthinsplesthinspconnaissancesthinspetthinsplesthinspcompeacutetences1thinspneacutecessairesthinsppourthinspintervenirthinspenthinspsituationthinspdrsquourgencethinsptellethinspquethinsplathinspreacuteanimationthinspcardiorespiratoire2thinsp(dethinsppreacutefeacuterencethinspenthinspsoinsthinspavanceacutes)thinspcrsquoest-agrave-direthinspmaicirctriserthinspenthinspprioriteacutethinsplesthinsptechniquesthinspdethinsplathinspprisethinspenthinspchargethinspdethinsplathinspventilationthinspduthinspmassagethinspcardiaquethinspetthinspdethinsplathinspmeacutedicationthinspassocieacutee

d avoirthinsplrsquoexpertisethinsprequisethinspselonthinsplathinspclientegravelethinspviseacuteethinspetthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspagravethinspreacutealiserthinsp

thinsp13thinspRESSOURCESthinspMATEacuteRIELLESthinsp

1thinspLOCAUX

LrsquoameacutenagementthinspdesthinsplocauxthinspdoitthinsppermettrethinspdethinspreacutealiserthinspdethinspfaccedilonthinspadeacutequatethinspetthinspenthinsptoutthinsptempsthinspunethinspreacuteanimationthinspcardiorespiratoirethinspainsithinspqursquounethinspeacutevacuationthinspdrsquourgencethinsplethinspcasthinspeacutecheacuteantthinspEntrethinspautresthinsplathinspsuperficiethinspdoitthinsppermettrethinspauthinsppersonnelthinspdethinspcircu-lerthinsplibrementthinsplrsquoeacuteclairagethinspdoitthinspecirctrethinspsuffisantthinsplethinspmateacuterielthinspdrsquourgencethinsp(pthinspexthinspthinspdethinspreacuteani-mation)thinspdoitthinspecirctrethinspfacilementthinspaccessiblethinspetthinspentreposeacutethinspdansthinspunthinsplieuthinspconnuthinspdethinsptousthinsp

Selonthinsplesthinspmodaliteacutesthinspdethinspfonctionnementthinspetthinsplethinsptypethinspdrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsppratiqueacutethinspilthinspestthinspdrsquousagethinspdethinspdisposerthinspdrsquounethinspsallethinspdethinspreacutecupeacutera-tionthinspouthinspdrsquoobservation

1thinspthinspthinspthinspOnthinspentendthinspparthinspconnaissancesthinspetthinspcompeacutetencesthinspqursquoellesthinspsoientthinspmisesthinspagravethinspjourthinspselonthinsplesthinsprecommandationsthinspenthinspvigueur2thinspthinspthinspOnthinspentendthinspparthinspcertificationthinspenthinspreacuteanimationthinspcardiorespiratoirethinsplesthinspformationsthinspsuivantesthinspthinsp thinsprsaquothinspReacuteanimationthinspcardiorespiratoirethinspdethinspbasethinspthinspSoinsthinspimmeacutediatsthinspenthinspreacuteanimationthinsp(SIR)thinsppourthinspprofessionnelsthinspdethinsplathinspsanteacutethinspthinspthinspthinspthinspthinspthinspthinspthinspouthinsplrsquoeacutequivalentthinsp thinsprsaquothinspReacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspSoinsthinspavanceacutesthinspenthinspreacuteanimationthinspcardiovasculairethinsp(SARC)thinspouthinsplrsquoeacutequivalent

CMQ - OIIQ - OPIQ 12

Pourthinspinformationthinspcompleacutementairethinsp(annexethinspII)thinspProceacutedures et interventions en milieu extrahospitalierthinsp(CMQthinsp2011)

2thinspEacuteQUIPEMENTthinsp(INTRAthinspETthinspEXTRAHOSPITALIER)

OBLIGATOIRE

Enthinspplusthinspduthinspmateacuterielthinspdirectementthinsplieacutethinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspjustifiantthinsplathinspseacutedation-analgeacutesiethinsponthinspdoitthinsptrouverthinspminimalementthinsplrsquoeacutequipe-

mentthinspsuivant

Dansthinsplathinspsallethinsp

thinsprsaquo tablethinspdrsquoexamenthinspciviegraverethinspouthinsptablethinspdethinspchirurgiethinsprsaquo tablethinsppourthinsplesthinspinstrumentsthinsprsaquo soluteacutesthinspetthinspmateacuterielthinspneacutecessairethinsppourthinsplrsquoinstallationthinspetthinsplethinspmaintienthinspdrsquounethinspvoiethinsp

endoveineusethinsprsaquo saturomegravetrethinsp(oxymegravetrethinspdethinsppouls)thinsp

Lethinspmonitoragethinspdethinsplathinspsaturationthinspenthinspoxygegravenethinsppermetthinsplrsquoeacutevaluationthinspdethinsplrsquooxy-geacutenationthinsp(deacutetectionthinsppreacutecocethinspdrsquounethinsphypoxeacutemie)thinspmaisthinspilthinspnethinsppeutthinsppasthinspdeacutetecterthinsppreacutecocementthinspunethinspobstructionthinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(AmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2012)thinspthinsp

thinsprsaquo steacutethoscopethinspthinsprsaquo sphygmomanomegravetrethinspouthinspappareilthinspautomatiseacutethinspnonthinspinvasifthinsppourthinsplathinspprisethinspdethinsplathinsp

pressionthinsparteacuteriellethinsprsaquo sourcethinspdrsquooxygegravenethinspcomprimeacutethinspenthinspquantiteacutethinspsuffisantethinsppourthinspenthinsppermettrethinsp

llsquoadministrationthinspagravethinspunthinspdeacutebitthinspdethinsp15thinsplitresthinspparthinspminutethinsppendantthinsp60thinspminutesthinspetthinspthinsplethinspmateacuterielthinspneacutecessairethinspagravethinsplrsquooxygeacutenotheacuterapie

thinsprsaquo appareilthinspagravethinspaspirationthinsppouvantthinspgeacuteneacutererthinspunethinsppressionthinspneacutegativethinspdethinsp40ndash60thinspmmthinspHgthinspouthinspunethinspcapaciteacutethinspdethinspflotthinspdethinsp100thinsplitresthinspparthinspminutethinspetthinsplethinspmateacuterielthinspneacutecessairethinspthinspagravethinsplrsquoaspiration

thinsprsaquo lethinspmateacuterielthinspneacutecessairethinspagravethinsplathinspprisethinspenthinspchargethinspventilatoirethinspentrethinspautresthinspreacuteanimateurthinspmanuelthinspautogonflablethinsp(Ambuthinspbag)thinspmasquethinspcanulesthinspnasothinspthinspetthinsporopharyngeacuteesthinspdethinsptaillesthinspvarieacutees

Ce mateacuteriel doit ecirctre disponible agrave porteacutee de la main

CMQ - OIIQ - OPIQ 13

thinsprsaquo appareilthinspdrsquoalimentationthinspeacutelectriquethinspdethinspsecoursthinsppourthinsplethinspfonctionnementthinspdesthinspeacutequipementsthinspdrsquourgence

Peutthinspecirctrethinspagravethinsplrsquoexteacuterieurthinspdethinsplathinspsallethinsp(maisthinspfacilethinspdrsquoaccegravesthinspetthinsprapidementthinspdisponible)thinsp

thinsprsaquo thinsparmoirethinspfermeacuteethinsppourthinspentreposerthinspsousthinspcleacutethinspauthinspbesointhinsplethinspmateacuterielthinspetthinsplesthinspsubstancesthinspcontrocircleacuteesthinspainsithinspquethinsplesthinspbenzodiazeacutepines

thinsprsaquo mateacuterielthinspneacutecessairethinspagravethinsplrsquointubationthinspendotracheacutealethinspentrethinspautresthinspsondesthinspendotracheacutealesthinspetthinsplamesthinspdethinsplaryngoscopethinspdethinsptaillesthinspvarieacuteesthinspainsithinspquethinspdesthinspalternativesthinspagravethinsplrsquointubationthinspdifficilethinsp(pthinspexthinspthinspoutilsthinspextraglottiquesthinsptelsthinspquethinspmasquesthinsplaryngeacutes)

thinsprsaquo deacutefibrillateurthinspcardiaquethinsp(dethinsppreacutefeacuterencethinspunthinspdeacutefibrillateurthinspexternethinspautomatiseacutethinsp[DEA])

thinsprsaquo pharmaciethinsp(troussethinspouthinspchariot)thinspcontenantthinsplesthinspmeacutedicamentsthinspneacutecessairesthinspauthinsptraitementthinspdesthinspsituationsthinspdrsquourgencethinsptellesthinspquethinspthinspsurdosagethinspauxthinspopioiumldesthinspouthinspauxthinspbenzodiazeacutepinesthinspurgencethinspcardiaquethinspreacuteactionthinspallergiquethinspcrisethinspdrsquoasthmethinspcrisethinspconvulsivethinspchocthinspvagalthinsphypoglyceacutemiethinspetc

RECOMMANDEacutethinspSELONthinspLAthinspSITUATION

thinsprsaquo moniteurthinspcardiaquethinspthinspdansthinspcertainsthinspcasthinspbienthinspdeacutefinisthinsplethinspmonitoragethinspcardiaquethinsppeutthinspecirctrethinsprecommandeacutethinspouthinspobligatoirethinsp(tableauthinsp3)

thinsprsaquo capnographethinspthinspdansthinspcertainsthinspcasthinspbienthinspdeacutefinisthinsplethinspmonitoragethinspduthinspCO2thinsppeutthinspecirctrethinsp

recommandeacutethinspouthinspobligatoirethinsp(tableauthinsp3)thinspthinspLethinspmonitoragethinspduthinspCO

2thinsppermetthinspdrsquoidentifierthinsppreacutecocementthinsplesthinspcomplicationsthinsp

tellesthinsplathinspseacutedationthinspexcessivethinsplrsquohypoventilationthinspetthinsplrsquoapneacuteethinspenthinspplusthinspdethinsppermettrethinspdethinspmieuxthinspcontrocirclerthinsplethinspniveauthinspdethinspseacutedationthinspenthinspfonctionthinspdethinsplrsquointerventionthinspthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinspSonthinsputilisationthinsppermetthinspeacutegalementthinspthinspdethinspsuivrethinsplethinspmonitoragethinspventilatoirethinspCelathinspestthinspparticuliegraverementthinspapproprieacutethinspthinsplorsqursquoilthinspnrsquoexistethinsppasthinspdrsquoantagonistesthinspagravethinsplathinspmeacutedicationthinsputiliseacuteethinsp(pthinspexthinspthinsppropofol)thinsp

OPTIONNEL

thinsprsaquo moniteurthinspdethinsptempeacuteraturethinspetthinspdispositifthinspdethinspreacutechauffementthinspduthinsppatientthinspselonthinsplethinsppatientthinspetthinsplathinspdureacuteethinspdethinsplrsquointerventionthinsp

thinsprsaquo systegravemethinspdrsquoantipollutionthinsp(eacutevacuationthinspduthinspprotoxydethinspdrsquoazote)thinspsrsquoilthinspythinspathinsplieuthinsprsaquo analyseurthinspdrsquooxygegravenethinsplorsqursquounthinspmeacutelangethinspestthinsputiliseacutethinsp(pthinspexthinspthinspO

2thinspetthinspprotoxydethinsp

drsquoazote)thinsprsaquo steacutethoscopethinsppreacutecordialthinspouthinsppreacutetracheacutealthinsppourthinspeacutecoutethinspenthinspcontinu

CMQ - OIIQ - OPIQ 14

LrsquoensemblethinspdethinspcesthinspeacutequipementsthinspdoitthinspecirctrethinspadapteacutethinspauthinsppatientthinspIlsthinspdoiventthinspecirctrethinspenthinspeacutetatthinspdethinspfonctionnerthinspetthinsplesthinspattestationsthinspdesthinspveacuterificationsthinsppeacuteriodiquesthinspdoiventthinspecirctrethinspconserveacuteesthinspdansthinspunthinspregistrethinsppreacutevuthinspagravethinspcettethinspfin

Pendantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplesthinspprofessionnelsthinspdoiventthinspthinsprespecterthinsplesthinspregraveglesthinspdethinsppreacuteventionthinspetthinspdethinspcontrocirclethinspdesthinspinfections

Unethinspproceacutedurethinsprelativethinspauxthinspsituationsthinspdrsquourgencethinsp(annexethinspIII)thinspagravethinsplrsquoaccegravesthinspauxthinspser-vicesthinspdrsquourgencethinsppreacutehospitaliersthinspetthinspdethinsptransfertthinspselonthinspunethinspententethinspintereacutetablisse-mentsthinspdoitthinspecirctrethinspeacutelaboreacuteethinspmaintenuethinspagravethinspjourthinspfacilementthinspdisponiblethinspenseigneacuteethinspagravethinsptoutthinsplethinsppersonnelthinspetthinspfairethinsplrsquoobjetthinspdrsquounthinsprappelthinspaupregravesthinspdethinspcethinspdernierthinspsurthinspunethinspbasethinsp

peacuteriodiquethinsp

CMQ - OIIQ - OPIQ 15

Volet professionnel

thinsp14thinspPREacuteSEacuteDATION-ANALGEacuteSIEthinsp

SEacuteLECTIONthinspDESthinspPATIENTS

Lathinspseacutelectionthinspdesthinsppatientsthinspdoitthinsptenirthinspcomptethinspnotammentthinspdethinsplrsquoeacutevaluationthinspdesthinspvoiesthinspaeacuteriennesthinspetthinspdethinsplrsquoeacutetatthinspdethinspsanteacutethinspgeacuteneacuteralthinspduthinsppatientthinspquithinspaurontthinspmisthinspenthinspeacutevi-dencethinsplathinsppreacutesencethinspouthinsplrsquoabsencethinspdrsquoindicateursthinspdethinsppossiblesthinspcomplicationsthinsplorsthinspdethinsplathinspseacutedation-analgeacutesiethinspIlthinspexistethinspdeuxthinsptypesthinspdethinsprisquesthinspenthinspseacutedation-analgeacutesiethinspthinsplesthinsprisquesthinsppreacutevisiblesthinsp(difficulteacutethinsppotentiellethinsplieacuteethinspagravethinsplathinspgestionthinspdesthinspvoiesthinspaeacuteriennesthinspouthinspinstabiliteacutethinspduthinsppatient)thinspetthinsplesthinsprisquesthinspimpreacutevisiblesthinsp(incidentaccidentthinsperreurthinsphu-mainethinspetc)thinspUnethinspeacutevaluationthinspinitialethinsp(histoirethinspexamenthinspphysique)thinspadeacutequatethinspavantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspdiminuethinspdethinsptelsthinsprisques

Agravethinsppartirthinspdethinsplrsquoensemblethinspdesthinspeacutevaluationsthinspeffectueacuteesthinsplethinspmeacutedecinthinspseacutelectionnethinsplesthinsppatientsthinspaptesthinspagravethinsprecevoirthinspunethinspseacutedation-analgeacutesiethinspselonthinspnotammentthinsp

thinsprsaquo lesthinspfacteursthinspdethinsprisquethinspidentifieacutesthinspagravethinsplathinspsuitethinspdethinsplrsquoeacutevaluationthinsp(cardiovasculairethinsprespiratoirethinspheacutepatiquethinspneurologique)thinspdethinsplathinsppossibiliteacutethinspdethinspgrossessethinspchezthinsplathinspfemmethinspenthinspacircgethinspdethinspprocreacuteerthinspouthinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspenvisageacutee

thinsprsaquo lrsquoeacutevaluationthinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(annexethinspIV)thinspafinthinspdethinsppreacuteciserthinsplethinsprisquethinspdrsquoassistancethinspventilatoirethinspetthinspdrsquointubationthinspdifficilethinsp

thinsprsaquo lesthinspanteacuteceacutedentsthinspanestheacutesiquesthinspetthinspchirurgicauxthinspafinthinspdrsquoidentifierthinsplesthinspcomplicationsthinsppotentielles

thinsprsaquo lesthinspcomorbiditeacutesthinspdontthinsplesthinsptroublesthinsprespiratoiresthinspduthinspsommeilthinsp(annexethinspV)thinsprsaquo lathinspmeacutedicationthinspouthinspautresthinspsubstancesthinsp(prescritesthinspouthinspenthinspventethinsplibre)thinspafinthinsp

drsquoidentifierthinsplesthinsprisquesthinspdrsquointeractionsthinspavecthinsplesthinspmeacutedicamentsthinsputiliseacutesthinsplorsthinspdethinsplrsquointerventionthinspouthinspdethinsplathinspseacutedation-analgeacutesie

thinsprsaquo lrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspquithinsppourraitthinspneacutecessiterthinspunethinspseacutedation-analgeacutesiethinspdrsquounthinspniveauthinspsupeacuterieurthinspagravethinspceluithinspdontthinspilthinspestthinspquestionthinspdansthinspcesthinsplignesthinspdirectrices

thinsprsaquo lesthinspcaracteacuteristiquesthinsppropresthinspauthinsppatientthinsp(fonctionsthinspcognitivesthinspisolementthinspsocialthinspautonomiethinspetc)

EacuteVALUATIONthinspDESthinspPATIENTS

Cettethinspeacutevaluationthinspdoitthinspsethinspfairethinsppeuthinspdethinsptempsthinsp(moinsthinspdethinsp3thinspmoisthinspenthinsplrsquoabsencethinspdethinspchangementthinspnotablethinspdansthinsplathinspconditionthinspcliniquethinspduthinsppatient)thinspavantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspetthinspdoitthinspnotammentthinsppreacuteciserthinspcethinspquithinspsuit

CMQ - OIIQ - OPIQ 16

AgravethinspLrsquoANAMNEgraveSEthinspthinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsp

lrsquoeacutevaluationthinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinsp(annexethinspVI)thinsp

thinsprsaquo raison(s)thinspdethinspconsultationthinspetthinsphistoirethinspdethinsplathinspmaladiethinspactuellethinsprsaquo anteacuteceacutedentsthinsprsaquo reacuteactionthinspanteacuterieurethinspagravethinsplathinspseacutedation-analgeacutesiethinspagravethinsplrsquoanestheacutesiethinspetthinspagravethinsplathinspchirurgiethinsprsaquo allergiesthinsprsaquo momentthinspduthinspdernierthinspingestathinsp(preacuteciserthinsplethinsptypethinspetthinsplathinspquantiteacute)thinsprsaquo meacutedicationthinspetthinspautresthinspsubstancesthinsp(prescritesthinspouthinspnon)thinsprsaquo preacutemeacutedicationthinspreccediluethinsp(pthinspexthinspthinspadministrationthinspdethinspmorphinethinspchezthinspunthinsppatientthinspenthinsp

attentethinspdrsquounethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutique)thinsprsaquo habitudesthinspdethinspviethinsp(tabacthinspalcoolthinspouthinspdrogues)thinsprsaquo troublethinsprespiratoirethinspduthinspsommeilthinspetthinsplathinsptheacuterapiethinspassocieacutee

AgravethinspLrsquoEXAMENthinspPHYSIQUEthinsp

Lrsquoexamenthinspphysiquethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinspcherchethinspagravethinspmettrethinspenthinspeacutevi-dencethinspcertainsthinspcritegraveresthinspreconnusthinsppourthinspecirctrethinspassocieacutesthinspagravethinspunethinspassistancethinspventila-toirethinspdifficilethinspquithinsppeutthinspsurvenirthinspdansthinsplethinspcasthinspdrsquounthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquethinspceluithinspviseacutethinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsplrsquoeacutevaluationthinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinsp(annexethinspVII)thinsp

Lrsquoexamenthinspphysiquethinspdoitthinspecirctrethinspadapteacutethinspagravethinspchaquethinsppatientthinspetthinspporterthinspnotammentthinspsurthinspdesthinspeacuteleacutementsthinsptelsthinspquethinspceux-cithinsp

thinsprsaquo preacutesencethinspdrsquoobeacutesiteacutethinsprsaquo tecirctethinspetthinspcouthinsp

thinsprsaquo mobiliteacutethinspcervicalethinspcompromisethinsprsaquo couthinspcourtthinspouthinsplargethinsp(circonfeacuterencethinsp )thinsprsaquo pathologiethinspouthinspanomaliethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(pthinspexthinspthinspmassethinsp

cervicale)thinspthinsprsaquo bouchethinsp

thinsprsaquo petitethinspouverturethinsprsaquo dentitionthinsp(pthinspexthinspthinspbouchethinspeacutedenteacuteethinspdentsthinspinstablesthinspincisivesthinspproeacuteminentesthinsp

outhinspappareilthinspdentairethinspmalocclusionthinspimportante)thinsp

LethinspscorethinspdethinspMallampatithinspmodifieacutethinspestthinspunthinspoutilthinspagravethinspprivileacutegierthinsp(annexethinspIV)

CMQ - OIIQ - OPIQ 17

UnethinspbonnethinspeacutevaluationthinspdethinsptousthinsplesthinspaspectsthinsprelatifsthinspauthinspmaintienthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspestthinspessentiellethinspDethinspplusthinspchezthinsplethinsppatientthinspsymptomatiquethinspthinsp(pthinspexthinspthinspdyspneacutee)thinspcettethinspeacutevaluationthinspdoitthinspecirctrethinspcompleacuteteacuteethinspparthinsplrsquoauscultation cardiorespiratoirethinspFinalementthinspsithinspdrsquoautresthinspexamensthinspdoiventthinspecirctrethinspfaitsthinspleurthinspchoixthinspserathinspguideacutethinspparthinsplesthinspproblegravemesthinspmeacutedicauxthinspsous-jacents

Bienthinspquethinsplathinspseacutedation-analgeacutesiethinspnethinsppreacutevoitthinspnormalementthinsppasthinspdethinspprisethinspenthinspchargethinspcomplegravetethinspdethinsplathinspventilationthinsp(assistancethinspventilatoirethinspouthinspintubationthinspthinspendotracheacuteale)thinspilthinspestthinspimportantthinspdrsquoeffectuerthinspcettethinspeacutevaluationthinsppuisqursquoagravethinspthinsptoutthinspmomentthinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspunethinspventilationthinspthinspassisteacuteethinspavecthinspouthinspsansthinspintubationthinspendotracheacutealethinsppeutthinspsrsquoaveacutererthinspneacutecessairethinspthinspsithinsplathinsprespirationthinspestthinspcompromisethinsp

Lorsthinspdethinspsituationsthinspparticuliegraveresthinspouthinspcomplexesthinsplethinspmeacutedecinthinspdevraitthinspconsulterthinspunthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinsp

cardiorespiratoirethinspavanceacutee

CONSENTEMENTthinsp(REacuteSUMEacute)

LethinsplecteurthinspdoitthinspsethinspreacutefeacutererthinspagravethinsplrsquoannexethinspVIIIthinsppourthinsplethinsptextethinspcomplet

SelonthinsplethinspdroitthinspenthinspvigueurthinspauthinspQueacutebecthinspilthinspestthinspobligatoirethinspdrsquoobtenirthinsplethinspconsentementthinspdrsquounthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspintervention

LethinspCode civil du QueacutebecthinspeacutetablitthinspdesthinspregraveglesthinspgeacuteneacuteralesthinspconcernantthinsplethinspconsentementthinspauxthinspsoinsthinspquithinspsrsquoappliquentthinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspdispenseacutesthinspOnthinspythinspfaitthinspcependantthinspcertainesthinspdistinctionsthinspselonthinspquethinsplethinsppatientthinspestthinspaptethinspouthinspnonthinspagravethinspconsentirthinspetthinspselonthinspquethinsplesthinspsoinsthinspsontthinsprequisthinspouthinspnonthinsp

parthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspLathinspLoi sur les services de santeacute et les services sociaux (LSSSS)thinspeacutetablitthinspquantthinspagravethinspellethinsplesthinspregraveglesthinspapplicablesthinspenthinspeacutetablissementthinspenthinspmatiegraverethinspdethinspconsentementthinspauxthinspinterventionsthinspchirurgicalesthinspetthinspagravethinsplrsquoanestheacutesiethinsp

LethinspCode de deacuteontologie des meacutedecinsthinspstipulethinspquethinsplethinspmeacutedecinthinspdoitthinspobtenirthinspunthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspavantthinsptoutethinspinterventionthinspilthinspestthinsppreacuteciseacutethinspquethinsplethinspmeacutedecinthinspdoitthinspsrsquoassurerthinspquethinsplrsquoinformationthinsppertinentethinspathinspeacuteteacutethinsptransmisethinspfaciliterthinsplathinspprisethinspdethinspdeacutecisionthinspduthinsppatientthinspetthinsplathinsprespecterthinspLethinspCode de deacuteontologie

des infirmiegraveres et infirmiersthinspstipulethinspquantthinspagravethinspluithinspquethinsplrsquoinfirmiegraverethinspouthinsplrsquoinfirmierthinspdoitthinspfournirthinspauthinspclientthinsptoutesthinsplesthinspinformationsthinsprequisesthinsplorsquethinsplrsquoobligationthinspdrsquoobtenirthinspunthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspincombethinspagravethinsplrsquoinfirmiegraverethinspouthinspagravethinsplrsquoinfirmierthinspIlthinspnrsquoythinspathinsppasthinspdethinspdispositionthinsptouchantthinsppreacuteciseacutementthinsplethinspconsentementthinspdansthinsplethinspCode de

CMQ - OIIQ - OPIQ 18

deacuteontologie des inhalotheacuterapeutes du QueacutebecthinspCependantthinspilthinspestthinsppreacuteciseacutethinspqursquoenthinspplusthinspdesthinspavisthinspetthinspdesthinspconseilsthinsplrsquoinhalotheacuterapeutethinspdoitthinspfournirthinspagravethinspsonthinspclientthinsplesthinspexplicationsthinspneacutecessairesthinspagravethinsplathinspcompreacutehensionthinspetthinspagravethinsplrsquoappreacuteciationthinspdesthinspservicesthinspqursquoilthinspluithinsprend

TousthinsplesthinspprofessionnelsthinspsontthinspeacutevidemmentthinsptenusthinspdethinsprespecterthinsplesthinspdispositionsthinspleacutegalesthinspexistantesthinspndashthinspincluantthinspleurthinspcodethinspdethinspdeacuteontologiethinsprespectifthinspndashthinspetthinsplesthinspnormesthinspdethinsppratiquethinspeacutetabliesthinspparthinspleurthinspordrethinspprofessionnelthinspToutefoisthinsplathinspquestionthinspsethinspposethinspdethinspsavoirthinspcommentthinspcesthinspexigencesthinspdoiventthinspsrsquoappliquerthinspmaintenantthinspquethinspplusieursthinspinterventionsthinspreacutealiseacuteesthinspautrefoisthinspenthinspeacutetablissementthinspsontthinspeffectueacuteesthinspenthinspdehorsthinspthinspdethinspceux-cithinspetthinspquethinsplesthinspprofessionnelsthinsppartagentthinspcertainesthinspactiviteacutesthinspetthinsptravaillentthinsp

enthinspeacutetroitethinspcollaboration

Mecircmethinspsithinsplathinsploithinspnethinsplrsquoexigethinsppasthinsptoujoursthinspilthinspestthinsprecommandeacutethinsp

thinsprsaquo quethinsplethinsppatientthinspdonnethinspunthinspconsentementthinspeacutecritthinsplorsqursquoilthinspythinspathinspseacutedation-analgeacutesiethinspthinspetthinspcethinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspprodigueacutes

thinsprsaquo quethinsplethinspconsentementthinspportethinspagravethinsplathinspfoisthinspsurthinsplathinspseacutedation-analgeacutesiethinspetthinspsurthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspquethinspcettethinspderniegraverethinsppermet

thinsprsaquo quethinsplrsquoinformationthinsptransmisethinspauthinsppatientthinspverbalementthinspouthinspparthinspeacutecritthinspcomprennethinsplesthinsprisquesthinspdethinsplathinspseacutedation-analgeacutesiethinspetthinsplesthinsprisquesthinspdethinsplrsquointerventionthinspelle-mecircme

thinsprsaquo quethinsplethinspmeacutedecinthinspouthinsplethinspprofessionnelthinspagravethinspquithinspilthinspathinspconfieacutethinsplathinsptacircchethinspversethinspauthinspdossierthinspduthinsppatientthinspunethinspnotethinspexplicativethinspsurthinsplesthinspinformationsthinspfourniesthinspetthinsplethinspconsentementthinspobtenu

Lrsquoobtentionthinspdrsquounthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspdemeurethinspunethinspobligationthinspthinspinheacuterentethinspagravethinsplrsquointerventionthinspmeacutedicalethinspelle-mecircmethinspIlthinsprelegravevethinspdoncthinspdethinsplathinspresponsabiliteacutethinspduthinspmeacutedecinthinspdethinspsrsquoassurerthinspdethinsplathinsptransmissionthinspdethinsplrsquoinformationthinsppertinentethinspauthinsppatientthinspetthinspdethinspsathinspcompreacutehensionthinspdethinsplathinspnaturethinspduthinspbutthinspetthinspdesthinsprisquesthinsprelatifsthinspagravethinsplrsquointerventionthinspToutefoisthinsplathinsptacircchethinspdethinsptransmettrethinspdethinsplrsquoinformationthinspcompleacutementairethinsppeutthinspecirctrethinspconfieacuteethinspagravethinspdrsquoautresthinspprofessionnelsthinspthinspetthinspcellethinspdethinsprecueillirthinsplathinspsignaturethinspdrsquounthinspformulairethinspdethinspconsentementthinspagravethinspdrsquoautresthinspmembresthinspdethinsplrsquoeacutequipethinspdethinspsoins

CMQ - OIIQ - OPIQ 19

DIRECTIVESthinspETthinspCONSEILSthinsp

Avantthinspdethinspsubirthinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspsousthinspseacutedationthinsp-analgeacutesiethinsplethinsppatientthinspdoitthinsprecevoirthinsplesthinspdirectivesthinspneacutecessairesthinspdethinsppreacutefeacuterencethinspdansthinsp

unthinspdocumentthinspcontenantthinspentrethinspautresthinsplesthinsprecommandationsthinspsuivantesthinsp

a eacuteviterthinspdethinspconsommerthinsptoutethinspboissonthinspalcooliseacuteethinspdroguethinspouthinspsubstancethinspenthinspventethinsplibrethinsp(agravethinspmoinsthinspqursquoellethinspsoitthinspprescrite)thinsppouvantthinspalteacutererthinsplethinspniveauthinspdethinspconsciencethinspthinsp24thinspheuresthinspavantthinspetthinspapregravesthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

b observerthinspunethinsppeacuteriodethinspdethinspjeucircnethinspquithinspsrsquoappliquethinspagravethinsptoutthinspacircgethinspauxthinspcasthinspeacutelectifsthinsp(nonthinspurgents)thinspetthinspselonthinsplrsquoeacutevaluationthinspduthinsplaquothinsprapportthinsprisquebeacuteneacuteficethinspraquothinsppourthinsplesthinspcasthinspurgents

c suivrethinsplesthinsprecommandationsthinspduthinspmeacutedecinthinspquithinsppreacutecisethinspsithinsplesthinspmeacutedicamentsthinspprescritsthinspsurthinspunethinspbasethinspreacuteguliegraverethinsppeuventthinspecirctrethinspadministreacutesthinspcommethinspagravethinsplrsquoaccoutumeacuteethinspetthinspquithinspfaitthinsppartthinspdesthinspexceptionsthinsp(pthinspexthinspthinspanticoagulantthinsppsychotropethinspetc)thinspsrsquoilthinspythinspathinsplieuthinsp

Unethinspseacutedation-analgeacutesiethinspleacutegegraverethinspougravethinsplesthinspreacuteflexesthinspdethinspprotectionthinspdesthinspvoiesthinspthinspaeacuteriennesthinspsontthinsppreacuteserveacutesthinspestthinsppeuthinspsusceptiblethinspdrsquoinduirethinspunethinspaspirationthinspduthinspcon-tenuthinspgastriquethinspcontrairementthinspagravethinspunethinspseacutedationthinspplusthinspprofondethinspIlthinspestthinsptoutthinspdethinspmecircmethinspraisonnablethinspdethinsppenserthinspquethinsplethinsprisquethinspdrsquoaspirationthinspestthinspdiminueacutethinsplorsquethinsplrsquoestomacthinspestthinspvidethinspetthinspqursquounethinsppeacuteriodethinspdethinspjeucircnethinspavantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacutera-peutiquethinspestthinsppreacutefeacuterablethinspToutefoisthinspdansthinsptousthinsplesthinspcasthinsplrsquourgencethinspdethinsplrsquointerventionthinspetthinsplethinspniveauthinspdeacutesireacutethinspdethinspseacutedation-analgeacutesiethinspdoiventthinspecirctrethinspsoupeseacutesthinspauthinspregardthinspdesthinsprisquesthinspassocieacutesthinspagravethinspunthinspjeucircnethinspinadeacutequatthinspAinsithinsplethinspdeacutelaithinspentrethinsplrsquoheurethinspduthinspdernierthinsprepasthinspetthinsplethinspmomentthinspdethinsplathinspblessureaccidentthinspdoitthinspecirctrethinsppristhinspenthinspconsideacuterationthinsppourthinspestimerthinsplrsquoeacutetatthinspdethinspjeucircnethinspetthinspcethinspenthinspraisonthinspdethinsplrsquoileacuteusthinspreacuteflexethinsp

Avantthinsplathinspseacutedation-analgeacutesiethinspdrsquounethinspinterventionthinspnonthinspurgentethinsp(eacutelective)thinsplethinsppatientthinspdoitthinsprespecterthinsplesthinspdeacutelaisthinspsuivantsthinspselonthinsplathinspnaturethinspetthinsplathinspquantiteacutethinspingeacutereacuteethinspdethinspthinsp(Merchantthinspetthinspcollabthinsp2014a)thinsp

thinsprsaquo liquidethinspclairthinsp(pthinspexthinspthinspeauthinspjusthinspdethinspfruitthinsp[sansthinsppulpe]thinsptheacutethinspetthinspcafeacutethinspnoir)thinspthinspjeucircnethinspdethinsp2thinspheures

thinsprsaquo repasthinspleacutegerthinsp(pthinspexthinspthinsppainthinspgrilleacutethinsp+thinspliquidethinspclair)thinspthinspjeucircnethinspdethinsp6thinspheuresthinsprsaquo repasthinspcomposeacutethinspdethinspviandethinspouthinspdrsquoalimentsthinspfritsthinspouthinspgrasthinspthinspjeucircnethinspdethinsp8thinspheuresthinsp

CMQ - OIIQ - OPIQ 20

15thinspPERSEacuteDATION-ANALGEacuteSIEthinsp

APPROCHEthinspPHARMACOLOGIQUE

Lrsquoadministrationthinspdethinsptoutthinspmeacutedicamentthinspneacutecessitethinsplrsquoobtentionthinspdrsquounethinspordonnancethinsp

faitethinspenthinspvertuthinspdethinsplrsquoarticlethinsp393thinspduthinspCode des professions du QueacutebecthinspDrsquoailleursthinspthinsplathinspmeilleurethinspfaccedilonthinspdrsquoencadrerthinsplathinsppratiquethinspdethinsplrsquoinfirmiegraverethinspetthinspdethinsplrsquoinhalotheacuterapeutethinspestthinsplrsquoadoptionthinspdrsquounthinspprotocoleordonnancethinspcollectivethinspcomprenantthinspunthinspeacuteventailthinsptheacuterapeutiquethinspquithinsplaissethinspplacethinspauthinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspthinspUnthinsptelthinspdocumentthinspdoitthinspparthinspcontrethinspecirctrethinspenteacuterineacutethinspparthinsplesthinspresponsablesthinspmeacutedicauxthinspthinspdethinsplrsquoeacutetablissementthinspqursquoilthinspsoitthinsppublicthinspouthinsppriveacutethinsp

Soulignonsthinsplrsquoimportancethinspdrsquounthinspaccegravesthinspveineuxthinspfonctionnelthinspquithinspfaciliterathinsplrsquoadmi-nistrationthinspdesthinspagentsthinspseacutedatifsthinspetthinspanalgeacutesiquesthinspainsithinspquethinsplesthinsptraitementsthinsppharma-cologiquesthinspdesthinspcomplications

LethinspmeacutedecinthinsplrsquoinfirmiegraverethinspetthinsplrsquoinhalotheacuterapeutethinspdoiventthinsputiliserthinspunethinspmeacutedicationthinspqursquoilsthinspconnaissentthinspetthinspquithinspestthinspreconnuethinspRappelonsthinspqursquoilsthinspdoiventthinspecirctrethinspenthinspmesurethinspdethinspprendrethinspenthinspchargethinsptoutethinspcomplicationthinsppotentiellethinspythinspcompristhinsplathinspgestionthinspdrsquounthinsppassagethinspmomentaneacutethinspagravethinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspsupeacuterieurthinspagravethinspceluithinspquithinspthinspathinspeacuteteacutethinspplanifieacute

LethinspchoixthinspdethinsplathinspmeacutedicationthinsppeutthinspvarierthinspselonthinsplathinspsituationthinspcliniquethinspetthinsplesthinspfacteursthinsppropresthinspauthinsppatientthinspParthinspexemplethinspcertainsthinsppatientsthinspnethinsptolegraverentthinsppasthinsplesthinspdosagesthinsphabituelsthinspouthinsppreacutesententthinspdesthinspcontre-indications

Ilthinspestthinspimportantthinspdethinspretenirthinspquethinsplethinsptitragethinspdethinsptoutethinspmeacutedicationthinspdoitthinspecirctrethinspthinspprivileacutegieacutethinspetthinspquethinspsonthinspadministrationthinspdoitthinspsethinspfairethinspparthinsppetitesthinspdosesthinspdethinspthinspfaccedilonthinspprogressivethinspjusqursquoagravethinsplrsquoobtentionthinspduthinspniveauthinspdethinspseacutedationthinspetthinspdrsquoanalgeacutesiethinspthinspdeacutesireacutethinsptoutthinspenthinsplaissantthinspsrsquoeacutecoulerthinspsuffisammentthinspdethinsptempsthinspentrethinspdeuxthinspdosesthinsppourthinspquethinsplethinspmeacutedicamentthinspproduisethinspsesthinspeffetsthinsp

Lesthinspmeacutedicamentsthinsputiliseacutesthinspenthinspseacutedation-analgeacutesiethinspontthinspunthinspeffetthinspsynergiquethinspthinspParthinspexemplethinsplrsquoassociationthinspdrsquounethinspbenzodiazeacutepinethinspavecthinspunthinspopioiumldethinspaugmentethinspthinsplesthinsprisquesthinspdethinspdeacutepressionthinsprespiratoirethinspLeurthinspdosagethinspdoitthinspdoncthinspecirctrethinspajusteacutethinspenthinspconseacutequencethinspSithinsplrsquoobstructionthinspdesthinspvoiesthinspaeacuteriennesthinsplrsquoapneacuteethinspetthinsplrsquohypotensionthinspthinspsontthinsplesthinspcomplicationsthinsplesthinspplusthinspfreacutequentesthinspenthinspseacutedation-analgeacutesiethinspilthinspfautthinspretenirthinspquethinspcertainesthinspcomplicationsthinsppeuventthinspecirctrethinspparticuliegraveresthinspagravethinsplathinspmeacutedicationthinsputiliseacuteethinspthinspCitonsthinspagravethinsptitrethinspdrsquoexemplethinsplrsquoassociationthinsplaryngospasmethinspetthinspkeacutetaminethinsp

CMQ - OIIQ - OPIQ 21

Lorsquethinspdesthinspbenzodiazeacutepinesthinspouthinspdesthinspopioiumldesthinspsontthinspadministreacutesthinspparthinspvoiethinspthinspintraveineusethinspleursthinspantagonistesthinsprespectifsthinsp(pthinspexthinspthinspflumazeacutenilthinsp[Anexatereg]thinspthinspnaloxonethinsp[Narcanreg])thinspdoiventthinspecirctrethinsprapidementthinspdisponiblesthinspIlsthinspserontthinsputiliseacutesthinspthinspauthinspmomentthinspdrsquounethinspdeacutepressionthinsprespiratoirethinspinduitethinspparthinsplathinspmeacutedicationthinspet non en prophylaxiethinspchezthinsplethinsppatientthinspstablethinspIlthinspestthinsphabituellementthinsppreacutefeacuterablethinspdethinspthinsprenverserthinspdrsquoabordthinsplrsquoagentthinspseacutedatifthinspafinthinspdethinspmaintenirthinspintactthinsplrsquoeffetthinspanalgeacutesiquethinspthinspSithinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspdemeurethinspcompromisethinspilthinspserathinspalorsthinspthinspneacutecessairethinspdethinsprenverserthinsplrsquoeffetthinspanalgeacutesique

IlthinspfautthinspsethinsprappelerthinspquethinsplathinspdureacuteethinspdrsquoactionthinspdesthinspantagonistesthinspestthinspbienthinspinfeacuterieurethinspthinspagravethinsplathinspdureacuteethinspdrsquoactionthinspduthinspmeacutedicamentthinspdevantthinspecirctrethinspneutraliseacutethinspParthinspconseacutequentthinspthinsplathinspreacuteapparitionthinspdethinsplrsquoeffetthinspindeacutesirablethinspestthinspagravethinspsurveillerthinspchezthinsplethinsppatientthinspquithinspreccediloitthinspunthinspantagonistethinsp

VousthinsptrouverezthinspunethinspfichethinspinformativethinspsurthinsplrsquoutilisationthinspdethinsplathinspnaloxonethinspetthinspduthinspflumazeacutenilthinspagravethinsplrsquoannexethinspXI

Lesthinspdirectivesthinspeacutenonceacuteesthinspdansthinspcesthinsplignesthinspdirectricesthinspnrsquoontthinsppasthinsppourthinspobjectifthinspdethinspdeacutecrirethinspdansthinsplethinspdeacutetailthinsplathinspmeacutedicationthinsputiliseacuteethinspenthinspseacutedation-analgeacutesiethinspleursthinspagentsthinsp

antagonistesthinspetthinsplesthinspmeacutedicamentsthinspdrsquourgencethinspIlthinsprevientthinspauthinspmeacutedecinthinspdethinspbienthinsp

connaicirctrethinsplathinspmeacutedicationthinspetthinspdethinspchoisirthinspunethinspmeacutedicationthinspouthinspunethinspcombinaisonthinspdethinspmeacutedicamentsthinspreconnuethinspEtthinspilthinsprevientthinspauxthinspprofessionnelsthinspquithinsplesthinspadministrentthinsp

dethinspbienthinsplesthinspconnaicirctrethinspeacutegalementthinsp(eacuteleacutementsthinspdethinspsurveillancethinspcliniquethinsptechniquethinspdrsquoadministrationthinspeffetsthinspsecondairesthinspinteractionsthinspcontre-indicationsthinspseuilsthinspthinsptoxiquesthinspetc)thinspetthinspdethinspmaintenirthinspagravethinspjourthinspleursthinspconnaissancesthinspdansthinspcethinspdomaine

thinspPRINCIPALESthinspCLASSESthinspPHARMACOTHEacuteRAPEUTIQUESthinspUTILISEacuteESthinspthinspthinspENthinspSEacuteDATION-ANALGEacuteSIEthinsp

Lathinsplistethinspdesthinspmeacutedicamentsthinspabordeacutesthinspci-dessousthinspnrsquoestthinsppasthinsplimitativethinsp

a BenzodiazeacutepinesthinspProprieacuteteacutesthinspthinspanxiolytiquethinspamneacutesiquethinsphypnotiquethinsprelaxantthinspmusculairethinspetthinspanticonvulsivantthinspthinspIlthinspfautthinspprivileacutegierthinsplesthinspmoleacuteculesthinspagravethinspcourtethinspdemi-viethinsp(pthinspexthinspthinspmidazolamthinsp[Versedreg])thinspenthinspretenantthinspqursquoilthinspfautthinspajusterthinsplethinspdosagethinspchezthinspcertainsthinsppatientsthinsp(pthinspexthinspthinspacircgeacutesthinspouthinspaffaiblis)thinspetthinsplorsthinspdethinsplrsquoutilisationthinspconcomitantethinspdrsquoautresthinspmeacutedicamentsthinspaffectantthinsplethinspsystegravemethinspnerveuxthinspcentralthinspDethinspplusthinsplathinspdemi-viethinsp

CMQ - OIIQ - OPIQ 22

dethinspcesthinspmeacutedicamentsthinsppeutthinspecirctrethinspaugmenteacuteethinsplorsthinspdethinspleurthinspadministrationthinspenthinspperfusionthinspcontinuethinsp(context sensitive half-life)thinsp

b OpioiumldesthinspProprieacuteteacutesthinspthinspanalgeacutesiquethinspetthinspseacutedativethinspLathinspmorphinethinspconstituethinspunthinspopioiumldethinspdontthinsplrsquoefficaciteacutethinspestthinspreconnuethinspCependantthinspellethinspfavorisethinsplathinsplibeacuterationthinspdrsquohistaminethinspcethinspquithinsppeutthinspcauserthinspduthinsppruritthinspetthinspdethinsplrsquohypotensionthinspUnethinspdysfonctionthinspreacutenalethinspseacutevegraverethinspentraicircnethinsplrsquoaccumulationthinspdethinspsesthinspmeacutetabolitesthinspactifsthinsp

thinsprsaquo lethinspfentanylthinsp(Sublimazereg)thinspestthinspunthinspopioiumldethinspsyntheacutetiquethinsppuissantthinspetthinspdethinspcourtethinspdureacuteethinspdrsquoactionthinspIlthinspnethinspdeacuteclenchethinsppasthinspdethinsplibeacuterationthinspdrsquohistaminethinsp(doncthinsppeuthinspdrsquoeffetthinspheacutemodynamique)thinspIlthinspfautthinspcependantthinspsethinspmeacutefierthinspdesthinspdosesthinspeacuteleveacuteesthinspetthinspdesthinspinjectionsthinsprapidesthinspquithinsppeuventthinspprovoquerthinspunethinsprigiditeacutethinspmusculairethinspthinspetthinspunethinspdeacutepressionthinsprespiratoire

thinsprsaquo lrsquohydromorphonethinsp(Dilaudidreg)thinspestthinspunthinspopioiumldethinspsemi-syntheacutetiquethinspdontthinsplesthinspmeacutetabolitesthinspconnusthinspsontthinsprarementthinspprobleacutematiquesthinspMoinsthinsputiliseacuteethinspenthinspthinspseacutedation-analgeacutesiethinspellethinspestthinspauthinspmoinsthinsp5thinspfoisthinspplusthinsppuissantethinspquethinsplathinspmorphinethinspthinspcethinspquithinspestthinspparfoisthinspsous-estimeacute

thinsprsaquo lathinspmeacutepeacuteridinethinsp(Demerolreg)thinspestthinspunthinspopioiumldethinspsyntheacutetiquethinspposseacutedantthinspunthinspmeacuteta-bolitethinspactifthinspneurotoxiquethinspEllethinspnrsquoestthinsphabituellementthinsppasthinsprecommandeacuteethinsp

c Anestheacutesiques geacuteneacuterauxthinspLethinspmeacutedecinthinspquithinspprocegravedethinspagravethinspunethinspinterventionthinspsousthinspseacutedation-analgeacutesiethinspenthinsputilisantthinspunthinspouthinspdesthinspanestheacutesiquesthinspgeacuteneacuterauxthinspdoitthinspecirctrethinspexpeacuterimenteacutethinspenthinspseacutedation-analgeacutesiethinspetthinspenthinspreacuteanimationthinspcardiorespiratoirethinspDansthinsplethinspcasthinspcontrairethinspilthinspdoitthinspsrsquoassurerthinspdethinsplathinspcollaborationthinspdrsquounthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspParthinspailleursthinsplethinspmeacutedecinthinspdoitthinspenthinsptoutthinsptempsthinspecirctrethinspsoutenuthinspparthinspunthinspouthinspdesthinspprofessionnelsthinspqualifieacutesthinsp

thinsprsaquo propofolthinsp(Diprivanreg)thinspProprieacuteteacutesthinspseacutedativethinsphypnotiquethinspamneacutesiquethinspanxiolytiquethinspAgravethinspnoterthinspqursquoilthinspnrsquoathinspaucune proprieacuteteacute analgeacutesiquethinsp

thinspIlthinsppossegravedethinspunethinspdemi-viethinspcourtethinsppeutthinspecirctrethinspcumulatifthinspetthinspnrsquoathinsppas drsquoantago-nistethinspIlthinspnrsquoestthinsppasthinsprecommandeacutethinspchezthinsplathinspfemmethinspenceintethinspouthinspquithinspallaitethinspEnthinspregraveglethinspgeacuteneacuteralethinspetthinspselonthinsplethinsptypethinspdrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspilthinsppeutthinspecirctrethinspplusthinspjudicieuxthinspdethinsplrsquoadministrerthinspenthinspinfusionthinspIVthinspplutocirctthinspthinspqursquoenthinspbolusthinspthinspthinspIlthinsppeutthinsprapidementthinspcauserthinspunethinspdiminutionthinspmarqueacuteethinspduthinspniveauthinspdethinspcon-sciencethinspetthinspunethinspdeacutepressionthinsprespiratoirethinsppouvantthinspconduirethinspmomentaneacute-

CMQ - OIIQ - OPIQ 23

mentthinspagravethinspunethinspanestheacutesiethinspgeacuteneacuteralethinspnonthinspdeacutesireacuteethinspLesthinspprofessionnelsthinspenthinspplacethinspdoiventthinspecirctrethinspenthinspmesurethinspdethinspprendrethinspenthinspchargethinspunethinsptellethinspsituationthinspLrsquoASAthinsp(AmericanthinspSocietythinspofthinspAnesthesiologiststhinspASAthinspHousethinspofthinspDelegatesthinsp2004bthinsp[Notrethinsptraduction])thinsprecommandethinspnotammentthinspquethinsplethinsppatientthinspagravethinspquithinsplrsquoonthinspadministrethinspduthinsppropofolthinspreccediloivethinspdesthinspsoinsthinspenthinsplienthinspavecthinspunethinspseacutedationthinsppro-fondethinsp(niveauthinspnonthinspviseacutethinspdansthinspcesthinsplignesthinspdirectrices)thinspetthinspquethinsplethinspprofessionnelthinsp(nonthinspanestheacutesiologiste)thinspadministrantthinsplethinsppropofolthinsppossegravedethinsplathinspformationthinsptheacuteoriquethinspetthinsppratiquethinspneacutecessairethinspagravethinsplrsquoidentificationthinspetthinspagravethinsplathinspprisethinspenthinspchargethinspdesthinspvoiesthinspaeacuteriennesthinspetthinspdesthinspchangementsthinspcardiovasculairesthinspquithinspsurvien-nentthinspchezthinspunthinsppatientthinspeacutevoluantthinspversthinspunthinspeacutetatthinspdrsquoanestheacutesiethinspgeacuteneacuteralethinsp(niveauthinspnonthinspviseacutethinspdansthinspcesthinsplignesthinspdirectrices)thinsp

thinspthinspLorsquethinsplethinsppropofolthinspestthinspadministreacutethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspthinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspthinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspthinspobligatoirethinsp(tableauthinsp3)thinspthinspthinsp

thinsprsaquo keacutetaminethinsp(Ketalarreg)thinspProprieacuteteacutesthinspthinspseacutedativethinspetthinspanalgeacutesiquethinspthinspUtiliseacuteethinspenthinsppeacutediatriethinspetthinspchezthinsplrsquoadultethinspEllethinspproduitthinspaussithinspunethinspbroncho-thinspdilatationthinspparfoisthinspsouhaiteacuteethinsplorsthinspdrsquointerventionsthinspdiagnostiquesthinspouthinsptheacutera-peutiquesthinspchezthinsplesthinsppatientsthinspasthmatiquesthinspEllethinspsrsquoaccompagnethinspdrsquounethinsplibeacutera-tionthinspdethinspcateacutecholaminesthinspetthinspdrsquoeffetsthinspsympathomimeacutetiquesthinsp(augmentationthinspdethinsplathinspsalivation)thinspEllethinsppeutthinspprovoquerthinspdesthinspsymptocircmesthinsppsychotiquesthinspouthinspdesthinspcomportementsthinspanormauxthinspCesthinspsymptocircmesthinsppeuventthinspnuirethinspagravethinsplrsquoeacutevaluationthinspdesthinsppatientsthinspsousthinspseacutedationthinspEllethinspabaissethinsplethinspseuilthinspconvulsifthinsp

Lorsquethinsplathinspkeacutetaminethinspestthinspadministreacuteethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspobligatoirethinsp(tableauthinsp3)thinspthinsp

thinsprsaquo protoxydethinspdrsquoazotethinsp(N2O)thinsp

ProprieacuteteacutesthinspthinspgazthinspseacutedatifthinspetthinspanalgeacutesiquethinspthinspActionthinspanalgeacutesiquethinspsemblablethinspagravethinspcellethinspdethinsplathinspmorphinethinspIlthinsppotentialisethinsplesthinspanalgeacutesiquesthinspcentrauxthinspetthinsplesthinspagentsthinsphypnotiquesthinspetthinsppeutthinspaussithinspdiminuerthinsplesthinspreacuteservesthinspenthinspoxygegravenethinspduthinsppatientthinspUtiliseacutethinspenthinspcombinaisonthinspavecthinsplrsquooxygegravenethinspIlthinsppeutthinsppolluerthinsplrsquoenvironnementthinspdethinsptravailthinsp(voirthinspnormesthinspCSST)thinspIlthinsppeutthinspecirctrethinsp

CMQ - OIIQ - OPIQ 24

utiliseacutethinspenthinsppeacutediatriethinspchezthinsplrsquoadultethinspetthinspchezthinsplathinspfemmethinspenceintethinsp(saufthinspauthinspthinsppremierthinsptrimestre)thinsp

thinspDansthinsplethinspcasthinspougravethinsplethinspprotoxydethinspdrsquoazotethinspestthinsputiliseacutethinspenthinspcombinaisonthinspavecthinspunthinspagentthinspseacutedatifthinspouthinspunthinspopioiumldethinspouthinspsithinsplrsquoappareilthinsputiliseacutethinsppermetthinspdethinspmodifierthinsplathinspconcentrationthinspdrsquooxygegravenethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivement agravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspthinsp

thinsprsaquo dexmeacutedeacutetomidinethinsp(PreacuteceacutedexMC)thinsp(Agonistethinspalpha2-adreacutenergique)thinspProprieacuteteacutesthinspthinspseacutedativethinspanalgeacutesiquethinspetthinspanxiolytiquethinspthinspLathinspdexmeacutedeacutetomidinethinspenthinspperfusionthinspintraveineusethinspcontinuethinspestthinspindiqueacuteethinspnotammentthinsppourthinsplathinspseacutedationthinspdethinsppatientsthinspnonthinspintubeacutesthinspavantthinspetouthinsppendantthinspunethinspinterventionthinspchirurgicalethinspouthinspdrsquoautresthinsptypesthinspdrsquointerventionsthinspthinspNethinspcausethinspaucunethinspdeacutepressionthinsprespiratoirethinspmaisthinsppeutthinspcauserthinspunethinspbradycar-diethinspetthinspunethinsphypotensionthinspthinsp

thinspLrsquoutilisationthinspdethinspdexmeacutedeacutetomidinethinspdevraitthinspecirctrethinspreacuteserveacuteethinspauthinspmilieuthinspthinsphospitalierthinspouthinspauxthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspthinspEllethinspdevraitthinspecirctrethinspadministreacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspthinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspetthinsprapidementthinspdisponiblethinspthinspLorsquethinspdethinsplathinspdexmeacutedeacutetomidinethinspestthinspadministreacuteethinspunthinspprofessionnelthinspthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspthinspduthinsppatientthinsp(tableauthinsp2)thinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspobligatoirethinsp(tableauthinsp3)thinspthinsp

Agravethinspnoterthinspqursquoilthinspestthinspobligatoirethinspdethinsptenirthinspunthinspregistrethinspdesthinspsubstancesthinspcontrocircleacuteesthinspetthinspdesthinspbenzodiazeacutepinesthinspcomportantthinspdesthinspsignatures

thinsp

CMQ - OIIQ - OPIQ 25

SURVEILLANCEthinspCLINIQUEthinspLathinspsurveillancethinspcliniquethinspcomprendthinspplusieursthinspeacuteleacutementsthinspquithinspconcernentthinspthinspnotammentthinsplesthinspsystegravemesthinsprespiratoirethinspcardiaquethinspetthinspneurologiquethinspEllethinspdoitthinspthinsptenirthinspcomptethinspentrethinspautresthinsp

thinsprsaquo dethinsplathinspconditionthinspduthinsppatientthinspavantthinspetthinsppendantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

thinsprsaquo dethinsplathinspcomplexiteacutethinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinsprsaquo dethinsplathinspmeacutedicationthinsputiliseacuteethinsp(dosethinspdureacuteethinspetthinsppicthinspdrsquoactionthinspvoiethinspetthinspvitessethinspthinsp

drsquoadministrationthinspcombinaisonthinspetthinspantagonistes)

thinsprsaquo dethinsplrsquoassistancethinspagravethinspapporterthinspauthinspmeacutedecin

Lethinspmeacutedecinthinspquithinsppratiquethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspchezthinspunthinsppatientthinspsousthinspseacutedation-analgeacutesiethinspdoitthinspcompterthinspsurthinsplathinsppreacutesencethinspdrsquoauthinspmoinsthinspunthinspautrethinspprofessionnelthinsphabiliteacutethinspduthinspmilieuthinspdethinsplathinspsanteacutethinsp(infirmiegraverethinspinhalotheacuterapeutethinspouthinspautrethinspmeacutedecin)thinsp(annexethinspII)thinspEnthinspeacutetroitethinspcollaborationthinspavecthinsplethinspmeacutedecinthinspreacuteali-santthinsplrsquointerventionthinspceux-cithinspassurentthinspthinsplathinspgestionthinspdethinsplathinspseacutedationthinspetthinspdethinsplrsquoanalgeacutesiethinspqui comprend entre autres la surveillance clinique du patientthinspresponsabiliteacutethinspthinspagravethinsplaquellethinspilsthinspdoiventthinspenthinsptoutthinsptempsthinspsethinspconsacrerthinspenthinspprioriteacutethinsp

Dansthinspcertainsthinspcasthinsplethinspprofessionnelthinspquithinspassurethinspen prioriteacutethinsplathinspsurveillancethinspthinspcliniquethinspduthinsppatientthinsppeutthinspecirctrethinspappeleacutethinspagravethinspassisterthinsplethinspmeacutedecinthinspdansthinsplathinspreacutealisationthinspthinspdethinspsonthinspinterventionthinspCettethinspassistancethinspquithinspdoitthinspsrsquoeffectuerthinspdansthinsplathinspmecircmethinsppiegravecethinspdoitthinspecirctrethinspdethinsptregravesthinspcourtethinspdureacuteethinspDethinspplusthinspellethinspdoitthinsppouvoirthinspecirctrethinspinterrompuethinspthinspagravethinsptoutthinspmomentthinsppourthinspintervenirthinspimmeacutediatementthinspaupregravesthinspduthinsppatientthinspenthinspcasthinspdethinsp

complicationsthinspouthinspdethinspbesoin

Parthinspailleursthinsplorsquethinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspthinspneacutecessitentthinspunethinspassistancethinsptechniquethinspcontinuellethinspauthinspmeacutedecinthinsplrsquoajoutthinspdrsquounthinsptroisiegravemethinspprofessionnelthinspdethinsplathinspsanteacutethinsphabiliteacutethinsp(meacutedecinthinspinfirmiegraverethinspouthinspinhalotheacuterapeute)thinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinspestthinsprequisthinsp

CMQ - OIIQ - OPIQ 26

Tableau 2 Tableau reacutecapitulatif du nombre de professionnels habiliteacutes requis en seacutedation-analgeacutesie - Clientegravele adulte

Toutthinspauthinsplongthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplathinspsurveillancethinspcliniquethinspthinspduthinsppatientthinspdoitthinspecirctrethinspcontinuethinspetthinsplathinspcommunicationthinspavecthinspcelui-cithinspmaintenue

Proceacutederthinspagravethinsplathinspsurveillancethinspcliniquethinspcrsquoestthinspeacutevaluerthinspqualitativementthinspetthinspquantitative-mentthinspdethinspfaccedilonthinspsoutenuethinspetthinspenthinspcontinuthinsplrsquoensemblethinspdesthinspparamegravetresthinspsuivantsthinsp(listethinsp

nonthinsplimitative)thinsp(tableauthinsp3)thinsp

thinsprsaquo mesurethinspdethinsplathinsppressionthinsparteacuteriellethinspduthinsppouls3thinspetthinspdethinsplathinsprespiration4thinsprsaquo lecturethinspdethinsplathinspsaturationthinspcapillairethinspenthinspoxygegravene

Ilthinspfautthinspnoterthinspquethinsplathinsptonaliteacutethinspdethinsppoulsthinspdoitthinspecirctrethinspactiveacuteethinspenthinsptoutthinsptempsthinspetthinspsonthinspniveauthinspdoitthinspecirctrethinspajusteacutethinspdethinspfaccedilonthinspagravethinspecirctrethinspentenduthinspclairement

thinsprsaquo eacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplathinspseacutedationthinsp(eacutevaluationthinspdethinsplathinspseacutedationagitationthinspetthinspduthinspniveauthinspdethinspconscience)thinsp(annexethinspIX)thinsp

thinsprsaquo eacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplrsquoanalgeacutesiethinsp(eacutevaluationthinspdethinsplathinspdouleur)thinspdethinsplrsquoanxieacuteteacutethinspetthinspdethinsplathinspreacuteactionthinspduthinsppatientthinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsp(annexethinspX)

thinsprsaquo eacutevaluationthinspdethinsplrsquoeacutetatthinspdethinsplathinspcolorationthinspetthinspdethinsplathinsptempeacuteraturethinspdethinsplathinsppeauthinsprsaquo eacutevaluationthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsprsaquo niveauthinspdrsquoO

2thinspdethinspCO

2thinspetthinspmonitoragethinspcardiaquethinspselonthinsplethinspcas

3thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp4thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

Nombrethinspdethinspprofessionnelsthinsphabiliteacutesthinsprequis

2 Nombrethinspmimimalthinsprequis

3 Sithinsputilisationthinspdethinsppropofolthinspkeacutetaminethinspouthinspdethinspdexmeacutedeacutetomidine

3 SithinsputilisationthinspconcomitantethinspdethinspN2Othinspetthinspdrsquounthinspagentthinspseacutedatifthinspouthinspthinsp

dunthinspopioiumldethinspouthinspsithinspconcentrationthinspdethinspN2Othinspmodifiable

3 Sithinsplassistancethinsptechniquethinspauthinspmeacutedecinthinspestthinspcontinuelle

CMQ - OIIQ - OPIQ 27

Tableau 3 Surveillance des paramegravetres cliniques en seacutedation-analgeacutesie - Clientegravele adulte

Paramegravetrethinspdethinspthinspsurveillancethinspthinspclinique

PatientNiveauthinspdethinspthinspseacutedation

MeacutedicationInterventionthinspdiagnostiquethinspouthinsptheacuterapeutique

TAthinspRC5thinspthinspRR6thinspthinspetthinspsaturationthinspdrsquoO

thinsp2thinspthinsp

rsaquothinspObligatoireChezthinsptousthinsplesthinsppatients

Niveauthinspdethinspthinsp-thinspseacutedationthinspthinspthinspagitationthinspthinspthinspthinspconscience-thinspdouleur

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

NiveauthinspdethinspCO2

SelonthinsplesthinspthinspcaracteacuteristiquesthinspAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspthinspmeacutedication

Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire

rsaquothinspAccegravesthinspindirectthinspthinspthinspthinspthinspouthinsprestreintthinspthinspthinspthinspauthinsppatientthinspthinspthinspthinsp(pthinspexthinspthinspIRM)

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

rsaquothinspRecommandeacute

rsaquothinspASAthinspgethinsp3thinsprsaquothinspApneacuteethinspthinspobstructivethinspthinspthinspthinspduthinspsommeilthinsprsaquothinspMaladiethinspthinspthinspthinsprespiratoirethinsprsaquothinspObeacutesiteacutethinspmorbide

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

Monitoragethinspcardiaque

SelonthinsplesthinspcaracteacuteristiquesAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

SelonthinsplathinspmeacutedicationSelonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoirersaquothinspASAthinspgethinsp3thinsprsaquothinspMaladiethinspthinspthinspthinspcardiaque

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

Interventionthinspdiagnostiquethinspthinspouthinsptheacuterapeutiquethinspprolongeacuteethinsp(effetthinspcumulatifthinspdethinsplathinspmeacutedication)

rsaquothinspRecommandeacute

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

thinspthinspthinspthinspthinspIlthinspnethinspsrsquoagitthinsppasthinspdrsquounethinsplistethinsplimiteacuteethinspdesthinspsituationsthinspcliniquesthinspDrsquoautresthinspsituationsthinspcliniquesthinsppeuventthinspneacutecessiterthinsplethinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspmonitoragethinspcardiaquethinspouthinspduthinspCO

2thinspIlthinsprevientthinspauxthinspprofessionnelsthinspdethinspjugerthinspdethinsplathinspsituationthinspenthinspfonctionthinspdethinspchaquethinspthinspthinsp

thinspthinspthinspthinspthinspthinsppatient5thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp6thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

CMQ - OIIQ - OPIQ 28

LethinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspimpliqueacutesthinspestthinspprimordialthinspetthinspcethinspmecircmethinspsithinsplrsquoappareillagethinspenthinspplacethinspestthinspcompletthinspetthinspfonctionnelthinspUnethinspbonnethinspcommunica-tionthinspentrethinspcesthinspderniersthinspestthinspdoncthinspessentiellethinspafinthinspdethinspbienthinspcoordonnerthinsplathinspseacutedationthinsp

etthinsplrsquoanalgeacutesiethinspavecthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspLes alarmes (audibles et visuelles) de chaque appareil doivent ecirctre en fonction et les paramegravetres ajusteacutes aux caracteacuteristiques du patient et agrave sa condition clinique

IlthinspfautthinspsrsquoassurerthinspdethinsplathinsptraccedilabiliteacutethinspdethinsplrsquoeacutevaluationthinspetthinspdethinsplathinspsurveillancethinspcliniquethinspthinspeffectueacuteesthinspparthinspunethinsptenuethinspdethinspdossiersthinspconformethinspauxthinspnormesthinspenthinspvigueurthinspLesthinspoutilsthinspdrsquoeacutevaluationthinsputiliseacutesthinspdoiventthinspecirctrethinspsimplesthinspstandardiseacutesthinspvalideacutesthinspdethinsppreacutefeacuterencethinspetthinspadapteacutesthinspauthinspcontextethinspetthinspauxthinspcaracteacuteristiquesthinspduthinsppatientthinspnotam-mentthinsppourthinsplrsquoeacutevaluationthinspduthinspniveauthinspdethinspseacutedationagitationthinspdethinspconsciencethinspetthinspdethinspdouleurthinsp(annexesthinspIXthinspetthinspX)

Lathinspfreacutequencethinspdethinsplathinspmesurethinspdethinspcesthinspparamegravetresthinspetthinspleurthinspenregistrementthinspdoiventthinspecirctrethinspdeacutetermineacutesthinspentrethinspautresthinspenthinspfonctionthinspdethinsplathinspmeacutedicationthinspetthinspdethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsp

Ideacutealementthinsplethinspprofessionnelthinspdoitthinsplesthinspdocumenterthinsp

thinsprsaquo avantthinsplethinspdeacutebutthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsprsaquo apregravesthinsplrsquoadministrationthinspdrsquounthinspagentthinspdethinspseacutedation-analgeacutesiethinspouthinspdrsquounthinspantagonistethinsprsaquo authinsppicthinspdrsquoactionthinspdethinspchacunthinspdesthinspagentsthinspadministreacutesthinspthinsprsaquo agravethinspintervallesthinspreacuteguliersthinsp(pthinspexthinspthinsp5thinspminutes)thinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-thinsp

analgeacutesiethinsprsaquo agravethinspintervallesthinspplusthinsprapprocheacutesthinsplorsquethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsplrsquoexigethinsprsaquo durantthinsplathinsppeacuteriodethinspdethinspreacutecupeacuterationthinspetthinspjusqursquoauthinspretourthinspduthinspniveauthinspdethinspconsciencethinsp

initialethinspselonthinsplathinspconditionthinspcliniquethinspduthinsppatientthinsprsaquo authinspmomentthinspduthinspcongeacute

ILthinspFAUTthinspSAVOIRthinspQUE

LathinspSocieacuteteacutethinspcanadiennethinspdesthinspanestheacutesiologistesthinsp(SCA)thinspindiquethinspquethinsplesthinspthinspdirectivesthinspgeacuteneacuteralesthinspdethinspsoinsthinsp(ythinspcompristhinsplethinspmonitorage)thinsppourthinsplathinspseacutedationthinspconscientethinspsontthinsplesthinspmecircmesthinspquethinsppourthinsplesthinspautresthinspformesthinspdrsquoanestheacutesiethinsp[]thinsp(Merchantthinspetthinspcollabthinsp2014b)thinspDethinspplusthinspellethinspindiquethinspquethinsplethinspcapnographethinspthinspestthinsprequisthinsplorsthinspdethinspseacutedation-analgeacutesiethinspdethinspniveauthinspplusthinspeacuteleveacutethinsp(pthinspexthinspthinspRamsaythinspthinsp4-6)thinsp(Merchantthinspetthinspcollabthinsp2014athinspop cit)

CMQ - OIIQ - OPIQ 29

thinsp16thinspPOSTSEacuteDATION-ANALGEacuteSIEthinsp

Lethinsppatientthinspestthinspagravethinsprisquethinspdethinspdeacutevelopperthinspdesthinspcomplicationsthinspagravethinsplathinspsuitethinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspsurtoutthinspsithinspcettethinspproceacutedurethinspestthinspdethinspcourtethinspdureacuteethinsp(pthinspexthinspthinspdeacutepressionthinsprespiratoirethinsphypotension)thinspEnthinspeffetthinspcertainsthinspmeacutedicamentsthinsptelsthinspquethinsplethinspmidazolamthinspetthinsplethinspfentanylthinspnethinspserontthinsppasthinspcomplegravetementthinspeacutelimineacutesthinspsithinsplathinspdureacuteethinspdethinsplrsquointerventionthinspestthinspmoinsthinspdethinsp30thinspminutesthinspDrsquoautresthinspfacteursthinsptelsthinspquethinsplethinspmanquethinspthinspdethinspstimulationthinspouthinsplrsquoabsorptionthinspretardeacuteethinspdrsquounthinspmeacutedicamentthinsppeuventthinspcontribuerthinspthinspagravethinspunethinspseacutedationthinspprolongeacuteethinspouthinsprebond

Unethinspdeacutepressionthinsprespiratoirethinsppeutthinspsurvenirthinspjusqursquoagravethinspeacuteliminationthinspcomplegravetethinspthinspduthinspmeacutedicamentthinsp

ParthinspconseacutequentthinspjusqursquoagravethinspsonthinspdeacutepartthinsplethinsppatientthinspdoitthinspecirctrethinspsousthinsplathinspsurveillancethinspdrsquounthinspprofessionnelthinsphabiliteacutethinspagravethinspreconnaicirctrethinsplesthinspcomplicationsthinspetthinspagravethinspintervenirthinsprapidementthinspplusthinspparticuliegraverementthinsppourthinspmaintenirthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspetthinspassurerthinsplrsquoassistancethinspventilatoirethinspLethinspmeacutedecinthinspayantthinspproceacutedeacutethinspagravethinsplrsquointerventionthinspsousthinspseacutedation-analgeacutesiethinspouthinspunthinspmeacutedecinthinspdeacutesigneacutethinspdoitthinspecirctrethinspdisponiblethinspenthinsptoutthinsptempsthinspafinthinspdethinsppouvoirthinspintervenirthinspsansthinspdeacutelaithinsplethinspcasthinspeacutecheacuteant

Rappelonsthinspquethinsplesthinspappareilsthinspdethinspmonitoragethinspdoiventthinspecirctrethinspenthinspfonctionthinspmaisthinspthinspenthinspaucunthinsptempsthinspilsthinspnethinspremplacentthinsplathinspsurveillancethinspdirectethinspduthinsppatientthinspparthinspthinsplethinspprofessionnel

Lethinsppatientthinspdoitthinspresterthinspagravethinsplathinspsallethinspdethinspreacutecupeacuterationthinspouthinspdrsquoobservationthinsppendantthinspthinsp30thinspminutesthinspauthinspminimumthinspapregravesthinspavoirthinspreccediluthinsplathinspderniegraverethinspdosethinspdethinspseacutedationthinspouthinspthinspdrsquoanalgeacutesiethinspintraveineusethinsp(Merchantthinspetthinspcollabthinsp2014bthinspop cit)

Sithinspunethinspmeacutedicationthinspantagonistethinspathinspeacuteteacutethinspadministreacuteethinsplethinsppatientthinspserathinspgardeacutethinspsousthinspthinspobservationthinsplethinsptempsthinspneacutecessairethinsp(lethinsptempsthinspserathinspaugmenteacutethinspdethinspgethinsp2thinspheuresthinspthinsp[Merchantthinspetthinspcollabthinsp2014bthinspop cit]thinspenthinspfonctionthinspdethinsplrsquoeacutetatthinspcliniquethinspduthinsppatient)thinsppourthinspsrsquoassurerthinspqursquoilthinspnrsquoythinspathinsppasthinspdethinspseacutedationthinsprebond

Parmithinsplesthinspcritegraveresthinspagravethinsprespecterthinspauthinspmomentthinspduthinspcongeacutethinsp

thinsprsaquo voiesthinspaeacuteriennesthinsppermeacuteablesthinspetthinspventilationthinspadeacutequatethinsprsaquo stabiliteacutethinspcardiovasculairethinspadeacutequatethinsprsaquo niveauthinspdethinspconsciencethinspduthinsppatientthinsprevenuthinspagravethinspsonthinspeacutetatthinspinitialthinsprsaquo douleurthinspreacutesiduellethinsptoleacuterablethinspabsentethinspouthinspcommethinspagravethinspsonthinspeacutetatthinspinitial

CMQ - OIIQ - OPIQ 30

thinsprsaquo mobiliteacutethinsprevenuethinspagravethinspsonthinspeacutetatthinspinitialthinsprsaquo peuthinspouthinsppasthinspdethinspvomissementsthinsprsaquo patientthinspouthinsppersonnethinspresponsablethinspduthinsppatientthinsppeutthinspcomprendrethinsplesthinspdirectivesthinsp

dethinspdeacutepart

thinsprsaquothinsprsaquo Cesthinspcritegraveresthinspdoiventthinspecirctrethinsprespecteacutesthinspdethinspfaccedilonthinspsysteacutematiquethinsp

Lesthinspprofessionnelsthinspdoiventthinspsrsquoassurerthinspquethinspquandthinsplethinsppatientthinspquittethinsplrsquoeacutetablis-sementthinspilthinspestthinspaccompagneacutethinspdrsquounthinspadultethinspresponsablethinspetthinspqursquounthinspdocumentthinsprelatifthinspauthinspcongeacutethinspcomprenantthinspdesthinspconsignesthinspclairesthinsppourthinsplathinspsurveillancethinspagravethinspdomicilethinsp(pthinspexthinspthinspquoithinspfairethinspenthinspcasthinspdrsquourgence)thinspleurthinspsoitthinspremisthinspetthinspexpliqueacutethinsp(annexethinspXII)thinsp

thinspthinsp17thinspDOCUMENTATIONthinspDESthinspSOINSthinspETthinspTENUEthinspthinspDEthinspDOSSIERSthinsp

Commethinsppourthinsptoutethinspautrethinspinterventionthinsplesthinspmecircmesthinspnormesthinspsrsquoappliquentthinsppourthinsplathinspreacutedactionthinspdesthinspnotesthinspenthinspseacutedation-analgeacutesiethinspthinsp

Enthinspplusthinspdesthinspeacuteleacutementsthinspgeacuteneacuteralementthinspverseacutesthinspauthinspdossierthinspcelui-cithinspdoitthinspcontenirthinsptoutesthinsplesthinspinformationsthinsprelativesthinspagravethinsplathinsppeacuteriodethinsppreacutethinspperthinspetthinsppostseacutedation-analgeacutesiethinspAinsithinsplesthinspeacuteleacutementsthinspsuivantsthinspdoiventthinspecirctrethinspdocumenteacutesthinspauthinspdossierthinspduthinsppatientthinsp

(listethinspnonthinsplimitative)thinsp

1 lrsquoidentificationthinspdesthinspfacteursthinspdethinsprisquethinsplieacutesthinspagravethinsplrsquointerventionthinspdiagnostiquethinspthinspouthinsptheacuterapeutiquethinspouthinspagravethinsplathinspseacutedation-analgeacutesie

2 lrsquoheurethinspduthinspdeacutebutthinspetthinspdethinsplathinspfinthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplrsquoheurethinspdrsquoarriveacuteethinspagravethinsplathinspsallethinspdethinspreacutecupeacuterationthinspouthinspdrsquoobservationthinsp(sithinspdiffeacuterente)thinspetthinsplrsquoheurethinspduthinspdeacutepart

3 lesthinspordonnancesthinspmeacutedicalesthinspcomplegravetes4 lathinspmeacutedicationthinspthinspdosagethinspquantiteacutethinspvoiethinspvitessethinspetthinspheurethinspdrsquoadministration5 lathinspconcentrationthinspouthinsplethinspdeacutebitthinspdethinsplrsquooxygegravenethinsp(outhinspduthinspmeacutelangethinspgazeux)thinspadministreacutethinspthinsp

lethinspcasthinspeacutecheacuteant

6 lathinspsurveillancethinspeffectueacuteethinspa lesthinspsignesthinspvitauxthinspavecthinsplrsquoheurethinspdesthinsplecturesb lethinsptauxthinspdethinspsaturationthinspcapillairethinspenthinspoxygegravenethinspavecthinsplrsquoheurethinspdesthinsplecturesc lethinspniveauthinspdethinspCO

2thinspthinsplethinspcasthinspeacutecheacuteantthinspavecthinsplrsquoheurethinspdesthinsplectures

d lathinspdescriptionthinsppeacuteriodiquethinspduthinspniveauthinspdethinspseacutedationagitationthinspetthinspdethinspthinspconsciencethinsplrsquoutilisationthinspdrsquounethinspeacutechellethinspestthinsprecommandeacuteethinsp(annexethinspIX)

e lathinspdescriptionthinsppeacuteriodiquethinspduthinspniveauthinspdethinspdouleurthinsplrsquoutilisationthinspdrsquounethinspeacutechellethinspestthinsprecommandeacuteethinsp(annexethinspX)

CMQ - OIIQ - OPIQ 31

f lathinspdescriptionthinspdethinsptoutethinspreacuteactionthinspdeacutefavorablethinsplethinspcasthinspeacutecheacuteantg lathinspdescriptionthinspdethinsplrsquoeacutetatthinspduthinsppatientthinspagravethinsplathinspfinthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-thinsp

analgeacutesieh lathinspdescriptionthinspdethinsplrsquoeacutetatthinspduthinsppatientthinspauthinspmomentthinspduthinspcongeacutethinspouthinsplathinspreacutefeacuterencethinspthinsp

agravethinspunthinspprotocolethinsp(critegraveresthinspdethinspcongeacute)7 lethinspmonitoragethinspthinspappareilthinspalarmethinspemplacementthinsplethinspcasthinspeacutecheacuteant8 lethinspconsentement9 unethinspcopiethinspdesthinsprecommandationsthinspeacutecritesthinspremisethinspauthinsppatientthinspauthinspmomentthinspduthinsp

congeacutethinsp(annexethinspXII)thinspouthinspagravethinspdeacutefautthinspunethinspnotethinspattestantthinsplathinspremisethinspdethinspcethinspdocumentthinspstandardiseacutethinspdontthinspunethinspcopiethinspestthinspconserveacutee

10 thinsplethinspprotocolethinspopeacuteratoire11 thinsplathinspnotethinspdethinspdeacutepart12 thinsptoutethinspautrethinspinformationthinspjugeacuteethinsppertinentethinsp(pthinspexthinspthinspreacutesultatthinspdrsquoauscultationthinspthinsp

complication)

Enfinthinsptousthinsplesthinspprofessionnelsthinspimpliqueacutesthinspdoiventthinspsrsquoassurerthinspduthinsprespectthinspdethinspleurthinspreacuteglementationthinspouthinspnormesthinsprespectivesthinspenthinspmatiegraverethinspdethinspdocumentationthinspdesthinspsoinsthinspetthinspdethinsptenuethinspdethinspdossiers

CMQ - OIIQ - OPIQ 32

Chapitre 2Patient peacutediatrique

thinspPREacuteAMBULEthinsp

Puisquethinsplrsquoenfantthinsppossegravedethinspdesthinspcaracteacuteristiquesthinspquithinspluithinspsontthinsppropresthinspetthinspquithinspeacutevoluentthinspenthinspfonctionthinspdethinspsonthinspstadethinspdethinspdeacuteveloppementthinspilthinspestthinspdoncthinspopportunthinspdrsquoeacutetablirthinspdesthinsplignesthinspdirectricesthinspparticuliegraveresthinspagravethinspcettethinspclientegravelethinsp

Cesthinsplignesthinspdirectricesthinspvisentthinsplesthinspenfantsthinspacircgeacutesthinspdethinspplusthinspdethinsp3thinspansthinsp

Unethinspseacutedation-analgeacutesiethinspreacuteussiethinspameacuteliorethinsplathinspqualiteacutethinspdesthinspexamensthinspdemandeacutesthinspdiminuethinsplathinspneacutecessiteacutethinspdethinsprecourirthinspagravethinspdesthinspcontentionsthinspphysiquesthinspameacuteliorethinsplathinspcollaborationthinspetthinsplathinspconfiancethinspdethinsplrsquoenfantthinspetthinspdesthinspparentsthinspquantthinspauxthinspsoinsthinspprodigueacutesthinspetthinspauxthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspreacutealiseacuteesthinsp

Lathinspseacutedation-analgeacutesiethinsp(tousthinspniveaux)thinspenthinsppeacutediatriethinspdoitthinspecirctrethinspreacuteserveacuteethinspauthinspmilieuthinsphospitalierthinspouthinspauxthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacuteces-sairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspetthinspcethinspenthinspraisonthinspduthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquithinspestthinspgeacuteneacuteralementthinspneacutecessairethinspEllethinspcomportethinspdesthinsprisquesthinspseacuterieuxthinsppeuthinspimportethinsplrsquoeacutetatthinspdethinspsanteacutethinspdethinsplrsquoenfantthinspLesthinspcomplicationsthinsplesthinspplusthinspfreacutequentesthinspsontthinsplrsquoobstructionthinspdesthinspvoiesthinspaeacuteriennesthinsplrsquoapneacuteethinsplrsquoaspirationthinspdethinspseacutecreacutetionsthinspthinspetthinsplesthinspvomissements

thinsp21thinspOBJECTIFSthinspETthinspCLIENTEgraveLEthinspCIBLEthinsp

OBJECTIFS

Outrethinsplesthinspobjectifsthinspdethinspseacutedation-analgeacutesiethinspdeacutefinisthinsppourthinsplathinspclientegravelethinspadultethinsp(pthinsp8)thinspthinsp

lathinspseacutedation-analgeacutesiethinsppourthinsplathinspclientegravelethinsppeacutediatriquethinspvisethinspeacutegalementthinspagravethinspthinsp

thinsprsaquo eacuteviterthinspunthinsptraumatismethinsppsychologiquethinsprsaquo diminuerthinsplrsquoanxieacuteteacutethinspetthinsplathinsppeurthinspdethinsplrsquoenfantthinspetthinspdesthinspparentsthinsprsaquo obtenirthinsplathinspcollaborationthinspdethinsplrsquoenfant

CMQ - OIIQ - OPIQ 33

CLIENTEgraveLEthinspCIBLE

EnthinsppeacutediatriethinsplethinspniveauthinspdethinspseacutedationthinsprequisthinspestthinsptributairethinspdethinsplrsquoacircgethinspduthinspstadethinspdethinspdeacuteveloppementthinspdethinsplathinspcapaciteacutethinspcognitivethinspetthinspdethinsplathinspcollaborationthinspdethinsplrsquoenfantthinspAinsithinspchezthinsplrsquoenfantthinspdethinsp

thinsprsaquo 3thinspagravethinsp6thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspmodeacutereacutethinspsrsquoavegraverethinsprarementthinspsuffisantethinspLathinspplupartthinspdesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspneacutecessitentthinspunthinspniveauthinspprofondthinsp(voirethinspunethinspanestheacutesiethinspgeacuteneacuterale)thinsp

thinsprsaquo 7thinspagravethinsp13thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspmodeacutereacutethinspsrsquoavegraverethinspgeacuteneacuteralementthinspsuffisantethinspToutefoisthinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinsppeuventthinspneacutecessiterthinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspprofondthinsp

thinsprsaquo gethinsp14thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspleacutegerthinspouthinspmodeacutereacutethinspsrsquoavegraverethinspsuffisantethinspToutefoisthinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinsppeuventthinspneacutecessiterthinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspprofond

Chezthinsplrsquoenfantthinspdethinspmoinsthinspdethinsp3thinspansthinspouthinspdansthinsplethinspcasthinspdrsquounethinspseacutedationthinspprofondethinspviseacuteethinsplethinspmeacutedecinthinspdoitthinspsrsquoassurerthinspdethinsplathinspcollaborationthinspdrsquounthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespira-toirethinsppeacutediatriquethinspavanceacutee

Dethinspplusthinspilthinspestthinsprecommandeacutethinspdrsquoutiliserthinsplathinspclassificationthinspdethinsplrsquoeacutetatthinspphysiquethinspduthinspthinsppatientthinspquethinsplrsquoonthinsptrouvethinspdansthinsplethinsptableauthinspdethinsplathinsppagethinspsuivante

CMQ - OIIQ - OPIQ 34

Tableau 4 Classification de lrsquoeacutetat physique du patient selon lrsquoAmerican Society of Anesthesiologists (ASA) (ASA Physical Status Classification System [En ligne]) (Notre traduction)

Classification Eacutetatthinspdethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp1 Patientthinspenthinspbonnethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp2Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspleacutegegravere

ASAthinspPhysicalthinspStatusthinsp3Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgrave

ASAthinspPhysicalthinspStatusthinsp4Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgravethinspquithinsprepreacutesentethinspunethinspmenacethinspconstantethinsppourthinspsathinspvie

ASAthinspPhysicalthinspStatusthinsp5Patientthinspmoribondthinspquithinspnethinspsurvivrathinsppasthinspthinspagravethinspmoinsthinspdrsquounethinspinterventionthinsp

ASAthinspPhysicalthinspStatusthinsp6Patientthinspdeacuteclareacutethinspenthinspeacutetatthinspdethinspmortthinspceacutereacutebralethinspdontthinsplesthinsporganesthinspontthinspeacuteteacutethinsppreacuteleveacutesthinspagravethinspdesthinspfinsthinspdethinspdon

CMQ - OIIQ - OPIQ 35

Volet organisationnelthinsp22thinspCOMPEacuteTENCESthinspPROFESSIONNELLESthinsp

Outrethinsplesthinspcompeacutetencesthinspprofessionnellesthinspmentionneacuteesthinsppourthinsplethinsppatientthinspadultethinspthinsp(pthinsp11)thinsptousthinsplesthinspprofessionnelsthinspdethinsplathinspsanteacutethinsp(meacutedecinthinspinfirmiegraverethinspetthinspinhalotheacutera-peute)thinspquithinspprocegravedentthinspagravethinspunethinspseacutedation-analgeacutesiethinspaupregravesthinspdethinsppatientsthinsppeacutediatriquesthinspdoiventthinspposseacutederthinsp

athinsp lesthinspconnaissancesthinspetthinsplesthinspcompeacutetences73neacutecessairesthinspagravethinsplathinspreacuteanimationthinspthinspcardiorespiratoirethinsppeacutediatrique84(dethinsppreacutefeacuterencethinspenthinspsoinsthinspavanceacutes)thinspcrsquoest-agrave-direthinspmaicirctriserthinspenthinspprioriteacutethinsplesthinsptechniquesthinspdethinsplathinspprisethinspenthinspchargethinspdethinsplathinspventilationthinspduthinspmassagethinspcardiaquethinspetthinspdethinsplathinspmeacutedicationthinspassocieacutee

bthinspunethinspexpertisethinspcliniquethinspspeacutecifiquethinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspagravethinspreacutealiserthinspthinsp

thinspthinsp23thinspRESSOURCESthinspMATEacuteRIELLESthinsp

Sithinsplesthinspressourcesthinspmateacuteriellesthinspdethinspbasethinspetthinsplrsquoemplacementthinspsontthinspessentiellementthinsplesthinspmecircmesthinspquethinspchezthinsplrsquoadultethinsp(pthinsp11)thinspcelles-cithinspdoiventthinsptoutefoisthinspecirctrethinspadapteacuteesthinspauthinsp

patientthinsppeacutediatriquethinsp(crsquoest-agrave-direthinsptaillethinsppoidsthinspetthinspparticulariteacutes)thinsp

Agravethinsptitrethinspdrsquoexemplethinsp(listethinspnonthinsplimitative)thinsp

thinsprsaquo capteurthinspduthinspsaturomegravetrethinspdethinspmodegravelethinsppeacutediatriquethinsprsaquo reacuteanimateurthinspautogonflantthinsp(Ambuthinspbag)thinspetthinspmasquesthinspdethinspdiffeacuterentesthinsptaillesthinspthinsprsaquo lamesthinspdethinsplaryngoscopethinspsondesthinspendotracheacutealesthinsp(avecthinspouthinspsansthinspballonnet)thinspdethinsp

taillesthinspdiffeacuterentesthinsprsaquo canulesthinsporonasopharyngeacuteesthinspdethinspdiffeacuterentesthinsptaillesthinsprsaquo tubulurethinspagravethinspsoluteacutethinspdethinsptypethinspmicrogouttesthinspavecthinspouthinspsansthinspburettethinsprsaquo outilsthinspsupraglottiquesthinsp(pthinspexthinspthinspmasquethinsplaryngeacute)thinspdethinspdiffeacuterentesthinsptaillesthinsprsaquo deacutefibrillateurthinspavecthinspeacutelectrodesthinsppeacutediatriquesthinsprsaquo steacutethoscopethinspdethinsptaillethinsppeacutediatriquethinsp(preacutecordialthinspouthinsppreacutetracheacutealthinsppourthinspeacutecoutethinspenthinsp

continuethinspsrsquoilthinspythinspathinsplieu)thinsprsaquo appareilthinspagravethinspaspirationthinsppouvantthinspgeacuteneacutererthinspunethinsppressionthinspneacutegativethinspdethinsp40thinspagravethinsp60thinspmmthinsp

Hgthinspouthinspunethinspcapaciteacutethinspdethinspflotthinspdethinsp100thinsplitresthinspparthinspminutethinspetthinsplethinspmateacuterielthinspneacutecessairethinspdethinsptaillethinspadapteacutee

7thinsp Onthinspentendthinspparthinspconnaissancesthinspetthinspcompeacutetencesthinspqursquoellesthinspsoientthinspmisesthinspagravethinspjourthinspselonthinsplesthinsprecommandationsthinspenthinspvigueur

8thinsp Onthinspentendthinspparthinspcertificationthinspenthinspreacuteanimationthinspcardiorespiratoirethinsplesthinspformationsthinspsuivantesthinspthinsp rsaquothinspReacuteanimationthinspcardiorespiratoirethinspdethinspbasethinspthinspSoinsthinspimmeacutediatsthinspenthinspreacuteanimationthinsp(SIR)thinsppourthinspprofessionnelsthinspdethinsplathinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspsanteacutethinspouthinsplrsquoeacutequivalentthinsp rsaquothinspReacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspSoinsthinspavanceacutesthinspenthinspreacuteanimationthinsppeacutediatriquethinsp(SARP)thinspouthinsplrsquoeacutequivalent

CMQ - OIIQ - OPIQ 36

Volet professionnelthinsp24thinspPREacuteSEacuteDATION-ANALGEacuteSIEthinsp

SEacuteLECTIONthinspDESthinspPATIENTS

Sithinspunethinspseacutelectionthinsprigoureusethinspdesthinsppatientsthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinspattentionthinspquethinspchezthinsplrsquoadultethinsp(pthinsp15)thinspcertainesthinspparticulariteacutesthinsppropresthinspagravethinsplrsquoenfantthinspdoiventthinsp

toutefoisthinspecirctrethinspprisesthinspenthinspcomptethinsp

LorsthinspdethinspsituationsthinspparticuliegraveresthinspouthinspcomplexesthinspapregravesthinsplrsquoeacutevaluationthinspduthinsppatientthinsplethinspmeacutedecinthinspdevraitthinspconsulterthinspunthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspCitonsthinspagravethinsptitrethinspdrsquoexemplethinspmaisthinspsansthinspsrsquoythinsplimiterthinsp

thinsprsaquo preacutesencethinspdethinspcertainsthinspsyndromesthinspdontthinsplathinsptrisomiethinsp21thinsprsaquo anomaliethinspdesthinspvoiesthinspaeacuteriennesthinsprsaquo anomaliethinspcranio-facialethinsprsaquo infectionthinsprespiratoirethinspasthmethinsprsaquo maladiethinspneuromusculairethinsprsaquo maladiethinspcardiaquethinsprsaquo troublethinsprespiratoirethinspduthinspsommeilthinspetthinsplathinsptheacuterapiethinspassocieacuteethinsprsaquo obeacutesiteacutethinspimportantethinsprsaquo refluxthinspgastro-œsophagienthinsprsaquo eacutetatthinspdethinspconsciencethinspalteacutereacutethinsprsaquo troublethinspenvahissantthinspduthinspdeacuteveloppementthinsp(pthinspexthinspthinspautisme)

Dethinspmecircmethinsptoutthinspcommethinspchezthinsplrsquoadultethinsplesthinspinterventionsthinspeffectueacuteesthinspsousthinspseacutedation-analgeacutesiethinspdoiventthinspecirctrethinspreacuteserveacuteesthinspprincipalementthinspauxthinsppatientsthinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp1thinspouthinspauxthinsppatientsthinspatteintsthinspdrsquounethinspaffectionthinsp

systeacutemiquethinspleacutegegraverethinspclasseacuteethinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp2thinsp

Notonsthinspquethinsplorsquethinspcestthinspjustifieacutethinspauthinspdossierthinspmeacutedicalthinsplathinspseacutedation-analgeacutesiethinsppeutthinspecirctrethinspeffectueacuteethinspchezthinsplesthinsppatientsthinspstablesthinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp3thinspetthinspexceptionnellementthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp4thinspToutefoisthinspellethinspdoitthinsplrsquoecirctrethinspdansthinspdesthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspDethinspplusthinspcesthinsppatientsthinspdoiventthinsp

fairethinsplrsquoobjetthinspdrsquounethinspeacutevaluationthinspindividualiseacuteethinspetthinspplusthinspapprofondiethinspEacuteVALUATIONthinspDESthinspPATIENTSthinsp

CMQ - OIIQ - OPIQ 37

EacuteVALUATIONthinspDESthinspPATIENTS

Sithinspunethinspeacutevaluationthinsprigoureusethinspdesthinsppatientsthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinspatten-tionthinspquethinspchezthinspladultethinsp(pthinsp15)thinspcettethinspeacutevaluationthinspdoitthinspaussithinspinclurethinspsansthinspsrsquoythinsplimiterthinsplrsquoacircgethinsplathinsptaillethinsplethinsppoidsthinsplethinspstadethinspdethinspdeacuteveloppementthinsplathinspcapaciteacutethinspcognitivethinsplesthinspallergiesthinsplesthinspproblegravemesthinspmeacutedicauxthinspouthinspfamiliauxthinsppertinentsthinsplesthinspmeacutedicamentsthinsp(outhinspautrethinspsubstancethinspnonthinspprescrite)thinsppristhinspreacuteguliegraverementthinspouthinspreacutecemmentthinspetthinsplrsquoheurethinspduthinspdernierthinspingestathinspainsithinspquethinsplethinsptypethinspetthinsplathinspquantiteacutethinspconsommeacutee

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsplrsquoeacutevaluationthinsp(anamnegravesethinspetthinspexamenthinspphysique)thinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinspthinsp

CONSENTEMENTthinsp(REacuteSUMEacute)

LethinsplecteurthinspdoitthinspsethinspreacutefeacutererthinspagravethinsplrsquoannexethinspVIIIthinsppourthinsplethinsptextethinspcomplet

ToutthinspcommethinspchezthinsplrsquoadultethinspilthinspestthinspobligatoirethinspauthinspQueacutebecthinspdrsquoobtenirthinsplethinspconsente-mentthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspinterventionthinspCelathinspditthinsppourthinsplathinspclientegravelethinsppeacutediatriquethinspilthinspfautthinspajouterthinspunethinsppreacutecisionthinspextraitethinspduthinsp

Code civil du QueacutebecthinspthinspSithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsp(traitementsthinspdethinspmeacutedecinethinspetthinspdethinspchirurgiethinspestheacutetiquethinspexpeacuterimentationthinspetthinspdonsthinspdrsquoorganes)thinsplethinsppatientthinspdoitthinspecirctrethinspinformeacutethinspdethinsptousthinsplesthinsprisquesthinsppossiblesthinspmecircmethinspsrsquoilsthinspsontthinspraresthinspthinspetthinsplethinspconsentementthinspdoitthinspecirctrethinspdonneacutethinspparthinspeacutecrit

thinsprsaquo Unethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsp(gethinsp14thinspans)thinsppeutthinspconsentirthinspseulethinspthinspagravethinspmoinsthinspqursquoilthinspsrsquoagissethinspdethinspsoinsthinspnonthinsprequisthinspetthinspcomportantthinspdesthinsprisques

thinsprsaquo Pourthinspunethinsppersonnethinspmineurethinspdethinspmoinsthinspdethinsp14thinspansthinsp(ltthinsp14thinspans)thinsplethinspconsentementthinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentale

Srsquoilthinspsrsquoagitthinspdethinspsoins requisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsplrsquoobligationthinspdrsquoinformerthinsp

croicirctthinspenthinspfonctionthinspdethinsplathinsppreacutevalencethinspetthinspdethinsplathinspgraviteacutethinspdesthinspcomplications

thinsprsaquo Lethinspconsentementthinspdrsquounethinsppersonnethinspmineurethinsp(ltthinsp18thinspans)thinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinsp

thinsprsaquo Unethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsp(gethinsp14thinspans)thinsppeutthinspconsentirthinspmaisthinspnethinsppeutthinsppasthinsprefuserthinspseulethinspdesthinspsoinsthinspquithinspseraientthinspjugeacutesthinsprequisthinsp

DIRECTIVESthinspETthinspCONSEILSthinsp

Toutthinspcommethinsppourthinsplrsquoadultethinsp(pthinsp19)thinsplrsquoenfantthinspetthinspsonthinspparentthinsp(outhinspremplaccedilant)thinspdoiventthinsprecevoirthinsplesthinspdirectivesthinspneacutecessairesthinspCelathinspditthinspauxthinspdirectivesthinsprelativesthinspauthinspjeucircnethinsp

CMQ - OIIQ - OPIQ 38

preacute-interventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspnonthinspurgentethinsp(eacutelective)thinspilthinspfautthinspajouterthinspcecithinsp(Merchantthinspetthinspcollabthinsp2014a op cit)thinsp

thinsprsaquo liquidethinspclairthinsp(pthinspexthinspthinspeauthinspjusthinspdethinspfruitthinsp[sansthinsppulpe])thinspthinspjeucircnethinspdethinsp2thinspheuresthinsprsaquo laitthinspmaternelthinspthinspjeucircnethinspdethinsp4thinspheuresthinsprsaquo formulesthinsplacteacuteesthinspnonthinsphumaniseacuteesthinspouthinsppreacuteparationsthinspcommercialesthinsppourthinsp

nourrissonsthinspthinspjeucircnethinspdethinsp6thinspheuresthinspthinspAucunthinspajoutthinspnrsquoestthinsppermisthinspauthinsplaitthinspmaternelthinsptireacutethinsp

thinsp25thinspPERSEacuteDATION-ANALGEacuteSIEthinsp

APPROCHEthinspPHARMACOLOGIQUEthinsp

Sithinsplathinspmeacutedicationthinspgeacuteneacuteralementthinsputiliseacuteethinspestthinsplathinspmecircmethinspquethinspchezthinsplrsquoadultethinsp(pthinsp20)thinsplathinspdosethinspdoitthinspecirctrethinspadapteacuteethinspnotammentthinspenthinspfonctionthinspduthinsppoidsthinspetthinspdethinsplathinspcondi-tionthinspcliniquethinspdethinsplrsquoenfantthinspParthinspailleursthinspilthinspfautthinspretenirthinspquethinsplathinsppharmacocineacutetiquethinspetthinsplathinsppharmacodynamiquethinspdesthinspagentsthinspdethinspseacutedation-analgeacutesiethinspsontthinspinfluenceacuteesthinspparthinsplrsquoacircgethinspduthinsppatientthinspAgravethinsptitrethinspdrsquoexemplethinsppourthinspunthinspenfantthinspacircgeacutethinspdethinspunthinspagravethinspsixthinspansthinsplathinspclairancethinspdesthinspagentsthinspdethinspseacutedation-analgeacutesiethinspestthinspsupeacuterieurethinspagravethinspcellethinspdethinsplrsquoadultethinspIlthinspfaudrathinspdoncthinspajusterthinsplesthinspdosesthinspchezthinspunthinspenfantthinspdrsquoacircgethinsppreacutescolairethinsp(Saunderthinspetthinsp

collabthinsp2008)thinsp

Lrsquoutilisationthinspdrsquounethinsppommadethinspanalgeacutesiquethinsp(pthinspexthinspthinsplathinspcregravemethinspEMLAreg)thinsppeutthinspecirctrethinspavantageusethinsppourthinspcontrerthinsplathinspdouleurthinspassocieacuteethinspagravethinsplathinspposethinspdrsquounthinspcatheacuteterthinspintra-veineuxthinspparthinspexemplethinsp(lethinsptempsthinspdrsquoattentethinspdethinsp60thinspagravethinsp90thinspminutesthinspdoitthinspecirctrethinsppristhinspenthinspconsideacuteration)thinsp

APPROCHEthinspNONthinspPHARMACOLOGIQUE

Pourthinsplrsquoenfantthinspquithinspnethinspbeacuteneacuteficiethinspquethinspdrsquounethinspanalgeacutesiethinsp(aucunethinspseacutedation)thinspilthinspfautthinspretenirthinspquethinsplathinspdistractionthinsp(attirerthinsplrsquoattentionthinspversthinspquelquethinspchosethinspdethinsppositif)thinsppen-dantthinspunthinspsointhinspdouloureuxthinsp(outhinspquithinspinquiegravete)thinsppeutthinspsrsquoaveacutererthinspunthinspmoyenthinspefficacethinsppourthinspdiminuerthinspsonthinspanxieacuteteacutethinspetthinsplathinspperceptionthinspdethinspsathinspdouleurthinsp(AssociationthinspSparadrapthinspthinsp[Enthinspligne])

Agravethinsptitrethinspdrsquoexemplethinspetthinspsansthinspsrsquoythinsplimiterthinsp

thinsprsaquo discuterthinspavecthinsplrsquoenfantthinspouthinsplrsquoadolescentthinspdethinspsesthinsppreacutefeacuterencesthinsprsaquo utiliserthinspunthinspjouetthinspchanterthinspunethinspchansonthinspouthinspraconterthinspunethinsphistoirethinspagravethinsplrsquoenfantthinspthinsp

plusthinspjeunethinsprsaquo lathinsppreacutesencethinspetthinsplathinspcollaborationthinspdrsquounthinspparentthinsppeuventthinspecirctrethinsppertinentes

CMQ - OIIQ - OPIQ 39

SURVEILLANCEthinspCLINIQUE

Lathinspsurveillancethinspcliniquethinspcomprendthinspplusieursthinspeacuteleacutementsthinspquithinspconcernentthinspnotam-mentthinsplesthinspsystegravemesthinsprespiratoirethinspcardiaquethinspetthinspneurologiquethinspetthinspellethinspdoitthinsptenirthinspcomptethinspentrethinspautresthinsp

thinsprsaquo dethinsplathinspconditionthinspduthinsppatientthinspavantthinspetthinsppendantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

thinsprsaquo dethinsplathinspcomplexiteacutethinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinsprsaquo dethinsplathinspmeacutedicationthinsputiliseacuteethinsp(dosethinspdureacuteethinspetthinsppicthinspdrsquoactionthinspvoiethinspetthinspvitessethinsp

drsquoadministrationthinspcombinaisonthinspetthinspantagonistes)thinsprsaquo dethinsplrsquoassistancethinspagravethinspapporterthinspauthinspmeacutedecin

Lethinspmeacutedecinthinspquithinsppratiquethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspchezthinspunthinspenfantthinspsousthinspseacutedation-analgeacutesiethinspdoitthinspcompterthinspsurthinsplathinsppreacutesencethinspdrsquoauthinspmoinsthinspunthinspautrethinspprofessionnelthinsphabiliteacutethinspduthinspmilieuthinspdethinsplathinspsanteacutethinsp(infirmiegraverethinspinhalotheacuterapeutethinspouthinspautrethinspmeacutedecin)thinsp(annexethinspII)thinspEnthinspeacutetroitethinspcollaborationthinspavecthinsplethinspmeacutedecinthinspreacuteali-santthinsplrsquointerventionthinspceux-cithinspassurentthinsplathinspgestionthinspdethinsplathinspseacutedationthinspetthinspdethinsplrsquoanalgeacutesiethinsp

qui comprend entre autres la surveillance clinique de lrsquoenfantthinspresponsabiliteacutethinspthinspagravethinsplaquellethinspilsthinspdoiventthinspenthinsptoutthinsptempsthinspsethinspconsacrerthinspen prioriteacutethinsp

Dansthinspcertainsthinspcasthinsplethinspprofessionnelthinspquithinspassurethinspen prioriteacutethinsplathinspsurveillancethinspthinspcliniquethinspdethinsplrsquoenfantthinsppeutthinspecirctrethinspappeleacutethinspagravethinspassisterthinsplethinspmeacutedecinthinspdansthinsplathinspreacutealisationthinspthinspdethinspsonthinspinterventionthinspCettethinspassistancethinspquithinspdoitthinspsrsquoeffectuerthinspdansthinsplathinspmecircmethinsppiegravecethinspdoitthinspecirctrethinspdethinsptregravesthinspcourtethinspdureacuteethinspDethinspplusthinspellethinspdoitthinsppouvoirthinspecirctrethinspinterrompuethinspagravethinsptoutthinspmomentthinsppourthinspintervenirthinspimmeacutediatementthinspaupregravesthinspdethinsplrsquoenfantthinspenthinspcasthinspdethinspcomplicationsthinspouthinspdethinspbesoin

Parthinspailleursthinsplorsquethinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspneacutecessitentthinspunethinspassistancethinsptechniquethinspcontinuellethinspauthinspmeacutedecinthinsplrsquoajoutthinspdrsquounthinsptroisiegravemethinspprofessionnelthinspdethinsplathinspsanteacutethinsphabiliteacutethinsp(meacutedecinthinspinfirmiegraverethinspouthinspinhalotheacutera-peute)thinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspdethinsplrsquoenfantthinspestthinsprequisthinsp

CMQ - OIIQ - OPIQ 40

Tableau 5 Tableau reacutecapitulatif du nombre de professionnels habiliteacutes requis en seacutedation-analgeacutesie - Clientegravele peacutediatrique

Toutthinspauthinsplongthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinspdoitthinspecirctrethinspcontinuethinspetthinsplathinspcommunicationthinspavecthinspcelui-cithinspmaintenuethinsp

Proceacutederthinspagravethinsplathinspsurveillancethinspcliniquethinspcrsquoestthinspeacutevaluerthinspqualitativementthinspetthinspquanti-tativementthinspdethinspfaccedilonthinspsoutenuethinspetthinspenthinspcontinuthinsplrsquoensemblethinspdesthinspparamegravetresthinspsui-vantsthinsp(listethinspnonthinsplimitative)thinsp(tableauthinsp6)thinsp

thinsprsaquo mesurethinspdethinsplathinsppressionthinsparteacuteriellethinspduthinsppouls95etthinspdethinsplathinsprespiration106

thinsprsaquo lecturethinspdethinsplathinspsaturationthinspcapillairethinspenthinspoxygegraveneLathinsptonaliteacutethinspdethinsppoulsthinspdoitthinspecirctrethinspactiveacuteethinspenthinsptoutthinsptempsthinspetthinspsonthinspniveauthinspdoitthinspecirctrethinspajusteacutethinspdethinspfaccedilonthinspagravethinspecirctrethinspentenduthinspclairement

thinsprsaquo eacutevaluationthinspdethinsplrsquoeacutetatthinspdethinsplathinspcolorationthinspetthinspdethinsplathinsptempeacuteraturethinspdethinsplathinsppeauthinsprsaquo niveauthinspdrsquoO

2thinspdethinspCO

2thinspetthinspmonitoragethinspcardiaquethinspselonthinsplethinspcasthinsp

Enthinspplusthinspdesthinspparamegravetresthinspdethinspmonitoragethinspcliniquethinsp(mentionneacutesthinsppreacuteceacutedemment)thinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsppeacutediatriquethinspdoitthinspcomprendrethinspthinsp

thinsprsaquo lrsquoeacutevaluationthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsp(pthinspexthinspthinspbradycardiethinsphypoxiquethinsppreacutecocethinspsithinspobstruction)

thinsprsaquo lrsquoapportthinspliquidienthinsprsaquo lathinsppertethinspdethinspchaleurthinsp(selonthinsplathinspdureacuteethinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesie)

9thinspthinspthinspthinspthinspLethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp10thinspthinspthinspthinspLathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinspetthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

Nombrethinspdethinspprofessionnelsthinsphabiliteacutesthinsprequis

2 Nombrethinspmimimalthinsprequis

3 Sithinsputilisationthinspdethinsppropofolthinspkeacutetaminethinspouthinspdethinspdexmeacutedeacutetomidine

3 SithinsputilisationthinspconcomitantethinspdethinspN2Othinspetthinspdrsquounthinspagentthinspseacutedatifthinspouthinspthinsp

dunthinspopioiumldethinspouthinspsithinspconcentrationthinspdethinspN2Othinspmodifiable

3 Sithinsplassistancethinsptechniquethinspauthinspmeacutedecinthinspestthinspcontinuelle

CMQ - OIIQ - OPIQ 41

thinsprsaquo lrsquoeacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplrsquoanalgeacutesiethinspetthinspdethinsplathinspseacutedationthinspagravethinsplrsquoaidethinspdrsquooutilsthinspadapteacutesthinspagravethinsplathinspconditionthinspetthinspagravethinsplrsquoacircgethinspdethinsplrsquoenfantthinsp(annexesthinspIXthinspetthinspX)

thinsprsaquo lathinsppositionthinspduthinsppatientthinspetthinsplesthinsppointsthinspdrsquoappuithinsp(compression)

Tableau 6 Surveillance des paramegravetres cliniques en seacutedation-analgeacutesie - Clientegravele peacutediatrique

Paramegravetrethinspdethinspthinspsurveillancethinspclinique

PatientNiveauthinspdethinspthinspseacutedation

MeacutedicationInterventionthinspdiagnostiquethinspouthinsptheacuterapeutique

TAthinspRC11thinspthinspRR12thinspthinspetthinspsaturationthinspdrsquoO

2thinspthinsp

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

Niveauthinspdethinspthinsp-thinspseacutedationagitationthinspthinspthinspthinspconscience-thinspdouleur

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

NiveauthinspdethinspCO2

SelonthinsplesthinspcaracteacuteristiquesthinspAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)thinsp

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspmeacutedication Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire rsaquothinspAccegravesthinspindirectthinspouthinspthinspthinspthinspthinsprestreintthinspauthinsppatientthinspthinspthinsp(pthinspexthinspthinspIRM)

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetaminethinsp

rsaquothinspRecommandeacute rsaquothinspASAthinspgethinsp3thinsprsaquothinspApneacuteethinspobstructivethinspthinspthinspduthinspsommeilthinsprsaquothinspMaladiethinspthinspthinsprespiratoirethinsprsaquothinspObeacutesiteacutethinspmorbide

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

Monitoragethinspcardiaque

SelonthinsplesthinspcaracteacuteristiquesAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspmeacutedication Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire rsaquothinspASAthinspgethinsp3thinsprsaquothinspMaladiethinspcardiaque

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

Interventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspprolongeacuteethinsp(effetthinspcumulatifthinspdethinsplathinspmeacutedication)

rsaquothinspRecommandeacute Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

thinspthinsp IlthinspnethinspsrsquoagitthinsppasthinspdrsquounethinsplistethinsplimiteacuteethinspdesthinspsituationsthinspcliniquesthinspDrsquoautresthinspsituationsthinspcliniquesthinsppeuventthinspneacutecessiterthinspthinsplethinspmonitoragethinspcardiaquethinspouthinspduthinspCO

2thinspIlthinsprevientthinspauxthinspprofessionnelsthinspdethinspjugerthinspdethinsplathinspsituationthinspenthinspfonctionthinspdethinspthinsp

chaquethinsppatient

11thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp12thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

CMQ - OIIQ - OPIQ 42

ILthinspFAUTthinspSAVOIRthinspQUE

LathinspSocieacuteteacutethinspcanadiennethinspdesthinspanestheacutesiologistesthinsp(SCA)thinspindiquethinspquethinsplesthinspthinspdirectivesthinspgeacuteneacuteralesthinspdethinspsoinsthinsp(ythinspcompristhinsplethinspmonitorage)thinsppourthinsplathinspseacutedationthinspthinspconscientethinspsontthinsplesthinspmecircmesthinspquethinsppourthinsplesthinspautresthinspformesthinspdrsquoanestheacutesiethinsp[]thinspthinsp(Merchantthinspetthinspcollabthinsp2014bthinspopthinspcit)thinspDethinspplusthinspellethinspindiquethinspquethinsplethinspthinspcapnographethinspestthinsprequisthinsplorsthinspdethinspseacutedation-analgeacutesiethinspdethinspniveauthinspplusthinspeacuteleveacutethinspthinsp(pthinspexthinspthinspRamsaythinsp4-6)thinsp(Merchantthinspetthinspcollabthinsp2014athinspop cit)

LethinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspimpliqueacutesthinspestthinspprimordialthinspetthinspcethinspmecircmethinspsithinsplrsquoappareillagethinspenthinspplacethinspestthinspcompletthinspetthinspfonctionnelthinspUnethinspbonnethinspcommunica-tionthinspentrethinspcesthinspderniersthinspestthinspdoncthinspessentiellethinspafinthinspdethinspbienthinspcoordonnerthinsplathinspseacutedationthinspetthinsplrsquoanalgeacutesiethinspavecthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspLes alarmes (audibles et visuelles) de chaque appareil doivent ecirctre en fonction et les paramegravetres ajusteacutes agrave lrsquoacircge et agrave la condition clinique de chaque enfant

IlthinspfautthinspsrsquoassurerthinspdethinsplathinsptraccedilabiliteacutethinspdethinsplrsquoeacutevaluationthinspetthinspdethinsplathinspsurveillancethinspcliniquethinspthinspeffectueacuteesthinspparthinspunethinsptenuethinspdethinspdossiersthinspconformethinspauxthinspnormesthinspenthinspvigueurthinspthinspLesthinspoutilsthinspdrsquoeacutevaluationthinsputiliseacutesthinspdoiventthinspecirctrethinspsimplesthinspstandardiseacutesthinspvalideacutesthinspdethinsppreacutefeacuterencethinspetthinspadapteacutesthinspauthinspcontextethinspetthinspauxthinspcaracteacuteristiquesthinspduthinsppatientthinspnotam-mentthinsppourthinsplrsquoeacutevaluationthinspduthinspniveauthinspdethinspseacutedationagitationthinspdethinspconsciencethinspetthinspdethinspdouleurthinsp(annexesthinspIXthinspetthinspX)

Lathinspfreacutequencethinspdethinsplathinspmesurethinspdethinspcesthinspparamegravetresthinspetthinspleurthinspenregistrementthinspdoiventthinspecirctrethinspdeacutetermineacutesthinspentrethinspautresthinspenthinspfonctionthinspdethinsplathinspmeacutedicationthinspetthinspdethinsplathinspconditionthinsp

cliniquethinspduthinsppatientthinsp

Ideacutealementthinsplethinspprofessionnelthinspdoitthinsplesthinspdocumenterthinsp

thinsprsaquo avantthinsplethinspdeacutebutthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsprsaquo apregravesthinsplrsquoadministrationthinspdrsquounthinspagentthinspdethinspseacutedation-analgeacutesiethinspouthinspdrsquounthinspantagonistethinsprsaquo authinsppicthinspdrsquoactionthinspdethinspchacunthinspdesthinspagentsthinspadministreacutesthinspthinsprsaquo agravethinspintervallesthinspreacuteguliersthinsp(pthinspexthinspthinsp5thinspminutes)thinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-

analgeacutesiethinsprsaquo agravethinspintervallesthinspplusthinsprapprocheacutesthinsplorsquethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsplrsquoexigethinsprsaquo durantthinsplathinsppeacuteriodethinspdethinspreacutecupeacuterationthinspetthinspjusqursquoauthinspretourthinspduthinspniveauthinspdethinspconsciencethinsp

initialthinspselonthinsplathinspconditionthinspcliniquethinspduthinsppatientthinsprsaquo authinspmomentthinspduthinspcongeacutethinsp

CMQ - OIIQ - OPIQ 43

thinsp26thinspPOSTSEacuteDATION-ANALGEacuteSIEthinsp

Commethinsppourthinsplethinsppatientthinspadultethinsp(pthinsp29)thinsplathinspsurveillancethinspcliniquethinspdoitthinspecirctrethinspcons-tantethinspetthinsprigoureusethinsptoutthinspauthinsplongthinspdethinsplathinsppeacuteriodethinsppostseacutedation-analgeacutesiethinspetthinspcethinspjusqursquoauthinspretourthinspdethinsplrsquoeacutetatthinspinitialthinspdethinsplrsquoenfantthinspenthinspfonctionthinspdethinspsonthinspstadethinspdethinspdeacutevelop-pement

Rappelonsthinspquethinsplesthinspappareilsthinspdethinspmonitoragethinspdoiventthinspecirctrethinspenthinspfonctionthinspthinspmaisthinspenthinspaucunthinsptempsthinspilsthinspnethinspremplacentthinsplathinspsurveillancethinspdirectethinspduthinsppatientthinspthinspparthinsplethinspprofessionnelthinsp

LathinsppeacuteriodethinspdrsquoobservationthinspenthinspeacutetablissementthinspdoitthinspecirctrethinspsuffisammentthinspprolongeacuteethinsppourthinsppreacutevenirthinsplesthinspproblegravemesthinsppendantthinspetthinspauthinspretourthinspagravethinsplathinspmaisonthinspComptethinsptenuthinspdethinspsonthinspacircgethinspetthinspdethinspsathinspconditionthinsplrsquoenfantthinspdoitthinspecirctrethinspcapablethinspdethinspsrsquoasseoirthinspdethinspboirethinspdethinspparlerthinspetthinspdethinspmarcherthinspavecthinspunethinspaidethinspminimalethinsp

Selonthinsplathinspdistancethinspagravethinspparcourirthinspauthinspretourthinspilthinsppeutthinspecirctrethinspjudicieuxthinspdethinspprolongerthinsplathinsppeacuteriodethinspdrsquoobservation

Unthinspdocumentthinsprelatifthinspauthinspcongeacutethinspcomprenantthinspdesthinspconsignesthinspclairesthinsppourthinsplathinspthinsp

surveillancethinspagravethinspdomicilethinspdoitthinspecirctrethinspremisthinspetthinspexpliqueacutethinspauxthinspparentsthinsp(annexethinspXII)

thinsp27thinspDOCUMENTATIONthinspDESthinspSOINSthinspETthinspTENUEthinspDEthinspDOSSIERSthinsp

Lathinsptenuethinspdethinspdossiersthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinsprigueurthinspetthinsplathinspmecircmethinsppreacutecisionthinspquethinspchezthinsplrsquoadultethinsp(pthinsp30)thinspCertainesthinspinformationsthinsppropresthinspagravethinsplrsquoenfantthinspdoiventthinspecirctrethinspajouteacuteesthinspnotammentthinsp

thinsprsaquo sithinsppreacutesencethinspdrsquounthinspparentthinsprsaquo lethinsppoidsthinspetthinsplrsquoacircgethinspdethinsplrsquoenfantthinsprsaquo lathinsptaillethinspouthinsplrsquoIMCthinspsrsquoilthinspythinspathinsplieu

CMQ - OIIQ - OPIQ 44

CONCLUSION

Lathinspseacutedation-analgeacutesiethinspvisethinspagravethinspalteacutererthinsplethinspniveauthinspdethinspconsciencethinspainsithinspqursquoagravethinspsoulagerthinsplrsquoanxieacuteteacutethinspetthinsplathinspdouleurthinspdrsquounthinsppatientthinspauthinspcoursthinspdrsquounethinspinterventionthinsptheacuterapeutiquethinspouthinspdiagnostiquethinspCettethinspproceacutedurethinspbienthinspquethinspfreacutequemmentthinsputiliseacuteethinspcomportethinspcependantthinspcertainsthinsprisques

On doit y recourir de faccedilon seacutecuritaire pour le patient et en tout temps preacutevenir et reconnaicirctre les complica-tions lieacutees agrave la seacutedation-analgeacutesie afin drsquoeffectuer rapidement et efficace-ment les manœuvres neacutecessaires

LethinsprespectthinspdesthinsplignesthinspdirectricesthinspeacutenonceacuteesthinspdansthinspcethinspdocumentthinspaiderathinsplesthinspprofessionnelsthinspagravethinspmenerthinspadeacutequatementthinspcettethinspproceacutedurethinspCeux-cithinspdemeurentthinsptoutefoisthinspresponsablesthinspdethinsplathinspmisethinspagravethinspjourthinspdethinspleursthinspconnaissancesthinspetthinspduthinspdeacuteveloppementthinspdethinspleursthinspcompeacutetencesthinsprespectivesthinsp

Parthinspailleursthinsplesthinspeacutetablissementsthinspdethinspsanteacutethinspetthinsplesthinspcliniquesthinspouthinspcabinetsthinsppriveacutesthinspdevraientthinspsrsquoinspirerthinspdethinspcesthinsplignesthinspdirectricesthinsppourthinspeacutelaborerthinspthinspdesthinspproceacuteduresthinsprelativesthinspagravethinsplathinspthinspseacutedation-analgeacutesiethinspetthinspenthinspassurerthinsplrsquoeacutevaluationthinsppeacuteriodiquethinspdethinsplathinspqualiteacutethinsp

CMQ - OIIQ - OPIQ 45

mdash Annexe

thinspANNEXEthinspIthinspndashthinspDEacuteFINITIONthinspDEthinspLrsquoANESTHEacuteSIEthinspGEacuteNEacuteRALEthinspETthinspthinsp

DESthinspNIVEAUXthinspDEthinspSEacuteDATION-ANALGEacuteSIEthinspSELONthinspLrsquoAMERICANthinspSOCIETYthinspOFthinsp

ANESTHESIOLOGISTSthinsp(ASA)thinsp(AMERICANthinspSOCIETYthinspOFthinspANESTHESIOLOGISTSthinsp

ASAthinspHOUSEthinspOFthinspDELEGATEthinsp2014AthinspOP CIT)thinsp(NOTREthinspTRADUCTION)

Seacutedationthinspminimalethinspthinspanxiolyse

Seacutedation-thinspthinspanalgeacutesiethinspthinspmodeacutereacutee(consciente)

Seacutedation-thinspanalgeacutesiethinspthinspprofonde

Anestheacutesiethinspthinspgeacuteneacuterale

Reacuteponse Reacuteponsethinspnormalethinspagravethinsplathinspstimulationthinspverbale

Reacuteponsethinspvolontairethinspagravethinsplathinspstimulationthinspverbalethinspouthinsptactile

Reacuteponsethinspvolontairethinspsuivantthinspunethinspstimulationthinspreacutepeacuteteacuteethinspouthinspdouloureuse

Nonthinspeacuteveillablethinspmecircmethinspavecthinspstimulusthinspdouloureux

Voiesthinspthinspaeacuteriennes

Nonthinspaffecteacutees Pasthinspdrsquointerventionthinsprequise

Interventionthinsppeutthinspecirctrethinsprequise

Interventionthinspthinspsouventthinsprequise

Ventilationspontaneacutee

Nonthinspaffecteacuteethinsp Adeacutequate Peutthinspecirctrethinspinadeacutequate

Freacutequemmentthinspinadeacutequate

Fonctionthinspcardio-thinspvasculaire

Nonthinspaffecteacutee Geacuteneacuteralementthinspthinspmaintenue

Geacuteneacuteralementthinspthinspmaintenue

Peutthinspecirctrethinspthinspcompromise

thinspthinspLethinspreacuteflexethinspdethinspretraitthinspagravethinsplathinspsuitethinspdrsquounethinspstimulationthinspdouloureusethinspnrsquoestthinsppasthinspconsideacutereacutethinspcommethinspunethinspreacuteponsethinspvolontaire

Rappelonsthinspquethinsplathinspseacutedation-analgeacutesiethinspprofondethinspchezthinsplrsquoadultethinspetthinsplrsquoanestheacutesiethinspgeacuteneacuteralethinsp(adultethinspetthinsppeacutediatrique)thinspthinspnethinspfontthinsppasthinsplrsquoobjetthinspdethinspcettethinsppublication

CMQ - OIIQ - OPIQ 46

mdash Annexe

thinspANNEXEthinspIIthinspndashthinspINFORMATIONthinspCOMPLEacuteMENTAIREthinsp-thinspLECTURESthinspDrsquoINTEacuteREcircT

COLLEgraveGEthinspDESthinspMEacuteDECINSthinspDUthinspQUEacuteBECthinsp(CMQ)

thinsprsaquo Proceacutedures et interventions en milieu extrahospitalier (2011)thinsprsaquo Code de deacuteontologie des meacutedecinsthinsp(2015)

ORDREthinspDESthinspINFIRMIEgraveRESthinspETthinspINFIRMIERSthinspDUthinspQUEacuteBECthinsp(OIIQ)thinsp

thinsprsaquo EacutediteurthinspofficielthinspduthinspQueacutebec Code de deacuteontologie des infirmiegraveres et infirmiers (2014)

thinsprsaquo Le champ drsquoexercice et les activiteacutes reacuteserveacutees des infirmiegraveresthinsp(2013)thinsp2ethinspeacutedthinspthinsprsaquo Mosaiumlque des compeacutetences cliniques de lrsquoinfirmiegravere Compeacutetences initiales

(2009)thinsp2ethinspeacutedthinspthinsprsaquo Les obligations deacuteontologiques de lrsquoinfirmiegravere et le consentement aux soins

(2005)

ORDREthinspPROFESSIONNELthinspDESthinspINHALOTHEacuteRAPEUTESthinspDUthinspQUEacuteBECthinsp(OPIQ)

thinsprsaquo Profil national des compeacutetencesthinspLrsquoalliancethinspdesthinsporganismesthinspdethinspregraveglementationthinspenthinsptheacuterapiethinsprespiratoirethinsp(2011)

thinsprsaquo Les notes au dossier dans le secteur de lrsquoassistance anestheacutesique et de la seacutedation analgeacutesiethinsp-thinspGuidethinspdethinsppratiquethinsp(2008)

thinsprsaquo Compeacutetences relatives agrave lrsquoentreacutee dans la pratique (2003)thinsprsaquo Regraveglement sur les dossiers les autres effets les cabinets et la cessation

drsquoexercice des membres de lrsquoOrdre professionnel des inhalotheacuterapeutes du Queacutebecthinsp(2002)thinsp

thinsprsaquo Code de deacuteontologie des inhalotheacuterapeutes du Queacutebec

CMQ - OIIQ - OPIQ 47

thinspANNEXEthinspIIIthinspndashthinspPROCEacuteDURESthinspPROTOCOLESthinspOUthinspALGORITHMESthinsp

Dansthinsptousthinsplesthinsplieuxthinspougravethinspsethinsppratiquethinsplathinspseacutedation-analgeacutesiethinspagravethinspdesthinspfinsthinspdiagnos-tiquesthinspouthinsptheacuterapeutiquesthinsplethinspmeacutedecinthinspresponsablethinspdoitthinspeacutelaborerthinspenthinspcollabora-tionthinspavecthinsplesthinspmembresthinspdethinspsonthinspeacutequipethinspsoignantethinsplesthinspproceacuteduresthinspprotocolesthinspouthinsp

algorithmesthinspconcernantthinspnotammentthinsplesthinspsujetsthinspsuivantsthinsp

PARMIthinspLESthinspPROCEacuteDURESthinspOUthinspPROTOCOLESthinsp(ADULTEthinspETthinspPEacuteDIATRIQUE)thinsp

thinsprsaquo allergiethinspauthinsplatexchocthinspanaphylactiquethinsprsaquo antagonistethinsprsaquo bradycardiethinsprsaquo critegraveresthinspcliniquesthinspdethinspcongeacutethinsprsaquo hypertensionthinspmalignethinsprsaquo seacutedation-analgeacutesiethinsprsaquo transfertthinspdrsquourgence

PARMIthinspLESthinspALGORITHMESthinsp(ADULTEthinspETthinspPEacuteDIATRIQUE)thinsp

thinsprsaquo gestionthinspdesthinspvoiesthinspaeacuteriennesthinspdifficilesthinsp(ventilationintubation)thinsprsaquo reacuteanimationthinspcardiorespiratoirethinsp

thinspthinspthinspILthinspFAUTthinspPENSERthinspAgravethinsp

thinsprsaquo Lrsquoaffichagethinspdesthinspproceacuteduresthinspprotocolesthinspouthinspalgorithmesthinspdrsquourgencethinspquithinsppermettrathinspdrsquoythinspavoirthinspaccegravesthinsprapidementthinspenthinspcasthinspdrsquourgencethinspetthinspdethinsplesthinspconsulterthinspreacuteguliegraverementthinspparthinsplathinspmecircmethinspoccasionthinsp

thinsprsaquo Lrsquoeacutelaborationthinspdrsquounthinspprogrammethinsppeacuteriodiquethinspdrsquoexercicethinsp(pthinspexthinspthinspsimulation)thinspquithinsppermettrathinspdethinsprevoirthinsplesthinspdiffeacuterentesthinspproceacuteduresthinspenthinspplacethinspavecthinsptousthinsplesthinspmembresthinspdethinsplrsquoeacutequipethinspsoignantethinspetthinspdrsquoinitierthinsplethinspnouveauthinsppersonnelthinspassurantthinspainsithinspunethinspmeilleurethinsprelegravevethinspDethinspmecircmethinspmettrethinsplethinspplanthinspenthinsppratiquethinsppermetthinspdrsquooptimiserthinsplathinsprapiditeacutethinspetthinsplathinsppreacutecisionthinspdesthinspgestesthinspposeacuteesthinspetthinspdrsquoidentifierthinspdesthinspproblegravemesthinsppotentielsthinsp(avecthinspdethinsplrsquoeacutequipementthinspparthinspexemple)thinspetthinspcethinspavantthinspqursquoilthinspythinspaitthinspurgencethinspdrsquoagirthinsp

mdash Annexe

CMQ - OIIQ - OPIQ 48

thinspANNEXEthinspIVthinspndashthinspEacuteVALUATIONthinspDESthinspVOIESthinspAEacuteRIENNESthinspSUPEacuteRIEURESthinspAUthinsp

thinspMOYENthinspDUthinspSCOREthinspDEthinspMALLAMPATIthinsp(DIEMUNSCHthinspETthinspCOLLABthinsp2008)thinsp

(Agravethinsptitrethinspinformatifthinspseulement)

Objectifthinspthinspthinsp Eacutevaluerthinsplathinspvisibiliteacutethinspdesthinspstructuresthinsporopharyngeacuteesthinspetthinsplathinsptaillethinspthinsp

dethinsplathinsplangue

Lesthinsp4thinspclassesthinspdethinspMallampatithinspmodifieacuteesthinsp(SamsoonthinspandthinspYoung)thinspsontthinsp

thinsprsaquo ClassethinspIthinspthinspluettethinsppiliersthinspduthinspvoilethinspduthinsppalaisthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIIthinspthinsppiliersthinspduthinspvoilethinspduthinsppalaisthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIIIthinspthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIVthinspthinsppalaisthinspdurthinspseulthinsp

LesthinspclassesthinspIthinspetthinspIIthinsppreacutesagentthinspdrsquounethinspintubationthinspathinsppriorithinspfacilethinsplesthinspclassesthinspIIIthinspetthinspIVthinspdrsquounethinspintubationthinspdifficile

ClassesthinspdethinspMallampatithinspmodifieacuteesthinsp(Jmarchnthinsp[Enthinspligne])

LrsquoinsuffisancethinspdethinsplathinspclassificationthinspdethinspMallampatithinspathinspeacuteteacutethinspspeacutecifiquementthinspmon-treacuteethinspchezthinsplrsquoobegravesethinspEllethinspnethinsppeutthinspecirctrethinspconsideacutereacuteethinspcommethinspunthinsppreacutedicteurthinspisoleacute-mentthinspsuffisantthinspdethinsplathinspdifficulteacutethinspdethinsplathinsplaryngoscopiethinspouthinspathinspfortiorithinspdethinsplrsquointuba-tionthinspdifficilethinsp

mdash Annexe

CMQ - OIIQ - OPIQ 49

ANNEXEthinspVthinspndashthinspOUTILthinspDrsquoEacuteVALUATIONthinspDEthinspLrsquoAPNEacuteEthinspOBSTRUCTIVEthinspDUthinspSOMMEILthinsp

(AOS)thinspADAPTEacutethinspAgravethinspLAthinspCONSULTATIONthinspPREacuteANESTHESIQUESEacuteDATION-thinsp

ANALGEacuteSIEthinspthinsp(ADAPTEacutethinspDEthinspCHUNGthinspETthinspSEETthinsp2010)thinsp(NOTREthinspTRADUCTION)

(Agravethinsptitrethinspinformatifthinspseulement)

mdash Annexe

Exemplethinspdethinspquestionnairethinspstop-bang

Question Reacuteponse

Sthinspnore PreacutesencethinspdethinspronflementVosthinspronflementsthinspsont-ilsthinspbruyants(suffisammentthinsppourthinspecirctrethinspentendusthinspagravethinsptraversthinspunethinspportethinspfermeacutee)

OuithinspouthinspNon

Tthinspiredthinspfatiguethinsporthinspsleepy PreacutesencethinspdethinspsomnolencethinspouthinspfatigueVousthinspsentez-vousthinspsouventthinspfatigueacutethinspeacutepuiseacutethinspouthinspsomnolentthinsppendantthinsplathinspjourneacutee

OuithinspouthinspNon

Othinspbservedthinspapnea ApneacuteethinspobserveacuteethinspQuelqursquounthinspa-t-ilthinspdeacutejagravethinspobserveacutethinspquethinspvousthinspthinsparrecirctiezthinspdethinsprespirerthinspenthinspdormant

OuithinspouthinspNon

Pthinspressure PreacutesencethinspdrsquoHTAAvez-vousthinspouthinspecirctes-vousthinsptraiteacutepourthinspunethinsptensionthinsparteacuteriellethinspeacuteleveacutee

OuithinspouthinspNon

BthinspMI IMCthinspgtthinsp35thinspkgm2 OuithinspouthinspNon

Athinspge Acircgethinspgtthinsp50thinspans OuithinspouthinspNon

Nthinspeck Circonfeacuterencethinspduthinspcouthinspgtthinsp40thinspcm OuithinspouthinspNon

Gthinspender Sexethinspmasculin OuithinspouthinspNon

INTERPREacuteTATIONthinspCLINIQUE

ltthinsp3thinspreacuteponsesthinsppositivesthinsp=thinspfaiblethinsprisquethinspdrsquoAOS

ge 3 reacuteponses positives = risque eacuteleveacute drsquoAOS

CMQ - OIIQ - OPIQ 50

thinspANNEXEthinspVIthinspndashthinspANAMNEgraveSEthinspthinspAIDEthinspMNEacuteMOTECHNIQUEthinsp

(Agravethinsptitrethinspinformatifthinspseulement)

ObjectifthinspthinspthinspthinspCetthinspoutilthinspdrsquoaidethinspmneacutemotechniquethinspsertthinspagravethinspstructurerthinsplathinspfaccedilonthinspdontthinspthinsponthinspprocegravedethinspagravethinsplathinspcollectethinspsommairethinspdesthinspdonneacuteesthinspdansthinsplethinspcadrethinspdethinsplrsquoeacutevaluationthinspcliniquethinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinspfacilitethinsplathinspcompreacutehensionthinspetthinsplathinspreacutealisationthinspdethinsplrsquoanamnegravesethinspchezthinsplrsquoadultethinspetthinsplrsquoenfant

SAMPLEthinsp(AdapteacutethinspdethinspAltonthinspetthinspcollabthinsp2007thinsp[Notrethinsptraduction])thinsp(outhinspvariante)

SthinspthinspSignesthinspetthinspsymptocircmes

AthinspthinspAllergiesthinspetthinspreacuteactionthinsp

MthinspthinspMeacutedicamentsthinspetthinspautresthinspsubstancesthinsp(prescritsthinspouthinspnon)thinspetthinsptraitement

PthinspthinspPasseacutethinspmeacutedicalfamilialthinsp

LthinspthinspLastthinspmeallunchthinsp(dernierthinsprepas)

EthinspthinspEnvironnementeacuteveacutenement

thinsp

mdash Annexe

CMQ - OIIQ - OPIQ 51

thinspANNEXEthinspVIIthinsp-thinspEXAMENthinspPHYSIQUEthinspthinspAIDEthinspMNEacuteMOTECHNIQUE

(Agravethinsptitrethinspinformatifthinspseulement)

Objectifthinspthinspthinsp Lrsquoexamenthinspphysiquethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinspcherchethinspagravethinspmettrethinspenthinspeacutevidencethinspcertainsthinspcritegraveresthinspreconnusthinsppourthinspecirctrethinspassocieacutesthinspagravethinspunethinspassis-tancethinspventilatoirethinspdifficilethinspquithinsppeutthinspsurvenirthinspdansthinsplethinspcasthinspdrsquounthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquethinspceluithinspviseacutethinspparthinspexemple

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinspfacilitethinsplathinspcompreacutehensionthinspetthinsplathinspreacutealisationthinspdethinsplrsquoexamenthinspphysiquethinsprelativementthinspauxthinspvoiesthinspaeacuteriennesthinspdethinsplrsquoadulte

1thinspIndicateursthinspdrsquounethinsppossiblethinspventilationthinspdifficilethinsp(MOANSthinsp[AdapteacutethinspdethinspWallsthinspetthinspthinspthinspthinspthinspMurphythinsp2012]thinsp[Notrethinsptraduction]thinspouthinspvariante)

Mthinspthinspmask sealthinsp(eacutetancheacuteiteacutethinspduthinspmasque)thinspthinspeacutetancheacuteiteacutethinspcompromisethinspenthinspraisonthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspdrsquounethinspbarriegraverethinspmeacutecaniquethinsp(barbethinspfourniethinsptraumatismethinspfacialthinspetc)

OthinspthinspobeacutesiteacuteobstructionthinspthinsppatientthinspdontthinsplrsquoIMCthinspestthinspgtthinsp25thinsp(kgm2)thinspfemmethinspenceintethinspthinspthinspthinspthinspthinspthinspthinspgtthinsp6thinspmoisthinsp(2ethinsptrimestre)thinspangio-œdegravemethinspabcegravesthinspetc

Athinspthinspacircgethinspthinsppatientthinspgethinsp55thinspansthinsp(variablethinspselonthinsplesthinspauteurs)thinspenthinspraisonthinspnotammentthinspthinspthinspthinspthinspthinspthinspdethinsplathinsppertethinspdrsquoeacutelasticiteacutethinspdesthinsptissus

Nthinspthinspno teeththinsp(eacutedenteacute)thinspthinspdifficulteacutethinsplorsthinspdethinsplrsquoassistancethinspventilatoire

Sthinspthinspstiffthinsp(rigiditeacute)thinspthinsppathologiesthinspagravethinspconseacutequencesthinspsurthinsplathinspcompliancethinspetthinsplathinspthinspthinspthinspthinspthinspreacutesistancethinsppulmonairethinsp(asthmethinspMPOCthinsppneumoniethinspdethinspstadethinspavanceacutethinspetc)

thinspthinspVentilationthinspdifficilethinsp(masquethinspouthinspoutilthinspextraglottiquethinsptelthinspquethinspmasquethinspthinspthinspthinspthinspthinsplaryngeacute)thinsp(AdapteacutethinspdethinsplrsquoAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinsp[Notrethinspthinspthinspthinspthinspthinsptraduction])thinspImpossiblethinspdrsquoeffectuerthinspunethinspventilationthinspdethinspfaccedilonthinspadeacutequatethinspthinspthinspthinspthinspthinspenthinspraisonthinspdethinsplrsquounethinspetouthinspdethinsplrsquoautrethinspdesthinspsituationsthinspsuivantesthinsp

athinspMauvaisethinspeacutetancheacuteiteacutethinspduthinspmasquethinspouthinspdethinsplrsquooutilthinspextraglottiquebthinspFuitethinspdethinspgazthinspexcessivecthinspReacutesistancethinspexcessivethinspagravethinsplrsquoinspirationthinspouthinspagravethinsplrsquoexpiration

thinsp

mdash Annexe

CMQ - OIIQ - OPIQ 52

2thinspIndicateursthinspdrsquounethinsppossiblethinsplaryngoscopiethinspouthinspintubationthinspdifficilethinsp(thinspLEMONthinspthinspthinspthinspthinspthinsp[WallsthinspetthinspMurphythinsp2012thinspopthinspcit]thinsp[Notrethinsptraduction]thinspouthinspvariante)

Lthinspthinspthinsplook externallythinsp(apparencethinspphysique)thinspthinspmicrognathiethinspmacroglossiethinspdenti-tionthinspirreacuteguliegraverethinspcirconfeacuterencethinspduthinspcouthinspgethinspgrossessethinspetc

thinspEthinspthinspthinspeacutevaluationthinspthinspregraveglethinspduthinsp3-3-2thinsp(variantethinsppossiblethinspselonthinsplesthinspauteurs)thinsp-thinspthinsp

consideacuterationsthinspgeacuteomeacutetriquesthinsp(agravethinsplrsquoaidethinspdesthinspdoigtsthinspduthinsppatient)3thinspthinsp ouverturethinspdethinspbouchethinspthinspinsertionthinspdethinsp3thinspdethinspsesthinspdoigts3thinspthinsp taillethinspduthinsplarynxthinsp(longueurthinspmandibulaire)thinspthinsp3thinspdoigtsthinspsousthinsplethinspmentonthinsp

(boutthinspdethinspsonthinspmentonthinspjusqursquoagravethinsplathinspjonctionthinspduthinspcouthinspauthinspniveauthinspdethinspthinsplrsquoosthinsphyoiumlde)

2thinspthinsp positionthinspduthinsplarynxthinspthinsp2thinspdethinspsesthinspdoigtsthinspentrethinsplathinspjonctionthinspcou-mentonthinsp(osthinspthinsphyoiumlde)thinspetthinsplethinspcartilagethinspthyroiumlde

thinspMthinspthinspthinspMallampatithinsp(annexethinspIV)thinspOthinspthinspthinspobeacutesiteacuteobstructionthinspthinspIMCthinspthinspœdegravemethinspduthinsplarynxthinspneacuteoplasiethinspdethinsplathinspsphegraverethinsp

ORLthinspcompressionthinspextrinsegravequethinspparthinspheacutematomethinspcervicalthinspdifficulteacutethinspagravethinspavalerthinspdyspneacutee

thinspNthinspthinspthinspneck mobilitythinsp(mobiliteacutethinspcervicale)thinspthinspimmobilisationthinspauthinspmoyenthinspdrsquounthinspcol-

lierthinspcervicalthinsppreacutesencethinspdrsquounethinsppathologiethinspouthinspdrsquounethinspsituationthinspcliniquethinspagravethinspconseacutequencethinspsurthinsplrsquoassistancethinspventilatoirethinspouthinspdethinsplrsquointubationthinsp(pthinspexthinspthinspthinsparthrosethinspouthinsparthritethinspimportantethinsptrisomiethinsp21thinspetc)

thinspthinsp Lanryngoscopiethinspdifficilethinspthinspimpossibiliteacutethinspdethinspvisualiserthinspnrsquoimportethinspquellethinsppartiethinspdesthinspcordesthinspvocalesthinspapregravesthinspdethinspmultiplesthinsptentativesthinspavecthinspunthinsplaryngoscopethinspconventionnelthinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinspop citthinsp[Notrethinsptraduction])thinsp

thinspthinspIntubationthinspendotracheacutealethinspdifficilethinspthinspintubationthinspquithinsprequiertthinspdethinspmultiplesthinspthinsptentativesthinspenthinsppreacutesencethinspouthinspenthinsplrsquoabsencethinspdrsquounethinsppathologiethinsptracheacutealethinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinspop citthinspthinsp[Notrethinsptraduction])

IlthinspfautthinspnoterthinspquethinsplrsquoinsuffisancethinspdethinsplathinspclassificationthinspdethinspMallampatithinspathinspeacuteteacutethinspspeacutecifiquementthinspmontreacuteethinspchezthinsplrsquoobegravesethinspellethinspnethinsppeutthinspecirctrethinspconsideacutereacuteethinspcommethinspunthinsppreacutedicteurthinspisoleacutementthinspsuffisantthinspdethinsplathinspdifficulteacutethinspdethinsplathinsplaryngoscopiethinspouthinspathinspfortiorithinspdethinsplrsquointubationthinspdifficile

mdash Annexe

ge

ge

CMQ - OIIQ - OPIQ 53

thinspANNEXEthinspVIIIthinsp-thinspLEthinspCONSENTEMENT

SelonthinsplethinspdroitthinspenthinspvigueurthinspilthinspestthinspobligatoirethinspauthinspQueacutebecthinspdrsquoobtenirthinsplethinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspintervention

LethinspCode civil du Queacutebec eacutetablitthinspdesthinspregraveglesthinspgeacuteneacuteralesthinspconcernantthinsplethinspconsente-mentthinspauxthinspsoinsthinspquithinspsrsquoappliquentthinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspOnthinspythinspfaitthinspcependantthinspcertainesthinspdistinctionsthinspselonthinspquethinsplesthinspsoinsthinspsontthinsprequisthinspouthinspnonthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspetthinspselonthinspquethinsplethinsppatientthinspestthinspaptethinspagravethinspconsentirthinspouthinspnon

Sithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsp(traitementsthinspdethinspmeacutedecinethinspetthinspdethinspchirurgiethinspestheacutetiquethinspexpeacuterimentationthinspetthinspdonsthinspdrsquoorganes)thinsplethinsppatientthinspdoitthinspecirctrethinspinformeacutethinspdethinsptousthinsplesthinsprisquesthinsppossiblesthinspmecircmethinspsrsquoilsthinspsontthinspraresthinspetthinsplethinspconsentementthinspdoitthinspecirctrethinspdonneacutethinspparthinspeacutecritthinspHabituellementthinspilthinspnethinsppeutthinspecirctrethinspdonneacutethinspquethinspparthinspunthinsppatientthinspaptethinspetthinspacircgeacutethinspdethinsp14thinspansthinspetthinspplusthinspparthinsplethinspmandatairethinsplethinsptuteurthinspouthinsplethinspcurateurthinspdrsquounethinsppersonnethinspinaptethinspouthinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinspdrsquounethinsppersonnethinspdethinspmoinsthinspdethinsp14thinspansthinspLrsquoautorisationthinspdethinsplathinspcourthinspestthinspenthinspoutrethinspneacutecessairethinspsithinsplesthinspsoinsthinsppreacutesententthinspunthinsprisquethinspseacuterieuxthinsppourthinsplathinspsanteacutethinspdethinspcesthinsppersonnesthinspouthinspsrsquoilsthinsppeuventthinspcauserthinspdesthinspeffetsthinspgravesthinspetthinsppermanentsthinspUnethinsppersonnethinspmineurethinspdethinspthinsp14thinspansthinspetthinspplusthinsppeutthinspconsentirthinspseulethinspagravethinspmoinsthinspqursquoilthinspsrsquoagissethinspdethinspsoinsthinspnonthinsprequisthinspetthinspthinspcomportantthinspdesthinsprisques

SrsquoilthinspsrsquoagitthinspdethinspsoinsthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsplrsquoobligationthinspdrsquoinformerthinspcroicirctthinspenthinspfonctionthinspdethinsplathinsppreacutevalencethinspetthinspdethinsplathinspgraviteacutethinspdesthinspcomplicationsthinspSithinsplethinsppatientthinspestthinspinaptethinspetthinspqursquoilthinspnrsquoestthinsppasthinsprepreacutesenteacutethinspparthinspunthinspmandatairethinspunthinsptuteurthinspouthinspunthinspcura-teurthinsplethinspconsentementthinsppeutthinspecirctrethinspdonneacutethinspparthinspunthinspconjointthinspouthinspagravethinspdeacutefautthinspduthinspconjointthinspparthinspunthinspprochethinspouthinspunethinsppersonnethinspquithinspdeacutemontrethinspunthinspinteacuterecirctthinspparticulierthinsppourthinsplathinspper-sonnethinspinaptethinspIlthinspnrsquoythinspathinsppasthinspdrsquoobligationthinspagravethinspcethinspquethinspcethinspconsentementthinspsoitthinspdonneacutethinspparthinspeacutecritthinspLethinspconsentementthinspauxthinspsoinsthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspdrsquounethinsppersonnethinspmi-neurethinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinspouthinsplethinsptuteurthinspUnethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsppeutthinspconsentirthinspmaisthinspnethinsppeutthinsppasthinsprefuserthinspseulethinspdesthinspsoinsthinspquithinspseraientthinspjugeacutesthinsprequisthinspEnthinspcasthinspdrsquourgencethinsplethinspconsentementthinspauxthinspsoinsthinspmeacutedicauxthinspnrsquoestthinsppasthinspneacutecessairethinsplorsquethinsplathinsppersonnethinspouthinspsonthinspinteacutegriteacutethinspestthinspmenaceacuteethinspetthinspquethinsplethinspconsentementthinspnethinsppeutthinspecirctrethinspobtenuthinspagravethinsptemps

LathinspLoi sur les servicesthinspdethinspsanteacutethinspetthinsplesthinspservicesthinspsociauxthinsp(LSSS)thinspeacutetablitthinspquantthinspagravethinspellethinspcertainesthinspregraveglesthinspenthinspmatiegraverethinspdethinspconsentementthinspauxthinspinterventionsthinspchirurgicalesthinspetthinspagravethinsplrsquoanestheacutesiethinsp

mdash Annexe

CMQ - OIIQ - OPIQ 54

Selonthinspcettethinsploithinsplethinspconsentementthinspagravethinspunethinspanestheacutesiethinspouthinspagravethinspunethinspinterventionthinspchirurgi-calethinspdoitthinspecirctrethinspattesteacutethinspparthinspunthinspdocumentthinspeacutecritthinspsigneacutethinspparthinsplethinsppatientthinspouthinspsonthinsprepreacutesen-tantthinspetthinspcethinspdocumentthinspdoitthinspfairethinspeacutetatthinspdesthinspinformationsthinspapproprieacuteesthinspconcernantthinspnotammentthinsplesthinsprisquesthinspouthinsplesthinspeffetsthinsppossiblesthinspCetthinspeacutecritthinspdoitthinspecirctrethinspcontresigneacutethinspparthinsplethinspmeacutedecinthinspouthinsplethinspdentistethinsptraitantthinspetthinspconserveacutethinspdansthinsplethinspdossierthinspduthinsppatientthinspLethinspdossierthinspdoitthinspcontenirthinspunthinspdocumentthinspattestantthinsplethinspconsentementthinsppourthinsplesthinspsoinsthinspetthinsplesthinspservicesthinspdispenseacutesthinspdansthinspunthinspcentrethinsphospitalierthinsp(CH)thinspunthinspcentrethinspdrsquoheacutebergementthinspetthinspdethinspsoinsthinspdethinsplonguethinspdureacuteethinsp(CHSLD)thinspetthinspunthinspcentrethinsplocalthinspdethinspservicesthinspcommunau-tairesthinsp(CLSC)

CesthinspdispositionsthinspnethinspsrsquoappliquentthinspqursquoauxthinspsoinsthinspdispenseacutesthinspenthinspeacutetablissementthinspthinspMaintenantthinspquethinspplusieursthinspinterventionsthinspautrefoisthinspreacuteserveacuteesthinspauxthinspeacutetablissementsthinsppeuventthinspecirctrethinspeffectueacuteesthinspenthinspdehorsthinspdethinspceux-cithinsplathinspquestionthinspsethinspposethinsptoutefoisthinspdethinspsavoirthinspsithinsplesthinspmecircmesthinspexigencesthinspdevraientthinspsrsquoappliquerthinsppartoutthinsp

Qursquoenthinspest-ilthinspparthinspexemplethinspdethinsplathinspsignaturethinspdrsquounthinspformulairethinspdethinspconsentementthinspEnthinsppratiquethinspetthinspagravethinsplrsquousagethinspilthinspsrsquoestthinspaveacutereacutethinspqursquounthinspformulairethinspdethinspconsentementthinspducircmentthinspsigneacutethinspnethinsppeutthinspagravethinspluithinspseulthinspprouverthinspquethinsplethinspconsentementthinspathinspeacuteteacutethinsplibrethinspetthinspeacuteclaireacutethinspUnethinspcourtethinspnotethinspverseacuteethinspauthinspdossierthinspreacutesumantthinsplesthinspinformationsthinsptransmisesthinspetthinsplesthinspeacutechangesthinspauxquelsthinspellesthinspontthinspdonneacutethinsplieuthinspestthinsppreacutesentementthinspjugeacuteethinspbeaucoupthinspplusthinsppertinentethinspagravethinspcetthinspeacutegardthinspLethinspformulairethinspdethinspconsentementthinspcomplegravetethinsplesthinsprenseigne-mentsthinspfournisthinspverbalementthinspIlthinspsrsquoagitthinspdrsquounthinspajoutthinspagravethinsplrsquoinformationthinspverbalethinsptransmisethinspthinsp

etthinspnonthinspdrsquounethinspmesurethinspvisantthinspagravethinsplathinspremplacer

LethinspCode de deacuteontologiethinspdes meacutedecinsthinsppreacutecisethinsplesthinspobligationsthinspdesthinspmeacutedecinsthinsp

quantthinspauthinspconsentementthinsp

Article 28Le meacutedecin doit sauf urgence avant drsquoentreprendre un examen une investiga-tion un traitement ou une recherche obtenir du patient ou de son repreacutesentant leacutegal un consentement libre et eacuteclaireacute

Article 29Le meacutedecin doit srsquoassurer que le patient ou son repreacutesentant leacutegal a reccedilu les explications pertinentes agrave leur compreacutehension de la nature du but et des conseacutequences possibles de lrsquoexamen de lrsquoinvestigation du traitement ou de la recherche qursquoil srsquoapprecircte agrave effectuer Il doit faciliter la prise de deacutecision du patient et la respecter

mdash Annexe

CMQ - OIIQ - OPIQ 55

DansthinspsesthinspguidesthinspdrsquoexercicethinspportantthinspsurthinsplathinsptenuethinspdesthinspdossiersthinsplethinspCollegravegethinspestimethinspdrsquoailleursthinspquethinsplethinspdossierthinspdrsquounthinsppatientthinspdoitthinspcontenirthinspunethinspnotethinspattestantthinspquethinsplesthinspin-formationsthinspneacutecessairesthinspagravethinspunethinspprisethinspdethinspdeacutecisionthinspeacuteclaireacuteethinspontthinspeacuteteacutethinsptransmisesthinspparthinsplethinspmeacutedecinthinspetthinspcomprisesthinspparthinsplethinsppatientthinspouthinspsonthinsprepreacutesentantthinsplorsquethinsplathinspchosethinspestthinspjugeacuteethinsppertinentethinspathinspfortiorithinsplorsqursquoilthinspsrsquoagitthinspdrsquounethinspinterventionthinspchirurgicalethinspdrsquounethinspinterventionthinspchirurgicalethinspsousthinspseacutedation-analgeacutesiethinspdrsquoanestheacutesiethinspreacutegionalethinspouthinspgeacuteneacuteralethinsp

DansthinsplethinspCode de deacuteontologie des infirmiegraveres et infirmiersthinsponthinsppreacutevoitthinspquethinsp

thinspArticle 40 Lrsquoinfirmiegravere ou lrsquoinfirmier doit fournir agrave son client toutes les explications neacuteces-saires agrave la compreacutehension des soins et des services qursquoil lui prodigue

Article 41Lorsque lrsquoobligation drsquoobtenir un consentement libre et eacuteclaireacute incombe agrave lrsquoin-firmiegravere ou agrave lrsquoinfirmier ce dernier doit fournir au client toutes les informations

requises

LethinspCode de deacuteontologie des inhalotheacuterapeutes du Queacutebecthinspnethinspcontientthinsppasthinspdethinsp

dispositionthinsptouchantthinsppreacuteciseacutementthinsplethinspconsentementthinspOnthinsppreacutecisethinspcependantthinspquethinsp

Article 13En plus des avis et des conseils lrsquoinhalotheacuterapeute doit fournir agrave son client les explications neacutecessaires agrave la compreacutehension et agrave lrsquoappreacuteciation des services qursquoil

lui rend

EnthinspcompleacutementthinspdansthinspsesthinspnormesthinspdethinsppratiquethinspportantthinspsurthinsplathinsptenuethinspdesthinspdossiersthinsplrsquoOrdrethinspprofessionnelthinspdesthinspinhalotheacuterapeutesthinspduthinspQueacutebecthinspdemandethinspquethinsplethinspdos-sierthinspdrsquounthinsppatientthinspcomportethinspunethinspmentionthinspdesthinspsoinsthinspetthinspdesthinspservicesthinspprodigueacutesthinspagravethinspsonthinspeacutegardthinspAgravethinspcetthinspeffetthinsptoutethinspactiviteacutethinspexerceacuteethinspparthinsplrsquoinhalotheacuterapeutethinsptellethinspquethinsplrsquoinformationthinsptransmisethinspauthinsppatientthinspeuthinspeacutegardthinspagravethinsplathinspseacutedation-analgeacutesiethinspdoitthinspecirctrethinspinscritethinspauthinspdossierthinspduthinsppatientthinspetthinspcethinspauthinspfurthinspetthinspagravethinspmesurethinspquethinsplesthinspactiviteacutesthinspsontthinspexerceacutees

EnthinspsommethinsplathinsploithinspexigethinspunthinspconsentementthinspeacutecritthinspsithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspainsithinspquethinsppourthinsplesthinspanestheacutesiesthinsplesthinspinterventionsthinspchirurgicalesthinspetthinsplesthinspsoinsthinspdispenseacutesthinspenthinspeacutetablissementthinspDansthinspsesthinspguidesthinspportantthinspsurthinsplesthinspproceacuteduresthinspetthinspinterventionsthinspenthinspmilieuthinspextrahospitalierthinspnotammentthinsplethinspCollegravegethinsprecommandethinsptoutefoisthinspquethinsplethinspmeacutedecinthinspversethinspunethinspnotethinspexplicativethinspauthinspdossierthinspetthinspobtiennethinspunthinspconsentementthinspeacutecritthinsppourthinsptoutethinspinterventionthinspmeacutedicalethinspouthinsp

mdash Annexe

CMQ - OIIQ - OPIQ 56

chirurgicalethinspeffractivethinspqursquoellethinspsoitthinspeffectueacuteethinspdansthinspunthinspbutthinspdiagnosticthinsptheacuterapeu-tiquethinspouthinspestheacutetiquethinspLorsquethinsplethinspconsentementthinspportethinspagravethinsplathinspfoisthinspsurthinsplathinspseacutedation-thinspthinspanalgeacutesiethinspetthinspsurthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsplrsquoinformationthinsptrans-misethinspdoitthinspinclurethinsplesthinsprisquesthinspdethinsplrsquointerventionthinspetthinspceuxthinspdethinsplathinspseacutedation-analgeacutesiethinspcelle-cithinsppouvantthinspcomporterthinspdesthinsprisquesthinspimportantsthinspmecircmethinspsithinsplrsquointerventionthinspestthinspmineure

Lrsquoobtentionthinspdrsquounthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspdemeurethinspunethinspobligationthinspthinspinheacuterentethinspagravethinsplrsquointerventionthinspmeacutedicalethinspelle-mecircmethinspIlthinsprelegravevethinspdoncthinspdethinsplathinspresponsabiliteacutethinspduthinspmeacutedecinthinspdethinspsrsquoassurerthinspdethinsplathinsptransmissionthinspdethinsplrsquoinformationthinsppertinentethinspauthinsppatientthinspetthinspdethinspsathinspcompreacutehensionthinspdethinsplathinspnaturethinspduthinspbutthinspetthinspdesthinsprisquesthinsprelatifsthinspagravethinsplrsquointerventionthinspToutefoisthinsplathinsptacircchethinspdethinsptransmettrethinspdethinsplrsquoinfor-mationthinspcompleacutementairethinspouthinspdethinspfairethinsplrsquoenseignementthinspauxthinsppatientsthinsppeutthinspecirctrethinspconfieacuteethinspagravethinspdrsquoautresthinspprofessionnelsthinspetthinspcellethinspdethinsprecueillirthinsplathinspsignaturethinspdrsquounthinspthinspformulairethinspdethinspconsentementthinspagravethinspdrsquoautresthinspmembresthinspdethinsplrsquoeacutequipethinspdethinspsoins

mdash Annexe

CMQ - OIIQ - OPIQ 57

mdash Annexe

thinspANNEXEthinspIXthinsp-thinspEacuteVALUATIONthinspDEthinspLrsquoEFFICACITEacutethinspDEthinspLAthinspSEacuteDATIONthinsp(EXEMPLES)thinsp

(Listethinspnonthinsplimitative)thinsp

1 Eacutechelle de seacutedation de Ramsay modifieacuteethinsp(Adapteacute de Merchant et collab 2014b op cit)

Instruction Descriptiondeacutefinition Valeur

thinspObserverthinsplethinsppatientEacuteveilleacutethinspthinsplethinsppatientthinspestthinspanxieuxthinspetthinspagiteacutethinspouthinspnerveuxthinspouthinsplesthinspdeux 1

ObserverthinsplethinsppatientLethinsppatientthinspeacutetablit-ilthinspunthinspcontactthinspvisuelthinspetthinspreacutepond-ilthinspauxthinspordres

Eacuteveilleacutethinspthinsplethinsppatientthinspestthinspcoopeacuteratifthinspthinsporienteacutethinspetthinspcalme 2

ParlerthinspauthinsppatientthinspLethinsppatientthinspeacutetablit-ilthinspunthinspcontactthinspvisuelthinspetthinspreacutepond-t-ilthinspauxthinspordres

Eacuteveilleacutethinspthinsplethinsppatientthinspreacutepondthinspseulementthinspauxthinspordres 3

StimulerthinspphysiquementthinsplethinsppatientthinspenthinspagitantthinspsonthinspeacutepaulethinsptoutthinspenthinspparlantthinspfortthinspLethinsppatientthinspreacuteagit-ilthinspdansthinsplesthinsp10thinspsecon-des

Endormithinspthinsplethinsppatientthinspreacuteagitthinspparthinspunethinspreacuteponsethinspvivethinspagravethinsplathinspstimulationthinspdethinsplathinspgla-bellethinspouthinspagravethinspunthinspstimulusthinspauditifthinspintense 4

StimulerthinspphysiquementthinsplethinsppatientthinspenthinspagitantthinspsonthinspeacutepaulethinsptoutthinspenthinspparlantthinspfortthinspLethinsppatientthinspreacuteagit-ilthinspapregravesthinsp10thinspsecondes

Endormithinspthinsplethinsppatientthinspreacuteagitthinspparthinspunethinspreacuteponsethinspfaiblethinspagravethinsplathinspstimulationthinspdethinsplathinspglabellethinspouthinspagravethinspunthinspstimulusthinspauditifthinspintense

5

UtiliserthinspdesthinspstimulithinspdouloureuxAucunethinspreacuteaction

Endormithinspthinsplethinsppatientthinspnethinspreacuteagitthinsppasthinspagravethinsplathinspdouleur 6

thinsp Peuthinspimportethinsplrsquoeacutechellethinsputiliseacuteethinspcelle-cithinspdoitthinspecirctrethinspchoisiethinspselonthinsplathinspclientegravelethinspetthinsplethinspcontextethinspdonneacutethinspDethinspmecircmethinspsonthinsputilisationthinspdoitthinspecirctrethinspuniformethinspetthinspstandardiseacuteethinspauthinspseinthinspdrsquounethinspmecircmethinspeacutequipethinsp

CettethinspeacutechellethinsppeutthinspecirctrethinsputiliseacuteethinspchezthinsplrsquoenfantthinspToutefoisthinspellethinspserathinspdavantagethinsputilethinspdansthinsplethinspcadrethinspdrsquounethinspeacutevaluationthinsppostseacutedationthinsp(soinsthinsppostproceacutedures)thinspcarthinspilthinsppeutthinspecirctrethinspcliniquementthinspinapproprieacutethinspdethinspstimulerthinspphysiquementthinspunthinspenfantthinspsousthinspseacutedationthinspprofondethinsp

CMQ - OIIQ - OPIQ 58

2 Eacutechelle de vigilance-agitation de Richmond (Richmond Agitation Sedation Scale - RASS) (Tireacute et adapteacute de Chanques et collab 2006)

Lathinsptraductionthinspfranccedilaisethinspdethinspcettethinspeacutechellethinspathinspfaitthinsplrsquoobjetthinspdrsquounethinspvalidationthinspdethinspsathinspthinspreproductibiliteacutethinspinterobservateurthinsp

mdash Annexe

Instruction DescriptionDeacutefinition Niveau

Observerthinsplethinsppatientthinspsansthinspfairethinspdethinspbruit

Srsquoilthinspmanifestethinspunethinspactiviteacutethinspmotricethinspspon-taneacuteethinspquantifierthinsplethinspniveauthinspdrsquoagitationthinsp

Combatifthinspthinspdangerthinspimmeacutediatthinspenversthinsplrsquoeacutequipe + 4Tregraves agiteacutethinspthinsptirethinsparrachethinsptuyauxthinspouthinspcatheacutetersthinspetouthinspagressifthinspenversthinsplrsquoeacutequipe + 3Agiteacutethinspthinspmouvementsthinspfreacutequentsthinspsansthinspbutthinsppreacutecisthinspetouthinspdeacutesadaptationthinspauthinsprespirateur + 2Ne tient pas en placethinspthinspanxieuxthinspouthinspcraintifthinspmaisthinspmouvementsthinsporienteacutesthinsppeuthinspfreacutequentsthinspnonthinspvigoureuxthinspnonthinspagressifs

+ 1

Srsquoilthinspestthinspcalmethinspetthinspreacutepondthinspouthinspnonthinspauxthinspordresthinspsimplesthinsp

Eacuteveilleacute et calmethinspthinspcalmethinspetthinsplesthinspyeuxthinspouvertsConscientthinspthinspRASSthinsp0thinsp+thinspreacutepondthinspauxthinspordresthinspsimples

0

Srsquoilthinspestthinspcalmethinsplesthinspyeuxthinspfermeacutesthinspthinspquan-tifierthinsplethinspniveauthinspdrsquohypovigilancethinsp(outhinspdrsquoendormissement)thinspenthinspsrsquoadressantthinspauthinsppatientthinspparthinspsonthinspnomthinspsansthinsplethinsptoucherthinspenthinsputilisantthinspunethinspvoixthinspdethinspplusthinspenthinspplusthinspfortethinspetthinspdrsquoautantthinspplusthinspfortethinspquethinsplethinsppatientthinspestthinspsusceptiblethinspdrsquoecirctrethinspsourdthinsp(sujetthinspacircgeacutethinspseacutejourthinspprolongeacutethinspenthinspreacuteanimationthinspthinspbouchonthinspdethinspceacuterumenthinsptoxiciteacutethinspdesthinspantibiotiquesthinspetthinspduthinspfuroseacutemide)thinsp

Somnolentthinspthinsppasthinspcomplegravetementthinspeacuteveilleacutethinspmaisthinsprestethinspeacuteveilleacutethinspauthinspcontactthinspvisuelthinspagravethinsplrsquoappelthinspthinsp(gtthinsp10thinsps)

- 1

Diminution leacutegegravere de la vigilancethinspthinsprestethinspeacuteveilleacutethinspbriegravevementthinspavecthinspcontactthinspvisuelthinspagravethinsplrsquoappelthinsp(ltthinsp10thinsps)

- 2

Diminution modeacutereacutee de la vigilancethinspthinspnrsquoimportethinspquelthinspmouvementthinspagravethinsplrsquoappelthinsp(ouverturethinspdesthinspyeux)thinspmaisthinsppasthinspdethinspcon-tactthinspvisuel

- 3

Sithinsplethinsppatientthinspnethinspfaitthinspaucunthinspmouvementthinspythinspcompristhinspenthinsplrsquoappelantthinspdrsquounethinspvoixthinspfortethinspthinspfrictionnerthinspdrsquoabordthinsplrsquoeacutepaulethinsppuisthinsplethinspster-numthinspsansthinspecirctrethinspnociceptifthinsp

Diminution profonde de la vigilancethinspthinspau-cunthinspmouvementthinspagravethinsplrsquoappelthinspnrsquoimportethinspquelthinspmouvementthinspagravethinsplathinspstimulationthinspphysiquethinsp(frictionthinspnonthinspnociceptivethinspdethinsplrsquoeacutepaulethinspouthinspduthinspsternum)

- 4

Non reacuteveillablethinspthinspaucunethinspmouvementthinspnithinspagravethinsplrsquoappelthinspnithinspagravethinsplathinspstimulationthinspphysiquethinsp(frictionthinspnonthinspnociceptivethinspdethinsplrsquoeacutepaulethinspouthinspduthinspsternum)

- 5

CMQ - OIIQ - OPIQ 59

thinspANNEXEthinspXthinsp-thinspEacuteVALUATIONthinspDEthinspLrsquoEFFICACITEacutethinspDEthinspLrsquoANALGEacuteSIEthinsp(EXEMPLES)

(Listethinspnonthinsplimitative)thinsp

Selonthinsplrsquoacircgethinspduthinsppatientthinspsathinspconditionthinspetthinsplethinspcontextethinspcliniquethinspdeuxthinspstrateacutegiesthinspdrsquoeacuteva-luationthinsppeuventthinspecirctrethinsputiliseacuteesthinspsoitthinsplrsquoauto-eacutevaluationthinsp(parthinspdesthinspmotsthinspdesthinspchiffresthinspthinspouthinspdesthinspdessins)thinspouthinsplrsquoheacuteteacutero-eacutevaluationthinspcomportementalethinspCelathinspditthinspsithinsplrsquoauto-thinspeacutevaluationthinspestthinspagravethinspprivileacutegierthinspcrsquoestthinsptoutefoisthinsplrsquoacircgethinspduthinsppatientthinsp(patientthinsppeacutediatrique)thinspetthinspsathinspcapaciteacutethinspcognitivethinspquithinspguiderontthinsplethinspchoixthinspduthinspclinicienthinspdansthinsplathinspseacutelectionthinspduthinspmeilleurthinspoutilthinsp

Pourthinsplethinsppatientthinspnrsquoayantthinsppasthinsplathinspcapaciteacutethinsp(pthinspexthinspthinsphabiliteacutethinspverbalethinspouthinspcognitivethinsplimiteacutee)thinspdrsquoeacutevaluerthinsplui-mecircmethinsplrsquointensiteacutethinspdethinsplathinspdouleurthinspunethinspreacuteponsethinspverbalethinsp(ouinon)thinspouthinspgestuellethinspsignifiantthinsplathinsppreacutesencethinspouthinsplrsquoabsencethinspdethinspdouleurthinspconstituethinspunethinspformethinspdrsquoauto-eacutevaluationthinspacceptablethinspenthinsppratiquethinspcliniquethinspaupregravesthinspdethinspcertainesthinsppopulationsthinsptellesthinspquethinsplethinspjeunethinspenfantthinsplethinsppatientthinspdeacutementthinspouthinspceluithinspvivantthinspavecthinspunethinspdeacuteficiencethinspintellectuellethinsp(McCafferythinspciteacutethinspdansthinspHerrthinspetthinspcollabthinsp2011thinsp[Notrethinsptraduc-

tion])

thinspthinsp Peuthinspimportethinsplrsquoeacutechellethinsputiliseacuteethinspcelle-cithinspdoitthinspecirctrethinspchoisiethinspselonthinsplathinspclientegravelethinspetthinsplethinspcontextethinspdonneacutethinspDethinspmecircmethinspsonthinsputilisationthinspdoitthinspecirctrethinspuniformethinspetthinspstandardiseacuteethinspauthinspseinthinspdrsquounethinspmecircmethinspeacutequipethinspsoignantethinsp

ADULTE-AIcircNEacutethinsp

AUTO-EacuteVALUATIONthinsp(DOULEURthinspAIGUEuml)

thinsprsaquo Eacutechellethinspnumeacuteriquethinsp(0thinspagravethinsp10)thinsp(EN)thinsprsaquo Eacutechellethinspverbalethinspsimplethinsp(EVS)thinsprsaquo Eacutechellethinspvisuellethinspanalogiquethinsp(EVA)

HEacuteTEacuteRO-EacuteVALUATIONthinspCOMPORTEMENTALEthinsp(DOULEURthinspAIGUEuml)

thinsprsaquo ALGOPLUSthinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspdesthinsptroublesthinspdethinsplathinspcommunicationthinspverbale)

thinsprsaquo PACSLACthinspouthinspPACSLAC-Fthinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspunethinspcapaciteacutethinsplimiteacuteethinspagravethinspcommuniquer

thinsprsaquo PAINADthinsp(anglais)thinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspunethinspdeacutemencethinspouthinspautrethinsptroublethinspcognitifthinspetthinspquithinspnethinsppeutthinspcommuniquerthinspdethinspmaniegraverethinspfiable

Les hyperliens concernant ces eacutechelles sont fournis agrave titre informatif seulement

mdash Annexe

CMQ - OIIQ - OPIQ 09

Classification Eacutetatthinspdethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp1 Patientthinspenthinspbonnethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp2Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspleacutegegravere

ASAthinspPhysicalthinspStatusthinsp3Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgrave

ASAthinspPhysicalthinspStatusthinsp4Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgravethinspquithinsprepreacutesentethinspthinspunethinspmenacethinspconstantethinsppourthinspsathinspvie

ASAthinspPhysicalthinspStatusthinsp5Patientthinspmoribondthinspquithinspnethinspsurvivrathinsppasthinspthinspagravethinspmoinsthinspdrsquounethinspinterventionthinsp

ASAthinspPhysicalthinspStatusthinsp6Patientthinspdeacuteclareacutethinspenthinspeacutetatthinspdethinspmortthinspceacutereacutebralethinspdontthinsplesthinsporganesthinspontthinspeacuteteacutethinsppreacuteleveacutesthinspagravethinspdesthinspfinsthinspdethinspdon

Tableau 1Classification de lrsquoeacutetat physique du patient selon lrsquoAmerican Society of Anesthesiologists (ASA) (ASA Physical Status Classification System) [En ligne] (Notre traduction)

Ainsithinsplorsquethinsplathinspseacutedation-analgeacutesiethinspestthinspreacutealiseacuteethinspparthinspunthinspmeacutedecinthinspsansthinsplathinspcolla-borationthinspdirectethinspdrsquounthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesio-logiethinspouthinspenthinspreacuteanimationthinspcardiorespiratoirethinspavanceacuteethinsplesthinspinterventionsthinspdiagnos-tiquesthinspouthinsptheacuterapeutiquesthinspdoiventthinspecirctrethinspreacuteserveacuteesthinspprincipalementthinspauxthinsppatientsthinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp1thinspouthinspauxthinsppatientsthinspatteintsthinspdrsquounethinspaffectionthinspsysteacutemiquethinspleacutegegraverethinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp2thinsp

CMQ - OIIQ - OPIQ 10

Notonsthinspquethinspdansthinspdesthinspsituationsthinspparticuliegraveresthinspetthinspjustifieacuteesthinspauthinspdossierthinspmeacutedi-calthinsplathinspseacutedation-analgeacutesiethinsppeutthinspecirctrethinspeffectueacuteethinspchezthinsplesthinsppatientsthinspstablesthinspdethinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp3thinspetthinspexceptionnellementthinspdethinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp4thinspToutefoisthinspellethinspdoitthinsplrsquoecirctrethinspdansthinspdesthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspopti-malethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespira-toirethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspDethinspplusthinspcesthinsppatientsthinspdoiventthinspfairethinsplrsquoobjetthinspdrsquounethinspeacutevaluationthinspindividualiseacuteethinspetthinspplusthinspapprofondiethinsp

Lathinspprofondeurthinspdethinsplathinspseacutedationthinspetthinsplethinspniveauthinspdrsquoanalgeacutesiethinsprechercheacutethinspenthinspseacutedation-analgeacutesiethinspdoiventthinspcorrespondrethinspauxthinspniveauxthinsppermettantthinsplrsquoatteintethinspdesthinspobjectifsthinspviseacutesthinspetthinspecirctrethinspmesureacutesthinspagravethinsplrsquoaidethinspdrsquoeacutechellesthinspstandardiseacuteesthinspvalideacuteesthinspdethinsppreacutefeacuterencethinspetthinspadapteacuteesthinspauthinspcontextethinspetthinspagravethinsplathinspconditionthinspduthinsppatientthinspLesthinspniveauxthinspdethinspseacutedation-analgeacutesiethinspviseacutesthinsptelsthinspquethinspdeacutefinisthinspdansthinsplathinspclassificationthinspdethinsplrsquoASAthinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinspASAthinspHousethinspofthinspDelegatethinsp2014a)thinsp(annexethinspI)thinspdoiventthinspcorrespondentthinspagravethinsplrsquounthinspouthinsplrsquoautrethinspdesthinspdeuxthinspniveauxthinspsuivantsthinsp(CMQthinsp2009)thinsp

thinsprsaquo seacutedationthinspminimalethinspouthinsplaquothinspanxiolysethinspraquothinspougravethinsplrsquoappreacutehensionthinspduthinsppatientthinspestthinspdiminueacuteethinspsansthinspchangementthinspdethinspsonthinspniveauthinspdethinspconsciencethinspetthinspsansthinspalteacutererthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsplathinspventilationthinspetthinsplathinspfonctionthinspcardiovasculaire

thinsprsaquo seacutedationthinspmodeacutereacuteethinspougravethinsplathinspreacuteponsethinspauxthinspstimulithinspverbauxthinspouthinsptactilesthinspleacutegersthinspestthinspvolontairethinspsansthinspaffecterthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsplathinspventilationthinspspontaneacuteethinspetthinsplathinspfonctionthinspcardiovasculaire

Notonsthinsptoutefoisthinspquethinsplrsquoeacutequipethinspsoignantethinspparticipantthinspagravethinsplathinspproceacutedurethinspdoitthinspconnaicirctrethinsplethinspniveauthinspdethinspseacutedation-analgeacutesiethinspgeacuteneacuteralementthinspneacutecessairethinsppourthinspunethinspinterventionthinspdonneacuteethinspDethinspmecircmethinspellethinspdoitthinspecirctrethinsppreacutepareacuteethinspagravethinspgeacutererthinsplethinsppassagethinspmomentaneacutethinspagravethinspunthinspniveauthinspdethinspseacutedationthinspsupeacuterieurthinspagravethinspceluithinspquithinspathinspeacuteteacutethinspplanifieacutethinsp(crsquoest-agrave-direthinspplusthinspprofondthinspquethinsppreacutevu)thinspcethinspquithinsppeutthinspsurvenirthinspenthinsptoutthinsptempsthinsplorsthinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsp

CMQ - OIIQ - OPIQ 11

Volet organisationnel

thinsp12thinspCOMPEacuteTENCESthinspPROFESSIONNELLESthinsp

Consideacuterantthinspquethinsplathinspseacutedation-analgeacutesiethinspsrsquoinscritthinspdansthinspunethinsppratiquethinspdethinspcollabo-rationthinspentrethinsplethinspmeacutedecinthinspetthinspdrsquoautresthinspprofessionnelsthinspdethinsplathinspsanteacutethinsp(infirmiegraveresthinspetthinspinhalotheacuterapeutes)thinspilthinspimportethinspdethinsppreacuteciserthinspqursquounethinsputilisationthinspjudicieusethinspdethinspleursthinspcompeacutetencesthinspestthinspdethinspmisethinsppourthinspassurerthinsplathinspqualiteacutethinspetthinsplrsquoefficiencethinspdesthinspsoinsthinspAinsithinsptousthinspdoiventthinspavoirthinsplesthinspqualificationsthinsprequisesthinspdansthinsplethinspdomainethinspdethinsplathinspseacutedation-thinspanalgeacutesie

Dethinspplusthinsplrsquoeacutequipethinspsoignantethinspquithinspreacutealisethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacutera-peutiquethinspsousthinspseacutedation-analgeacutesiethinspdoitthinsp

a ecirctrethinspenthinspmesurethinspdrsquoeacutevaluerthinspadeacutequatementthinsplathinspconditionthinspdethinspsanteacutethinspduthinsppatientthinspetthinspdrsquoenthinspassurerthinsplathinspsurveillancethinspclinique

b connaicirctrethinspetthinsputiliserthinspjudicieusementthinsplathinspmeacutedicationthinspainsithinspquethinspsesthinspantagonistes

c posseacutederthinsplesthinspconnaissancesthinspetthinsplesthinspcompeacutetences1thinspneacutecessairesthinsppourthinspintervenirthinspenthinspsituationthinspdrsquourgencethinsptellethinspquethinsplathinspreacuteanimationthinspcardiorespiratoire2thinsp(dethinsppreacutefeacuterencethinspenthinspsoinsthinspavanceacutes)thinspcrsquoest-agrave-direthinspmaicirctriserthinspenthinspprioriteacutethinsplesthinsptechniquesthinspdethinsplathinspprisethinspenthinspchargethinspdethinsplathinspventilationthinspduthinspmassagethinspcardiaquethinspetthinspdethinsplathinspmeacutedicationthinspassocieacutee

d avoirthinsplrsquoexpertisethinsprequisethinspselonthinsplathinspclientegravelethinspviseacuteethinspetthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspagravethinspreacutealiserthinsp

thinsp13thinspRESSOURCESthinspMATEacuteRIELLESthinsp

1thinspLOCAUX

LrsquoameacutenagementthinspdesthinsplocauxthinspdoitthinsppermettrethinspdethinspreacutealiserthinspdethinspfaccedilonthinspadeacutequatethinspetthinspenthinsptoutthinsptempsthinspunethinspreacuteanimationthinspcardiorespiratoirethinspainsithinspqursquounethinspeacutevacuationthinspdrsquourgencethinsplethinspcasthinspeacutecheacuteantthinspEntrethinspautresthinsplathinspsuperficiethinspdoitthinsppermettrethinspauthinsppersonnelthinspdethinspcircu-lerthinsplibrementthinsplrsquoeacuteclairagethinspdoitthinspecirctrethinspsuffisantthinsplethinspmateacuterielthinspdrsquourgencethinsp(pthinspexthinspthinspdethinspreacuteani-mation)thinspdoitthinspecirctrethinspfacilementthinspaccessiblethinspetthinspentreposeacutethinspdansthinspunthinsplieuthinspconnuthinspdethinsptousthinsp

Selonthinsplesthinspmodaliteacutesthinspdethinspfonctionnementthinspetthinsplethinsptypethinspdrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsppratiqueacutethinspilthinspestthinspdrsquousagethinspdethinspdisposerthinspdrsquounethinspsallethinspdethinspreacutecupeacutera-tionthinspouthinspdrsquoobservation

1thinspthinspthinspthinspOnthinspentendthinspparthinspconnaissancesthinspetthinspcompeacutetencesthinspqursquoellesthinspsoientthinspmisesthinspagravethinspjourthinspselonthinsplesthinsprecommandationsthinspenthinspvigueur2thinspthinspthinspOnthinspentendthinspparthinspcertificationthinspenthinspreacuteanimationthinspcardiorespiratoirethinsplesthinspformationsthinspsuivantesthinspthinsp thinsprsaquothinspReacuteanimationthinspcardiorespiratoirethinspdethinspbasethinspthinspSoinsthinspimmeacutediatsthinspenthinspreacuteanimationthinsp(SIR)thinsppourthinspprofessionnelsthinspdethinsplathinspsanteacutethinspthinspthinspthinspthinspthinspthinspthinspthinspouthinsplrsquoeacutequivalentthinsp thinsprsaquothinspReacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspSoinsthinspavanceacutesthinspenthinspreacuteanimationthinspcardiovasculairethinsp(SARC)thinspouthinsplrsquoeacutequivalent

CMQ - OIIQ - OPIQ 12

Pourthinspinformationthinspcompleacutementairethinsp(annexethinspII)thinspProceacutedures et interventions en milieu extrahospitalierthinsp(CMQthinsp2011)

2thinspEacuteQUIPEMENTthinsp(INTRAthinspETthinspEXTRAHOSPITALIER)

OBLIGATOIRE

Enthinspplusthinspduthinspmateacuterielthinspdirectementthinsplieacutethinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspjustifiantthinsplathinspseacutedation-analgeacutesiethinsponthinspdoitthinsptrouverthinspminimalementthinsplrsquoeacutequipe-

mentthinspsuivant

Dansthinsplathinspsallethinsp

thinsprsaquo tablethinspdrsquoexamenthinspciviegraverethinspouthinsptablethinspdethinspchirurgiethinsprsaquo tablethinsppourthinsplesthinspinstrumentsthinsprsaquo soluteacutesthinspetthinspmateacuterielthinspneacutecessairethinsppourthinsplrsquoinstallationthinspetthinsplethinspmaintienthinspdrsquounethinspvoiethinsp

endoveineusethinsprsaquo saturomegravetrethinsp(oxymegravetrethinspdethinsppouls)thinsp

Lethinspmonitoragethinspdethinsplathinspsaturationthinspenthinspoxygegravenethinsppermetthinsplrsquoeacutevaluationthinspdethinsplrsquooxy-geacutenationthinsp(deacutetectionthinsppreacutecocethinspdrsquounethinsphypoxeacutemie)thinspmaisthinspilthinspnethinsppeutthinsppasthinspdeacutetecterthinsppreacutecocementthinspunethinspobstructionthinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(AmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2012)thinspthinsp

thinsprsaquo steacutethoscopethinspthinsprsaquo sphygmomanomegravetrethinspouthinspappareilthinspautomatiseacutethinspnonthinspinvasifthinsppourthinsplathinspprisethinspdethinsplathinsp

pressionthinsparteacuteriellethinsprsaquo sourcethinspdrsquooxygegravenethinspcomprimeacutethinspenthinspquantiteacutethinspsuffisantethinsppourthinspenthinsppermettrethinsp

llsquoadministrationthinspagravethinspunthinspdeacutebitthinspdethinsp15thinsplitresthinspparthinspminutethinsppendantthinsp60thinspminutesthinspetthinspthinsplethinspmateacuterielthinspneacutecessairethinspagravethinsplrsquooxygeacutenotheacuterapie

thinsprsaquo appareilthinspagravethinspaspirationthinsppouvantthinspgeacuteneacutererthinspunethinsppressionthinspneacutegativethinspdethinsp40ndash60thinspmmthinspHgthinspouthinspunethinspcapaciteacutethinspdethinspflotthinspdethinsp100thinsplitresthinspparthinspminutethinspetthinsplethinspmateacuterielthinspneacutecessairethinspthinspagravethinsplrsquoaspiration

thinsprsaquo lethinspmateacuterielthinspneacutecessairethinspagravethinsplathinspprisethinspenthinspchargethinspventilatoirethinspentrethinspautresthinspreacuteanimateurthinspmanuelthinspautogonflablethinsp(Ambuthinspbag)thinspmasquethinspcanulesthinspnasothinspthinspetthinsporopharyngeacuteesthinspdethinsptaillesthinspvarieacutees

Ce mateacuteriel doit ecirctre disponible agrave porteacutee de la main

CMQ - OIIQ - OPIQ 13

thinsprsaquo appareilthinspdrsquoalimentationthinspeacutelectriquethinspdethinspsecoursthinsppourthinsplethinspfonctionnementthinspdesthinspeacutequipementsthinspdrsquourgence

Peutthinspecirctrethinspagravethinsplrsquoexteacuterieurthinspdethinsplathinspsallethinsp(maisthinspfacilethinspdrsquoaccegravesthinspetthinsprapidementthinspdisponible)thinsp

thinsprsaquo thinsparmoirethinspfermeacuteethinsppourthinspentreposerthinspsousthinspcleacutethinspauthinspbesointhinsplethinspmateacuterielthinspetthinsplesthinspsubstancesthinspcontrocircleacuteesthinspainsithinspquethinsplesthinspbenzodiazeacutepines

thinsprsaquo mateacuterielthinspneacutecessairethinspagravethinsplrsquointubationthinspendotracheacutealethinspentrethinspautresthinspsondesthinspendotracheacutealesthinspetthinsplamesthinspdethinsplaryngoscopethinspdethinsptaillesthinspvarieacuteesthinspainsithinspquethinspdesthinspalternativesthinspagravethinsplrsquointubationthinspdifficilethinsp(pthinspexthinspthinspoutilsthinspextraglottiquesthinsptelsthinspquethinspmasquesthinsplaryngeacutes)

thinsprsaquo deacutefibrillateurthinspcardiaquethinsp(dethinsppreacutefeacuterencethinspunthinspdeacutefibrillateurthinspexternethinspautomatiseacutethinsp[DEA])

thinsprsaquo pharmaciethinsp(troussethinspouthinspchariot)thinspcontenantthinsplesthinspmeacutedicamentsthinspneacutecessairesthinspauthinsptraitementthinspdesthinspsituationsthinspdrsquourgencethinsptellesthinspquethinspthinspsurdosagethinspauxthinspopioiumldesthinspouthinspauxthinspbenzodiazeacutepinesthinspurgencethinspcardiaquethinspreacuteactionthinspallergiquethinspcrisethinspdrsquoasthmethinspcrisethinspconvulsivethinspchocthinspvagalthinsphypoglyceacutemiethinspetc

RECOMMANDEacutethinspSELONthinspLAthinspSITUATION

thinsprsaquo moniteurthinspcardiaquethinspthinspdansthinspcertainsthinspcasthinspbienthinspdeacutefinisthinsplethinspmonitoragethinspcardiaquethinsppeutthinspecirctrethinsprecommandeacutethinspouthinspobligatoirethinsp(tableauthinsp3)

thinsprsaquo capnographethinspthinspdansthinspcertainsthinspcasthinspbienthinspdeacutefinisthinsplethinspmonitoragethinspduthinspCO2thinsppeutthinspecirctrethinsp

recommandeacutethinspouthinspobligatoirethinsp(tableauthinsp3)thinspthinspLethinspmonitoragethinspduthinspCO

2thinsppermetthinspdrsquoidentifierthinsppreacutecocementthinsplesthinspcomplicationsthinsp

tellesthinsplathinspseacutedationthinspexcessivethinsplrsquohypoventilationthinspetthinsplrsquoapneacuteethinspenthinspplusthinspdethinsppermettrethinspdethinspmieuxthinspcontrocirclerthinsplethinspniveauthinspdethinspseacutedationthinspenthinspfonctionthinspdethinsplrsquointerventionthinspthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinspSonthinsputilisationthinsppermetthinspeacutegalementthinspthinspdethinspsuivrethinsplethinspmonitoragethinspventilatoirethinspCelathinspestthinspparticuliegraverementthinspapproprieacutethinspthinsplorsqursquoilthinspnrsquoexistethinsppasthinspdrsquoantagonistesthinspagravethinsplathinspmeacutedicationthinsputiliseacuteethinsp(pthinspexthinspthinsppropofol)thinsp

OPTIONNEL

thinsprsaquo moniteurthinspdethinsptempeacuteraturethinspetthinspdispositifthinspdethinspreacutechauffementthinspduthinsppatientthinspselonthinsplethinsppatientthinspetthinsplathinspdureacuteethinspdethinsplrsquointerventionthinsp

thinsprsaquo systegravemethinspdrsquoantipollutionthinsp(eacutevacuationthinspduthinspprotoxydethinspdrsquoazote)thinspsrsquoilthinspythinspathinsplieuthinsprsaquo analyseurthinspdrsquooxygegravenethinsplorsqursquounthinspmeacutelangethinspestthinsputiliseacutethinsp(pthinspexthinspthinspO

2thinspetthinspprotoxydethinsp

drsquoazote)thinsprsaquo steacutethoscopethinsppreacutecordialthinspouthinsppreacutetracheacutealthinsppourthinspeacutecoutethinspenthinspcontinu

CMQ - OIIQ - OPIQ 14

LrsquoensemblethinspdethinspcesthinspeacutequipementsthinspdoitthinspecirctrethinspadapteacutethinspauthinsppatientthinspIlsthinspdoiventthinspecirctrethinspenthinspeacutetatthinspdethinspfonctionnerthinspetthinsplesthinspattestationsthinspdesthinspveacuterificationsthinsppeacuteriodiquesthinspdoiventthinspecirctrethinspconserveacuteesthinspdansthinspunthinspregistrethinsppreacutevuthinspagravethinspcettethinspfin

Pendantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplesthinspprofessionnelsthinspdoiventthinspthinsprespecterthinsplesthinspregraveglesthinspdethinsppreacuteventionthinspetthinspdethinspcontrocirclethinspdesthinspinfections

Unethinspproceacutedurethinsprelativethinspauxthinspsituationsthinspdrsquourgencethinsp(annexethinspIII)thinspagravethinsplrsquoaccegravesthinspauxthinspser-vicesthinspdrsquourgencethinsppreacutehospitaliersthinspetthinspdethinsptransfertthinspselonthinspunethinspententethinspintereacutetablisse-mentsthinspdoitthinspecirctrethinspeacutelaboreacuteethinspmaintenuethinspagravethinspjourthinspfacilementthinspdisponiblethinspenseigneacuteethinspagravethinsptoutthinsplethinsppersonnelthinspetthinspfairethinsplrsquoobjetthinspdrsquounthinsprappelthinspaupregravesthinspdethinspcethinspdernierthinspsurthinspunethinspbasethinsp

peacuteriodiquethinsp

CMQ - OIIQ - OPIQ 15

Volet professionnel

thinsp14thinspPREacuteSEacuteDATION-ANALGEacuteSIEthinsp

SEacuteLECTIONthinspDESthinspPATIENTS

Lathinspseacutelectionthinspdesthinsppatientsthinspdoitthinsptenirthinspcomptethinspnotammentthinspdethinsplrsquoeacutevaluationthinspdesthinspvoiesthinspaeacuteriennesthinspetthinspdethinsplrsquoeacutetatthinspdethinspsanteacutethinspgeacuteneacuteralthinspduthinsppatientthinspquithinspaurontthinspmisthinspenthinspeacutevi-dencethinsplathinsppreacutesencethinspouthinsplrsquoabsencethinspdrsquoindicateursthinspdethinsppossiblesthinspcomplicationsthinsplorsthinspdethinsplathinspseacutedation-analgeacutesiethinspIlthinspexistethinspdeuxthinsptypesthinspdethinsprisquesthinspenthinspseacutedation-analgeacutesiethinspthinsplesthinsprisquesthinsppreacutevisiblesthinsp(difficulteacutethinsppotentiellethinsplieacuteethinspagravethinsplathinspgestionthinspdesthinspvoiesthinspaeacuteriennesthinspouthinspinstabiliteacutethinspduthinsppatient)thinspetthinsplesthinsprisquesthinspimpreacutevisiblesthinsp(incidentaccidentthinsperreurthinsphu-mainethinspetc)thinspUnethinspeacutevaluationthinspinitialethinsp(histoirethinspexamenthinspphysique)thinspadeacutequatethinspavantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspdiminuethinspdethinsptelsthinsprisques

Agravethinsppartirthinspdethinsplrsquoensemblethinspdesthinspeacutevaluationsthinspeffectueacuteesthinsplethinspmeacutedecinthinspseacutelectionnethinsplesthinsppatientsthinspaptesthinspagravethinsprecevoirthinspunethinspseacutedation-analgeacutesiethinspselonthinspnotammentthinsp

thinsprsaquo lesthinspfacteursthinspdethinsprisquethinspidentifieacutesthinspagravethinsplathinspsuitethinspdethinsplrsquoeacutevaluationthinsp(cardiovasculairethinsprespiratoirethinspheacutepatiquethinspneurologique)thinspdethinsplathinsppossibiliteacutethinspdethinspgrossessethinspchezthinsplathinspfemmethinspenthinspacircgethinspdethinspprocreacuteerthinspouthinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspenvisageacutee

thinsprsaquo lrsquoeacutevaluationthinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(annexethinspIV)thinspafinthinspdethinsppreacuteciserthinsplethinsprisquethinspdrsquoassistancethinspventilatoirethinspetthinspdrsquointubationthinspdifficilethinsp

thinsprsaquo lesthinspanteacuteceacutedentsthinspanestheacutesiquesthinspetthinspchirurgicauxthinspafinthinspdrsquoidentifierthinsplesthinspcomplicationsthinsppotentielles

thinsprsaquo lesthinspcomorbiditeacutesthinspdontthinsplesthinsptroublesthinsprespiratoiresthinspduthinspsommeilthinsp(annexethinspV)thinsprsaquo lathinspmeacutedicationthinspouthinspautresthinspsubstancesthinsp(prescritesthinspouthinspenthinspventethinsplibre)thinspafinthinsp

drsquoidentifierthinsplesthinsprisquesthinspdrsquointeractionsthinspavecthinsplesthinspmeacutedicamentsthinsputiliseacutesthinsplorsthinspdethinsplrsquointerventionthinspouthinspdethinsplathinspseacutedation-analgeacutesie

thinsprsaquo lrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspquithinsppourraitthinspneacutecessiterthinspunethinspseacutedation-analgeacutesiethinspdrsquounthinspniveauthinspsupeacuterieurthinspagravethinspceluithinspdontthinspilthinspestthinspquestionthinspdansthinspcesthinsplignesthinspdirectrices

thinsprsaquo lesthinspcaracteacuteristiquesthinsppropresthinspauthinsppatientthinsp(fonctionsthinspcognitivesthinspisolementthinspsocialthinspautonomiethinspetc)

EacuteVALUATIONthinspDESthinspPATIENTS

Cettethinspeacutevaluationthinspdoitthinspsethinspfairethinsppeuthinspdethinsptempsthinsp(moinsthinspdethinsp3thinspmoisthinspenthinsplrsquoabsencethinspdethinspchangementthinspnotablethinspdansthinsplathinspconditionthinspcliniquethinspduthinsppatient)thinspavantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspetthinspdoitthinspnotammentthinsppreacuteciserthinspcethinspquithinspsuit

CMQ - OIIQ - OPIQ 16

AgravethinspLrsquoANAMNEgraveSEthinspthinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsp

lrsquoeacutevaluationthinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinsp(annexethinspVI)thinsp

thinsprsaquo raison(s)thinspdethinspconsultationthinspetthinsphistoirethinspdethinsplathinspmaladiethinspactuellethinsprsaquo anteacuteceacutedentsthinsprsaquo reacuteactionthinspanteacuterieurethinspagravethinsplathinspseacutedation-analgeacutesiethinspagravethinsplrsquoanestheacutesiethinspetthinspagravethinsplathinspchirurgiethinsprsaquo allergiesthinsprsaquo momentthinspduthinspdernierthinspingestathinsp(preacuteciserthinsplethinsptypethinspetthinsplathinspquantiteacute)thinsprsaquo meacutedicationthinspetthinspautresthinspsubstancesthinsp(prescritesthinspouthinspnon)thinsprsaquo preacutemeacutedicationthinspreccediluethinsp(pthinspexthinspthinspadministrationthinspdethinspmorphinethinspchezthinspunthinsppatientthinspenthinsp

attentethinspdrsquounethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutique)thinsprsaquo habitudesthinspdethinspviethinsp(tabacthinspalcoolthinspouthinspdrogues)thinsprsaquo troublethinsprespiratoirethinspduthinspsommeilthinspetthinsplathinsptheacuterapiethinspassocieacutee

AgravethinspLrsquoEXAMENthinspPHYSIQUEthinsp

Lrsquoexamenthinspphysiquethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinspcherchethinspagravethinspmettrethinspenthinspeacutevi-dencethinspcertainsthinspcritegraveresthinspreconnusthinsppourthinspecirctrethinspassocieacutesthinspagravethinspunethinspassistancethinspventila-toirethinspdifficilethinspquithinsppeutthinspsurvenirthinspdansthinsplethinspcasthinspdrsquounthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquethinspceluithinspviseacutethinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsplrsquoeacutevaluationthinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinsp(annexethinspVII)thinsp

Lrsquoexamenthinspphysiquethinspdoitthinspecirctrethinspadapteacutethinspagravethinspchaquethinsppatientthinspetthinspporterthinspnotammentthinspsurthinspdesthinspeacuteleacutementsthinsptelsthinspquethinspceux-cithinsp

thinsprsaquo preacutesencethinspdrsquoobeacutesiteacutethinsprsaquo tecirctethinspetthinspcouthinsp

thinsprsaquo mobiliteacutethinspcervicalethinspcompromisethinsprsaquo couthinspcourtthinspouthinsplargethinsp(circonfeacuterencethinsp )thinsprsaquo pathologiethinspouthinspanomaliethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(pthinspexthinspthinspmassethinsp

cervicale)thinspthinsprsaquo bouchethinsp

thinsprsaquo petitethinspouverturethinsprsaquo dentitionthinsp(pthinspexthinspthinspbouchethinspeacutedenteacuteethinspdentsthinspinstablesthinspincisivesthinspproeacuteminentesthinsp

outhinspappareilthinspdentairethinspmalocclusionthinspimportante)thinsp

LethinspscorethinspdethinspMallampatithinspmodifieacutethinspestthinspunthinspoutilthinspagravethinspprivileacutegierthinsp(annexethinspIV)

CMQ - OIIQ - OPIQ 17

UnethinspbonnethinspeacutevaluationthinspdethinsptousthinsplesthinspaspectsthinsprelatifsthinspauthinspmaintienthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspestthinspessentiellethinspDethinspplusthinspchezthinsplethinsppatientthinspsymptomatiquethinspthinsp(pthinspexthinspthinspdyspneacutee)thinspcettethinspeacutevaluationthinspdoitthinspecirctrethinspcompleacuteteacuteethinspparthinsplrsquoauscultation cardiorespiratoirethinspFinalementthinspsithinspdrsquoautresthinspexamensthinspdoiventthinspecirctrethinspfaitsthinspleurthinspchoixthinspserathinspguideacutethinspparthinsplesthinspproblegravemesthinspmeacutedicauxthinspsous-jacents

Bienthinspquethinsplathinspseacutedation-analgeacutesiethinspnethinsppreacutevoitthinspnormalementthinsppasthinspdethinspprisethinspenthinspchargethinspcomplegravetethinspdethinsplathinspventilationthinsp(assistancethinspventilatoirethinspouthinspintubationthinspthinspendotracheacuteale)thinspilthinspestthinspimportantthinspdrsquoeffectuerthinspcettethinspeacutevaluationthinsppuisqursquoagravethinspthinsptoutthinspmomentthinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspunethinspventilationthinspthinspassisteacuteethinspavecthinspouthinspsansthinspintubationthinspendotracheacutealethinsppeutthinspsrsquoaveacutererthinspneacutecessairethinspthinspsithinsplathinsprespirationthinspestthinspcompromisethinsp

Lorsthinspdethinspsituationsthinspparticuliegraveresthinspouthinspcomplexesthinsplethinspmeacutedecinthinspdevraitthinspconsulterthinspunthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinsp

cardiorespiratoirethinspavanceacutee

CONSENTEMENTthinsp(REacuteSUMEacute)

LethinsplecteurthinspdoitthinspsethinspreacutefeacutererthinspagravethinsplrsquoannexethinspVIIIthinsppourthinsplethinsptextethinspcomplet

SelonthinsplethinspdroitthinspenthinspvigueurthinspauthinspQueacutebecthinspilthinspestthinspobligatoirethinspdrsquoobtenirthinsplethinspconsentementthinspdrsquounthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspintervention

LethinspCode civil du QueacutebecthinspeacutetablitthinspdesthinspregraveglesthinspgeacuteneacuteralesthinspconcernantthinsplethinspconsentementthinspauxthinspsoinsthinspquithinspsrsquoappliquentthinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspdispenseacutesthinspOnthinspythinspfaitthinspcependantthinspcertainesthinspdistinctionsthinspselonthinspquethinsplethinsppatientthinspestthinspaptethinspouthinspnonthinspagravethinspconsentirthinspetthinspselonthinspquethinsplesthinspsoinsthinspsontthinsprequisthinspouthinspnonthinsp

parthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspLathinspLoi sur les services de santeacute et les services sociaux (LSSSS)thinspeacutetablitthinspquantthinspagravethinspellethinsplesthinspregraveglesthinspapplicablesthinspenthinspeacutetablissementthinspenthinspmatiegraverethinspdethinspconsentementthinspauxthinspinterventionsthinspchirurgicalesthinspetthinspagravethinsplrsquoanestheacutesiethinsp

LethinspCode de deacuteontologie des meacutedecinsthinspstipulethinspquethinsplethinspmeacutedecinthinspdoitthinspobtenirthinspunthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspavantthinsptoutethinspinterventionthinspilthinspestthinsppreacuteciseacutethinspquethinsplethinspmeacutedecinthinspdoitthinspsrsquoassurerthinspquethinsplrsquoinformationthinsppertinentethinspathinspeacuteteacutethinsptransmisethinspfaciliterthinsplathinspprisethinspdethinspdeacutecisionthinspduthinsppatientthinspetthinsplathinsprespecterthinspLethinspCode de deacuteontologie

des infirmiegraveres et infirmiersthinspstipulethinspquantthinspagravethinspluithinspquethinsplrsquoinfirmiegraverethinspouthinsplrsquoinfirmierthinspdoitthinspfournirthinspauthinspclientthinsptoutesthinsplesthinspinformationsthinsprequisesthinsplorsquethinsplrsquoobligationthinspdrsquoobtenirthinspunthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspincombethinspagravethinsplrsquoinfirmiegraverethinspouthinspagravethinsplrsquoinfirmierthinspIlthinspnrsquoythinspathinsppasthinspdethinspdispositionthinsptouchantthinsppreacuteciseacutementthinsplethinspconsentementthinspdansthinsplethinspCode de

CMQ - OIIQ - OPIQ 18

deacuteontologie des inhalotheacuterapeutes du QueacutebecthinspCependantthinspilthinspestthinsppreacuteciseacutethinspqursquoenthinspplusthinspdesthinspavisthinspetthinspdesthinspconseilsthinsplrsquoinhalotheacuterapeutethinspdoitthinspfournirthinspagravethinspsonthinspclientthinsplesthinspexplicationsthinspneacutecessairesthinspagravethinsplathinspcompreacutehensionthinspetthinspagravethinsplrsquoappreacuteciationthinspdesthinspservicesthinspqursquoilthinspluithinsprend

TousthinsplesthinspprofessionnelsthinspsontthinspeacutevidemmentthinsptenusthinspdethinsprespecterthinsplesthinspdispositionsthinspleacutegalesthinspexistantesthinspndashthinspincluantthinspleurthinspcodethinspdethinspdeacuteontologiethinsprespectifthinspndashthinspetthinsplesthinspnormesthinspdethinsppratiquethinspeacutetabliesthinspparthinspleurthinspordrethinspprofessionnelthinspToutefoisthinsplathinspquestionthinspsethinspposethinspdethinspsavoirthinspcommentthinspcesthinspexigencesthinspdoiventthinspsrsquoappliquerthinspmaintenantthinspquethinspplusieursthinspinterventionsthinspreacutealiseacuteesthinspautrefoisthinspenthinspeacutetablissementthinspsontthinspeffectueacuteesthinspenthinspdehorsthinspthinspdethinspceux-cithinspetthinspquethinsplesthinspprofessionnelsthinsppartagentthinspcertainesthinspactiviteacutesthinspetthinsptravaillentthinsp

enthinspeacutetroitethinspcollaboration

Mecircmethinspsithinsplathinsploithinspnethinsplrsquoexigethinsppasthinsptoujoursthinspilthinspestthinsprecommandeacutethinsp

thinsprsaquo quethinsplethinsppatientthinspdonnethinspunthinspconsentementthinspeacutecritthinsplorsqursquoilthinspythinspathinspseacutedation-analgeacutesiethinspthinspetthinspcethinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspprodigueacutes

thinsprsaquo quethinsplethinspconsentementthinspportethinspagravethinsplathinspfoisthinspsurthinsplathinspseacutedation-analgeacutesiethinspetthinspsurthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspquethinspcettethinspderniegraverethinsppermet

thinsprsaquo quethinsplrsquoinformationthinsptransmisethinspauthinsppatientthinspverbalementthinspouthinspparthinspeacutecritthinspcomprennethinsplesthinsprisquesthinspdethinsplathinspseacutedation-analgeacutesiethinspetthinsplesthinsprisquesthinspdethinsplrsquointerventionthinspelle-mecircme

thinsprsaquo quethinsplethinspmeacutedecinthinspouthinsplethinspprofessionnelthinspagravethinspquithinspilthinspathinspconfieacutethinsplathinsptacircchethinspversethinspauthinspdossierthinspduthinsppatientthinspunethinspnotethinspexplicativethinspsurthinsplesthinspinformationsthinspfourniesthinspetthinsplethinspconsentementthinspobtenu

Lrsquoobtentionthinspdrsquounthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspdemeurethinspunethinspobligationthinspthinspinheacuterentethinspagravethinsplrsquointerventionthinspmeacutedicalethinspelle-mecircmethinspIlthinsprelegravevethinspdoncthinspdethinsplathinspresponsabiliteacutethinspduthinspmeacutedecinthinspdethinspsrsquoassurerthinspdethinsplathinsptransmissionthinspdethinsplrsquoinformationthinsppertinentethinspauthinsppatientthinspetthinspdethinspsathinspcompreacutehensionthinspdethinsplathinspnaturethinspduthinspbutthinspetthinspdesthinsprisquesthinsprelatifsthinspagravethinsplrsquointerventionthinspToutefoisthinsplathinsptacircchethinspdethinsptransmettrethinspdethinsplrsquoinformationthinspcompleacutementairethinsppeutthinspecirctrethinspconfieacuteethinspagravethinspdrsquoautresthinspprofessionnelsthinspthinspetthinspcellethinspdethinsprecueillirthinsplathinspsignaturethinspdrsquounthinspformulairethinspdethinspconsentementthinspagravethinspdrsquoautresthinspmembresthinspdethinsplrsquoeacutequipethinspdethinspsoins

CMQ - OIIQ - OPIQ 19

DIRECTIVESthinspETthinspCONSEILSthinsp

Avantthinspdethinspsubirthinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspsousthinspseacutedationthinsp-analgeacutesiethinsplethinsppatientthinspdoitthinsprecevoirthinsplesthinspdirectivesthinspneacutecessairesthinspdethinsppreacutefeacuterencethinspdansthinsp

unthinspdocumentthinspcontenantthinspentrethinspautresthinsplesthinsprecommandationsthinspsuivantesthinsp

a eacuteviterthinspdethinspconsommerthinsptoutethinspboissonthinspalcooliseacuteethinspdroguethinspouthinspsubstancethinspenthinspventethinsplibrethinsp(agravethinspmoinsthinspqursquoellethinspsoitthinspprescrite)thinsppouvantthinspalteacutererthinsplethinspniveauthinspdethinspconsciencethinspthinsp24thinspheuresthinspavantthinspetthinspapregravesthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

b observerthinspunethinsppeacuteriodethinspdethinspjeucircnethinspquithinspsrsquoappliquethinspagravethinsptoutthinspacircgethinspauxthinspcasthinspeacutelectifsthinsp(nonthinspurgents)thinspetthinspselonthinsplrsquoeacutevaluationthinspduthinsplaquothinsprapportthinsprisquebeacuteneacuteficethinspraquothinsppourthinsplesthinspcasthinspurgents

c suivrethinsplesthinsprecommandationsthinspduthinspmeacutedecinthinspquithinsppreacutecisethinspsithinsplesthinspmeacutedicamentsthinspprescritsthinspsurthinspunethinspbasethinspreacuteguliegraverethinsppeuventthinspecirctrethinspadministreacutesthinspcommethinspagravethinsplrsquoaccoutumeacuteethinspetthinspquithinspfaitthinsppartthinspdesthinspexceptionsthinsp(pthinspexthinspthinspanticoagulantthinsppsychotropethinspetc)thinspsrsquoilthinspythinspathinsplieuthinsp

Unethinspseacutedation-analgeacutesiethinspleacutegegraverethinspougravethinsplesthinspreacuteflexesthinspdethinspprotectionthinspdesthinspvoiesthinspthinspaeacuteriennesthinspsontthinsppreacuteserveacutesthinspestthinsppeuthinspsusceptiblethinspdrsquoinduirethinspunethinspaspirationthinspduthinspcon-tenuthinspgastriquethinspcontrairementthinspagravethinspunethinspseacutedationthinspplusthinspprofondethinspIlthinspestthinsptoutthinspdethinspmecircmethinspraisonnablethinspdethinsppenserthinspquethinsplethinsprisquethinspdrsquoaspirationthinspestthinspdiminueacutethinsplorsquethinsplrsquoestomacthinspestthinspvidethinspetthinspqursquounethinsppeacuteriodethinspdethinspjeucircnethinspavantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacutera-peutiquethinspestthinsppreacutefeacuterablethinspToutefoisthinspdansthinsptousthinsplesthinspcasthinsplrsquourgencethinspdethinsplrsquointerventionthinspetthinsplethinspniveauthinspdeacutesireacutethinspdethinspseacutedation-analgeacutesiethinspdoiventthinspecirctrethinspsoupeseacutesthinspauthinspregardthinspdesthinsprisquesthinspassocieacutesthinspagravethinspunthinspjeucircnethinspinadeacutequatthinspAinsithinsplethinspdeacutelaithinspentrethinsplrsquoheurethinspduthinspdernierthinsprepasthinspetthinsplethinspmomentthinspdethinsplathinspblessureaccidentthinspdoitthinspecirctrethinsppristhinspenthinspconsideacuterationthinsppourthinspestimerthinsplrsquoeacutetatthinspdethinspjeucircnethinspetthinspcethinspenthinspraisonthinspdethinsplrsquoileacuteusthinspreacuteflexethinsp

Avantthinsplathinspseacutedation-analgeacutesiethinspdrsquounethinspinterventionthinspnonthinspurgentethinsp(eacutelective)thinsplethinsppatientthinspdoitthinsprespecterthinsplesthinspdeacutelaisthinspsuivantsthinspselonthinsplathinspnaturethinspetthinsplathinspquantiteacutethinspingeacutereacuteethinspdethinspthinsp(Merchantthinspetthinspcollabthinsp2014a)thinsp

thinsprsaquo liquidethinspclairthinsp(pthinspexthinspthinspeauthinspjusthinspdethinspfruitthinsp[sansthinsppulpe]thinsptheacutethinspetthinspcafeacutethinspnoir)thinspthinspjeucircnethinspdethinsp2thinspheures

thinsprsaquo repasthinspleacutegerthinsp(pthinspexthinspthinsppainthinspgrilleacutethinsp+thinspliquidethinspclair)thinspthinspjeucircnethinspdethinsp6thinspheuresthinsprsaquo repasthinspcomposeacutethinspdethinspviandethinspouthinspdrsquoalimentsthinspfritsthinspouthinspgrasthinspthinspjeucircnethinspdethinsp8thinspheuresthinsp

CMQ - OIIQ - OPIQ 20

15thinspPERSEacuteDATION-ANALGEacuteSIEthinsp

APPROCHEthinspPHARMACOLOGIQUE

Lrsquoadministrationthinspdethinsptoutthinspmeacutedicamentthinspneacutecessitethinsplrsquoobtentionthinspdrsquounethinspordonnancethinsp

faitethinspenthinspvertuthinspdethinsplrsquoarticlethinsp393thinspduthinspCode des professions du QueacutebecthinspDrsquoailleursthinspthinsplathinspmeilleurethinspfaccedilonthinspdrsquoencadrerthinsplathinsppratiquethinspdethinsplrsquoinfirmiegraverethinspetthinspdethinsplrsquoinhalotheacuterapeutethinspestthinsplrsquoadoptionthinspdrsquounthinspprotocoleordonnancethinspcollectivethinspcomprenantthinspunthinspeacuteventailthinsptheacuterapeutiquethinspquithinsplaissethinspplacethinspauthinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspthinspUnthinsptelthinspdocumentthinspdoitthinspparthinspcontrethinspecirctrethinspenteacuterineacutethinspparthinsplesthinspresponsablesthinspmeacutedicauxthinspthinspdethinsplrsquoeacutetablissementthinspqursquoilthinspsoitthinsppublicthinspouthinsppriveacutethinsp

Soulignonsthinsplrsquoimportancethinspdrsquounthinspaccegravesthinspveineuxthinspfonctionnelthinspquithinspfaciliterathinsplrsquoadmi-nistrationthinspdesthinspagentsthinspseacutedatifsthinspetthinspanalgeacutesiquesthinspainsithinspquethinsplesthinsptraitementsthinsppharma-cologiquesthinspdesthinspcomplications

LethinspmeacutedecinthinsplrsquoinfirmiegraverethinspetthinsplrsquoinhalotheacuterapeutethinspdoiventthinsputiliserthinspunethinspmeacutedicationthinspqursquoilsthinspconnaissentthinspetthinspquithinspestthinspreconnuethinspRappelonsthinspqursquoilsthinspdoiventthinspecirctrethinspenthinspmesurethinspdethinspprendrethinspenthinspchargethinsptoutethinspcomplicationthinsppotentiellethinspythinspcompristhinsplathinspgestionthinspdrsquounthinsppassagethinspmomentaneacutethinspagravethinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspsupeacuterieurthinspagravethinspceluithinspquithinspthinspathinspeacuteteacutethinspplanifieacute

LethinspchoixthinspdethinsplathinspmeacutedicationthinsppeutthinspvarierthinspselonthinsplathinspsituationthinspcliniquethinspetthinsplesthinspfacteursthinsppropresthinspauthinsppatientthinspParthinspexemplethinspcertainsthinsppatientsthinspnethinsptolegraverentthinsppasthinsplesthinspdosagesthinsphabituelsthinspouthinsppreacutesententthinspdesthinspcontre-indications

Ilthinspestthinspimportantthinspdethinspretenirthinspquethinsplethinsptitragethinspdethinsptoutethinspmeacutedicationthinspdoitthinspecirctrethinspthinspprivileacutegieacutethinspetthinspquethinspsonthinspadministrationthinspdoitthinspsethinspfairethinspparthinsppetitesthinspdosesthinspdethinspthinspfaccedilonthinspprogressivethinspjusqursquoagravethinsplrsquoobtentionthinspduthinspniveauthinspdethinspseacutedationthinspetthinspdrsquoanalgeacutesiethinspthinspdeacutesireacutethinsptoutthinspenthinsplaissantthinspsrsquoeacutecoulerthinspsuffisammentthinspdethinsptempsthinspentrethinspdeuxthinspdosesthinsppourthinspquethinsplethinspmeacutedicamentthinspproduisethinspsesthinspeffetsthinsp

Lesthinspmeacutedicamentsthinsputiliseacutesthinspenthinspseacutedation-analgeacutesiethinspontthinspunthinspeffetthinspsynergiquethinspthinspParthinspexemplethinsplrsquoassociationthinspdrsquounethinspbenzodiazeacutepinethinspavecthinspunthinspopioiumldethinspaugmentethinspthinsplesthinsprisquesthinspdethinspdeacutepressionthinsprespiratoirethinspLeurthinspdosagethinspdoitthinspdoncthinspecirctrethinspajusteacutethinspenthinspconseacutequencethinspSithinsplrsquoobstructionthinspdesthinspvoiesthinspaeacuteriennesthinsplrsquoapneacuteethinspetthinsplrsquohypotensionthinspthinspsontthinsplesthinspcomplicationsthinsplesthinspplusthinspfreacutequentesthinspenthinspseacutedation-analgeacutesiethinspilthinspfautthinspretenirthinspquethinspcertainesthinspcomplicationsthinsppeuventthinspecirctrethinspparticuliegraveresthinspagravethinsplathinspmeacutedicationthinsputiliseacuteethinspthinspCitonsthinspagravethinsptitrethinspdrsquoexemplethinsplrsquoassociationthinsplaryngospasmethinspetthinspkeacutetaminethinsp

CMQ - OIIQ - OPIQ 21

Lorsquethinspdesthinspbenzodiazeacutepinesthinspouthinspdesthinspopioiumldesthinspsontthinspadministreacutesthinspparthinspvoiethinspthinspintraveineusethinspleursthinspantagonistesthinsprespectifsthinsp(pthinspexthinspthinspflumazeacutenilthinsp[Anexatereg]thinspthinspnaloxonethinsp[Narcanreg])thinspdoiventthinspecirctrethinsprapidementthinspdisponiblesthinspIlsthinspserontthinsputiliseacutesthinspthinspauthinspmomentthinspdrsquounethinspdeacutepressionthinsprespiratoirethinspinduitethinspparthinsplathinspmeacutedicationthinspet non en prophylaxiethinspchezthinsplethinsppatientthinspstablethinspIlthinspestthinsphabituellementthinsppreacutefeacuterablethinspdethinspthinsprenverserthinspdrsquoabordthinsplrsquoagentthinspseacutedatifthinspafinthinspdethinspmaintenirthinspintactthinsplrsquoeffetthinspanalgeacutesiquethinspthinspSithinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspdemeurethinspcompromisethinspilthinspserathinspalorsthinspthinspneacutecessairethinspdethinsprenverserthinsplrsquoeffetthinspanalgeacutesique

IlthinspfautthinspsethinsprappelerthinspquethinsplathinspdureacuteethinspdrsquoactionthinspdesthinspantagonistesthinspestthinspbienthinspinfeacuterieurethinspthinspagravethinsplathinspdureacuteethinspdrsquoactionthinspduthinspmeacutedicamentthinspdevantthinspecirctrethinspneutraliseacutethinspParthinspconseacutequentthinspthinsplathinspreacuteapparitionthinspdethinsplrsquoeffetthinspindeacutesirablethinspestthinspagravethinspsurveillerthinspchezthinsplethinsppatientthinspquithinspreccediloitthinspunthinspantagonistethinsp

VousthinsptrouverezthinspunethinspfichethinspinformativethinspsurthinsplrsquoutilisationthinspdethinsplathinspnaloxonethinspetthinspduthinspflumazeacutenilthinspagravethinsplrsquoannexethinspXI

Lesthinspdirectivesthinspeacutenonceacuteesthinspdansthinspcesthinsplignesthinspdirectricesthinspnrsquoontthinsppasthinsppourthinspobjectifthinspdethinspdeacutecrirethinspdansthinsplethinspdeacutetailthinsplathinspmeacutedicationthinsputiliseacuteethinspenthinspseacutedation-analgeacutesiethinspleursthinspagentsthinsp

antagonistesthinspetthinsplesthinspmeacutedicamentsthinspdrsquourgencethinspIlthinsprevientthinspauthinspmeacutedecinthinspdethinspbienthinsp

connaicirctrethinsplathinspmeacutedicationthinspetthinspdethinspchoisirthinspunethinspmeacutedicationthinspouthinspunethinspcombinaisonthinspdethinspmeacutedicamentsthinspreconnuethinspEtthinspilthinsprevientthinspauxthinspprofessionnelsthinspquithinsplesthinspadministrentthinsp

dethinspbienthinsplesthinspconnaicirctrethinspeacutegalementthinsp(eacuteleacutementsthinspdethinspsurveillancethinspcliniquethinsptechniquethinspdrsquoadministrationthinspeffetsthinspsecondairesthinspinteractionsthinspcontre-indicationsthinspseuilsthinspthinsptoxiquesthinspetc)thinspetthinspdethinspmaintenirthinspagravethinspjourthinspleursthinspconnaissancesthinspdansthinspcethinspdomaine

thinspPRINCIPALESthinspCLASSESthinspPHARMACOTHEacuteRAPEUTIQUESthinspUTILISEacuteESthinspthinspthinspENthinspSEacuteDATION-ANALGEacuteSIEthinsp

Lathinsplistethinspdesthinspmeacutedicamentsthinspabordeacutesthinspci-dessousthinspnrsquoestthinsppasthinsplimitativethinsp

a BenzodiazeacutepinesthinspProprieacuteteacutesthinspthinspanxiolytiquethinspamneacutesiquethinsphypnotiquethinsprelaxantthinspmusculairethinspetthinspanticonvulsivantthinspthinspIlthinspfautthinspprivileacutegierthinsplesthinspmoleacuteculesthinspagravethinspcourtethinspdemi-viethinsp(pthinspexthinspthinspmidazolamthinsp[Versedreg])thinspenthinspretenantthinspqursquoilthinspfautthinspajusterthinsplethinspdosagethinspchezthinspcertainsthinsppatientsthinsp(pthinspexthinspthinspacircgeacutesthinspouthinspaffaiblis)thinspetthinsplorsthinspdethinsplrsquoutilisationthinspconcomitantethinspdrsquoautresthinspmeacutedicamentsthinspaffectantthinsplethinspsystegravemethinspnerveuxthinspcentralthinspDethinspplusthinsplathinspdemi-viethinsp

CMQ - OIIQ - OPIQ 22

dethinspcesthinspmeacutedicamentsthinsppeutthinspecirctrethinspaugmenteacuteethinsplorsthinspdethinspleurthinspadministrationthinspenthinspperfusionthinspcontinuethinsp(context sensitive half-life)thinsp

b OpioiumldesthinspProprieacuteteacutesthinspthinspanalgeacutesiquethinspetthinspseacutedativethinspLathinspmorphinethinspconstituethinspunthinspopioiumldethinspdontthinsplrsquoefficaciteacutethinspestthinspreconnuethinspCependantthinspellethinspfavorisethinsplathinsplibeacuterationthinspdrsquohistaminethinspcethinspquithinsppeutthinspcauserthinspduthinsppruritthinspetthinspdethinsplrsquohypotensionthinspUnethinspdysfonctionthinspreacutenalethinspseacutevegraverethinspentraicircnethinsplrsquoaccumulationthinspdethinspsesthinspmeacutetabolitesthinspactifsthinsp

thinsprsaquo lethinspfentanylthinsp(Sublimazereg)thinspestthinspunthinspopioiumldethinspsyntheacutetiquethinsppuissantthinspetthinspdethinspcourtethinspdureacuteethinspdrsquoactionthinspIlthinspnethinspdeacuteclenchethinsppasthinspdethinsplibeacuterationthinspdrsquohistaminethinsp(doncthinsppeuthinspdrsquoeffetthinspheacutemodynamique)thinspIlthinspfautthinspcependantthinspsethinspmeacutefierthinspdesthinspdosesthinspeacuteleveacuteesthinspetthinspdesthinspinjectionsthinsprapidesthinspquithinsppeuventthinspprovoquerthinspunethinsprigiditeacutethinspmusculairethinspthinspetthinspunethinspdeacutepressionthinsprespiratoire

thinsprsaquo lrsquohydromorphonethinsp(Dilaudidreg)thinspestthinspunthinspopioiumldethinspsemi-syntheacutetiquethinspdontthinsplesthinspmeacutetabolitesthinspconnusthinspsontthinsprarementthinspprobleacutematiquesthinspMoinsthinsputiliseacuteethinspenthinspthinspseacutedation-analgeacutesiethinspellethinspestthinspauthinspmoinsthinsp5thinspfoisthinspplusthinsppuissantethinspquethinsplathinspmorphinethinspthinspcethinspquithinspestthinspparfoisthinspsous-estimeacute

thinsprsaquo lathinspmeacutepeacuteridinethinsp(Demerolreg)thinspestthinspunthinspopioiumldethinspsyntheacutetiquethinspposseacutedantthinspunthinspmeacuteta-bolitethinspactifthinspneurotoxiquethinspEllethinspnrsquoestthinsphabituellementthinsppasthinsprecommandeacuteethinsp

c Anestheacutesiques geacuteneacuterauxthinspLethinspmeacutedecinthinspquithinspprocegravedethinspagravethinspunethinspinterventionthinspsousthinspseacutedation-analgeacutesiethinspenthinsputilisantthinspunthinspouthinspdesthinspanestheacutesiquesthinspgeacuteneacuterauxthinspdoitthinspecirctrethinspexpeacuterimenteacutethinspenthinspseacutedation-analgeacutesiethinspetthinspenthinspreacuteanimationthinspcardiorespiratoirethinspDansthinsplethinspcasthinspcontrairethinspilthinspdoitthinspsrsquoassurerthinspdethinsplathinspcollaborationthinspdrsquounthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspParthinspailleursthinsplethinspmeacutedecinthinspdoitthinspenthinsptoutthinsptempsthinspecirctrethinspsoutenuthinspparthinspunthinspouthinspdesthinspprofessionnelsthinspqualifieacutesthinsp

thinsprsaquo propofolthinsp(Diprivanreg)thinspProprieacuteteacutesthinspseacutedativethinsphypnotiquethinspamneacutesiquethinspanxiolytiquethinspAgravethinspnoterthinspqursquoilthinspnrsquoathinspaucune proprieacuteteacute analgeacutesiquethinsp

thinspIlthinsppossegravedethinspunethinspdemi-viethinspcourtethinsppeutthinspecirctrethinspcumulatifthinspetthinspnrsquoathinsppas drsquoantago-nistethinspIlthinspnrsquoestthinsppasthinsprecommandeacutethinspchezthinsplathinspfemmethinspenceintethinspouthinspquithinspallaitethinspEnthinspregraveglethinspgeacuteneacuteralethinspetthinspselonthinsplethinsptypethinspdrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspilthinsppeutthinspecirctrethinspplusthinspjudicieuxthinspdethinsplrsquoadministrerthinspenthinspinfusionthinspIVthinspplutocirctthinspthinspqursquoenthinspbolusthinspthinspthinspIlthinsppeutthinsprapidementthinspcauserthinspunethinspdiminutionthinspmarqueacuteethinspduthinspniveauthinspdethinspcon-sciencethinspetthinspunethinspdeacutepressionthinsprespiratoirethinsppouvantthinspconduirethinspmomentaneacute-

CMQ - OIIQ - OPIQ 23

mentthinspagravethinspunethinspanestheacutesiethinspgeacuteneacuteralethinspnonthinspdeacutesireacuteethinspLesthinspprofessionnelsthinspenthinspplacethinspdoiventthinspecirctrethinspenthinspmesurethinspdethinspprendrethinspenthinspchargethinspunethinsptellethinspsituationthinspLrsquoASAthinsp(AmericanthinspSocietythinspofthinspAnesthesiologiststhinspASAthinspHousethinspofthinspDelegatesthinsp2004bthinsp[Notrethinsptraduction])thinsprecommandethinspnotammentthinspquethinsplethinsppatientthinspagravethinspquithinsplrsquoonthinspadministrethinspduthinsppropofolthinspreccediloivethinspdesthinspsoinsthinspenthinsplienthinspavecthinspunethinspseacutedationthinsppro-fondethinsp(niveauthinspnonthinspviseacutethinspdansthinspcesthinsplignesthinspdirectrices)thinspetthinspquethinsplethinspprofessionnelthinsp(nonthinspanestheacutesiologiste)thinspadministrantthinsplethinsppropofolthinsppossegravedethinsplathinspformationthinsptheacuteoriquethinspetthinsppratiquethinspneacutecessairethinspagravethinsplrsquoidentificationthinspetthinspagravethinsplathinspprisethinspenthinspchargethinspdesthinspvoiesthinspaeacuteriennesthinspetthinspdesthinspchangementsthinspcardiovasculairesthinspquithinspsurvien-nentthinspchezthinspunthinsppatientthinspeacutevoluantthinspversthinspunthinspeacutetatthinspdrsquoanestheacutesiethinspgeacuteneacuteralethinsp(niveauthinspnonthinspviseacutethinspdansthinspcesthinsplignesthinspdirectrices)thinsp

thinspthinspLorsquethinsplethinsppropofolthinspestthinspadministreacutethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspthinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspthinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspthinspobligatoirethinsp(tableauthinsp3)thinspthinspthinsp

thinsprsaquo keacutetaminethinsp(Ketalarreg)thinspProprieacuteteacutesthinspthinspseacutedativethinspetthinspanalgeacutesiquethinspthinspUtiliseacuteethinspenthinsppeacutediatriethinspetthinspchezthinsplrsquoadultethinspEllethinspproduitthinspaussithinspunethinspbroncho-thinspdilatationthinspparfoisthinspsouhaiteacuteethinsplorsthinspdrsquointerventionsthinspdiagnostiquesthinspouthinsptheacutera-peutiquesthinspchezthinsplesthinsppatientsthinspasthmatiquesthinspEllethinspsrsquoaccompagnethinspdrsquounethinsplibeacutera-tionthinspdethinspcateacutecholaminesthinspetthinspdrsquoeffetsthinspsympathomimeacutetiquesthinsp(augmentationthinspdethinsplathinspsalivation)thinspEllethinsppeutthinspprovoquerthinspdesthinspsymptocircmesthinsppsychotiquesthinspouthinspdesthinspcomportementsthinspanormauxthinspCesthinspsymptocircmesthinsppeuventthinspnuirethinspagravethinsplrsquoeacutevaluationthinspdesthinsppatientsthinspsousthinspseacutedationthinspEllethinspabaissethinsplethinspseuilthinspconvulsifthinsp

Lorsquethinsplathinspkeacutetaminethinspestthinspadministreacuteethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspobligatoirethinsp(tableauthinsp3)thinspthinsp

thinsprsaquo protoxydethinspdrsquoazotethinsp(N2O)thinsp

ProprieacuteteacutesthinspthinspgazthinspseacutedatifthinspetthinspanalgeacutesiquethinspthinspActionthinspanalgeacutesiquethinspsemblablethinspagravethinspcellethinspdethinsplathinspmorphinethinspIlthinsppotentialisethinsplesthinspanalgeacutesiquesthinspcentrauxthinspetthinsplesthinspagentsthinsphypnotiquesthinspetthinsppeutthinspaussithinspdiminuerthinsplesthinspreacuteservesthinspenthinspoxygegravenethinspduthinsppatientthinspUtiliseacutethinspenthinspcombinaisonthinspavecthinsplrsquooxygegravenethinspIlthinsppeutthinsppolluerthinsplrsquoenvironnementthinspdethinsptravailthinsp(voirthinspnormesthinspCSST)thinspIlthinsppeutthinspecirctrethinsp

CMQ - OIIQ - OPIQ 24

utiliseacutethinspenthinsppeacutediatriethinspchezthinsplrsquoadultethinspetthinspchezthinsplathinspfemmethinspenceintethinsp(saufthinspauthinspthinsppremierthinsptrimestre)thinsp

thinspDansthinsplethinspcasthinspougravethinsplethinspprotoxydethinspdrsquoazotethinspestthinsputiliseacutethinspenthinspcombinaisonthinspavecthinspunthinspagentthinspseacutedatifthinspouthinspunthinspopioiumldethinspouthinspsithinsplrsquoappareilthinsputiliseacutethinsppermetthinspdethinspmodifierthinsplathinspconcentrationthinspdrsquooxygegravenethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivement agravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspthinsp

thinsprsaquo dexmeacutedeacutetomidinethinsp(PreacuteceacutedexMC)thinsp(Agonistethinspalpha2-adreacutenergique)thinspProprieacuteteacutesthinspthinspseacutedativethinspanalgeacutesiquethinspetthinspanxiolytiquethinspthinspLathinspdexmeacutedeacutetomidinethinspenthinspperfusionthinspintraveineusethinspcontinuethinspestthinspindiqueacuteethinspnotammentthinsppourthinsplathinspseacutedationthinspdethinsppatientsthinspnonthinspintubeacutesthinspavantthinspetouthinsppendantthinspunethinspinterventionthinspchirurgicalethinspouthinspdrsquoautresthinsptypesthinspdrsquointerventionsthinspthinspNethinspcausethinspaucunethinspdeacutepressionthinsprespiratoirethinspmaisthinsppeutthinspcauserthinspunethinspbradycar-diethinspetthinspunethinsphypotensionthinspthinsp

thinspLrsquoutilisationthinspdethinspdexmeacutedeacutetomidinethinspdevraitthinspecirctrethinspreacuteserveacuteethinspauthinspmilieuthinspthinsphospitalierthinspouthinspauxthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspthinspEllethinspdevraitthinspecirctrethinspadministreacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspthinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspetthinsprapidementthinspdisponiblethinspthinspLorsquethinspdethinsplathinspdexmeacutedeacutetomidinethinspestthinspadministreacuteethinspunthinspprofessionnelthinspthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspthinspduthinsppatientthinsp(tableauthinsp2)thinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspobligatoirethinsp(tableauthinsp3)thinspthinsp

Agravethinspnoterthinspqursquoilthinspestthinspobligatoirethinspdethinsptenirthinspunthinspregistrethinspdesthinspsubstancesthinspcontrocircleacuteesthinspetthinspdesthinspbenzodiazeacutepinesthinspcomportantthinspdesthinspsignatures

thinsp

CMQ - OIIQ - OPIQ 25

SURVEILLANCEthinspCLINIQUEthinspLathinspsurveillancethinspcliniquethinspcomprendthinspplusieursthinspeacuteleacutementsthinspquithinspconcernentthinspthinspnotammentthinsplesthinspsystegravemesthinsprespiratoirethinspcardiaquethinspetthinspneurologiquethinspEllethinspdoitthinspthinsptenirthinspcomptethinspentrethinspautresthinsp

thinsprsaquo dethinsplathinspconditionthinspduthinsppatientthinspavantthinspetthinsppendantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

thinsprsaquo dethinsplathinspcomplexiteacutethinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinsprsaquo dethinsplathinspmeacutedicationthinsputiliseacuteethinsp(dosethinspdureacuteethinspetthinsppicthinspdrsquoactionthinspvoiethinspetthinspvitessethinspthinsp

drsquoadministrationthinspcombinaisonthinspetthinspantagonistes)

thinsprsaquo dethinsplrsquoassistancethinspagravethinspapporterthinspauthinspmeacutedecin

Lethinspmeacutedecinthinspquithinsppratiquethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspchezthinspunthinsppatientthinspsousthinspseacutedation-analgeacutesiethinspdoitthinspcompterthinspsurthinsplathinsppreacutesencethinspdrsquoauthinspmoinsthinspunthinspautrethinspprofessionnelthinsphabiliteacutethinspduthinspmilieuthinspdethinsplathinspsanteacutethinsp(infirmiegraverethinspinhalotheacuterapeutethinspouthinspautrethinspmeacutedecin)thinsp(annexethinspII)thinspEnthinspeacutetroitethinspcollaborationthinspavecthinsplethinspmeacutedecinthinspreacuteali-santthinsplrsquointerventionthinspceux-cithinspassurentthinspthinsplathinspgestionthinspdethinsplathinspseacutedationthinspetthinspdethinsplrsquoanalgeacutesiethinspqui comprend entre autres la surveillance clinique du patientthinspresponsabiliteacutethinspthinspagravethinsplaquellethinspilsthinspdoiventthinspenthinsptoutthinsptempsthinspsethinspconsacrerthinspenthinspprioriteacutethinsp

Dansthinspcertainsthinspcasthinsplethinspprofessionnelthinspquithinspassurethinspen prioriteacutethinsplathinspsurveillancethinspthinspcliniquethinspduthinsppatientthinsppeutthinspecirctrethinspappeleacutethinspagravethinspassisterthinsplethinspmeacutedecinthinspdansthinsplathinspreacutealisationthinspthinspdethinspsonthinspinterventionthinspCettethinspassistancethinspquithinspdoitthinspsrsquoeffectuerthinspdansthinsplathinspmecircmethinsppiegravecethinspdoitthinspecirctrethinspdethinsptregravesthinspcourtethinspdureacuteethinspDethinspplusthinspellethinspdoitthinsppouvoirthinspecirctrethinspinterrompuethinspthinspagravethinsptoutthinspmomentthinsppourthinspintervenirthinspimmeacutediatementthinspaupregravesthinspduthinsppatientthinspenthinspcasthinspdethinsp

complicationsthinspouthinspdethinspbesoin

Parthinspailleursthinsplorsquethinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspthinspneacutecessitentthinspunethinspassistancethinsptechniquethinspcontinuellethinspauthinspmeacutedecinthinsplrsquoajoutthinspdrsquounthinsptroisiegravemethinspprofessionnelthinspdethinsplathinspsanteacutethinsphabiliteacutethinsp(meacutedecinthinspinfirmiegraverethinspouthinspinhalotheacuterapeute)thinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinspestthinsprequisthinsp

CMQ - OIIQ - OPIQ 26

Tableau 2 Tableau reacutecapitulatif du nombre de professionnels habiliteacutes requis en seacutedation-analgeacutesie - Clientegravele adulte

Toutthinspauthinsplongthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplathinspsurveillancethinspcliniquethinspthinspduthinsppatientthinspdoitthinspecirctrethinspcontinuethinspetthinsplathinspcommunicationthinspavecthinspcelui-cithinspmaintenue

Proceacutederthinspagravethinsplathinspsurveillancethinspcliniquethinspcrsquoestthinspeacutevaluerthinspqualitativementthinspetthinspquantitative-mentthinspdethinspfaccedilonthinspsoutenuethinspetthinspenthinspcontinuthinsplrsquoensemblethinspdesthinspparamegravetresthinspsuivantsthinsp(listethinsp

nonthinsplimitative)thinsp(tableauthinsp3)thinsp

thinsprsaquo mesurethinspdethinsplathinsppressionthinsparteacuteriellethinspduthinsppouls3thinspetthinspdethinsplathinsprespiration4thinsprsaquo lecturethinspdethinsplathinspsaturationthinspcapillairethinspenthinspoxygegravene

Ilthinspfautthinspnoterthinspquethinsplathinsptonaliteacutethinspdethinsppoulsthinspdoitthinspecirctrethinspactiveacuteethinspenthinsptoutthinsptempsthinspetthinspsonthinspniveauthinspdoitthinspecirctrethinspajusteacutethinspdethinspfaccedilonthinspagravethinspecirctrethinspentenduthinspclairement

thinsprsaquo eacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplathinspseacutedationthinsp(eacutevaluationthinspdethinsplathinspseacutedationagitationthinspetthinspduthinspniveauthinspdethinspconscience)thinsp(annexethinspIX)thinsp

thinsprsaquo eacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplrsquoanalgeacutesiethinsp(eacutevaluationthinspdethinsplathinspdouleur)thinspdethinsplrsquoanxieacuteteacutethinspetthinspdethinsplathinspreacuteactionthinspduthinsppatientthinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsp(annexethinspX)

thinsprsaquo eacutevaluationthinspdethinsplrsquoeacutetatthinspdethinsplathinspcolorationthinspetthinspdethinsplathinsptempeacuteraturethinspdethinsplathinsppeauthinsprsaquo eacutevaluationthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsprsaquo niveauthinspdrsquoO

2thinspdethinspCO

2thinspetthinspmonitoragethinspcardiaquethinspselonthinsplethinspcas

3thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp4thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

Nombrethinspdethinspprofessionnelsthinsphabiliteacutesthinsprequis

2 Nombrethinspmimimalthinsprequis

3 Sithinsputilisationthinspdethinsppropofolthinspkeacutetaminethinspouthinspdethinspdexmeacutedeacutetomidine

3 SithinsputilisationthinspconcomitantethinspdethinspN2Othinspetthinspdrsquounthinspagentthinspseacutedatifthinspouthinspthinsp

dunthinspopioiumldethinspouthinspsithinspconcentrationthinspdethinspN2Othinspmodifiable

3 Sithinsplassistancethinsptechniquethinspauthinspmeacutedecinthinspestthinspcontinuelle

CMQ - OIIQ - OPIQ 27

Tableau 3 Surveillance des paramegravetres cliniques en seacutedation-analgeacutesie - Clientegravele adulte

Paramegravetrethinspdethinspthinspsurveillancethinspthinspclinique

PatientNiveauthinspdethinspthinspseacutedation

MeacutedicationInterventionthinspdiagnostiquethinspouthinsptheacuterapeutique

TAthinspRC5thinspthinspRR6thinspthinspetthinspsaturationthinspdrsquoO

thinsp2thinspthinsp

rsaquothinspObligatoireChezthinsptousthinsplesthinsppatients

Niveauthinspdethinspthinsp-thinspseacutedationthinspthinspthinspagitationthinspthinspthinspthinspconscience-thinspdouleur

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

NiveauthinspdethinspCO2

SelonthinsplesthinspthinspcaracteacuteristiquesthinspAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspthinspmeacutedication

Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire

rsaquothinspAccegravesthinspindirectthinspthinspthinspthinspthinspouthinsprestreintthinspthinspthinspthinspauthinsppatientthinspthinspthinspthinsp(pthinspexthinspthinspIRM)

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

rsaquothinspRecommandeacute

rsaquothinspASAthinspgethinsp3thinsprsaquothinspApneacuteethinspthinspobstructivethinspthinspthinspthinspduthinspsommeilthinsprsaquothinspMaladiethinspthinspthinspthinsprespiratoirethinsprsaquothinspObeacutesiteacutethinspmorbide

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

Monitoragethinspcardiaque

SelonthinsplesthinspcaracteacuteristiquesAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

SelonthinsplathinspmeacutedicationSelonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoirersaquothinspASAthinspgethinsp3thinsprsaquothinspMaladiethinspthinspthinspthinspcardiaque

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

Interventionthinspdiagnostiquethinspthinspouthinsptheacuterapeutiquethinspprolongeacuteethinsp(effetthinspcumulatifthinspdethinsplathinspmeacutedication)

rsaquothinspRecommandeacute

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

thinspthinspthinspthinspthinspIlthinspnethinspsrsquoagitthinsppasthinspdrsquounethinsplistethinsplimiteacuteethinspdesthinspsituationsthinspcliniquesthinspDrsquoautresthinspsituationsthinspcliniquesthinsppeuventthinspneacutecessiterthinsplethinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspmonitoragethinspcardiaquethinspouthinspduthinspCO

2thinspIlthinsprevientthinspauxthinspprofessionnelsthinspdethinspjugerthinspdethinsplathinspsituationthinspenthinspfonctionthinspdethinspchaquethinspthinspthinsp

thinspthinspthinspthinspthinspthinsppatient5thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp6thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

CMQ - OIIQ - OPIQ 28

LethinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspimpliqueacutesthinspestthinspprimordialthinspetthinspcethinspmecircmethinspsithinsplrsquoappareillagethinspenthinspplacethinspestthinspcompletthinspetthinspfonctionnelthinspUnethinspbonnethinspcommunica-tionthinspentrethinspcesthinspderniersthinspestthinspdoncthinspessentiellethinspafinthinspdethinspbienthinspcoordonnerthinsplathinspseacutedationthinsp

etthinsplrsquoanalgeacutesiethinspavecthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspLes alarmes (audibles et visuelles) de chaque appareil doivent ecirctre en fonction et les paramegravetres ajusteacutes aux caracteacuteristiques du patient et agrave sa condition clinique

IlthinspfautthinspsrsquoassurerthinspdethinsplathinsptraccedilabiliteacutethinspdethinsplrsquoeacutevaluationthinspetthinspdethinsplathinspsurveillancethinspcliniquethinspthinspeffectueacuteesthinspparthinspunethinsptenuethinspdethinspdossiersthinspconformethinspauxthinspnormesthinspenthinspvigueurthinspLesthinspoutilsthinspdrsquoeacutevaluationthinsputiliseacutesthinspdoiventthinspecirctrethinspsimplesthinspstandardiseacutesthinspvalideacutesthinspdethinsppreacutefeacuterencethinspetthinspadapteacutesthinspauthinspcontextethinspetthinspauxthinspcaracteacuteristiquesthinspduthinsppatientthinspnotam-mentthinsppourthinsplrsquoeacutevaluationthinspduthinspniveauthinspdethinspseacutedationagitationthinspdethinspconsciencethinspetthinspdethinspdouleurthinsp(annexesthinspIXthinspetthinspX)

Lathinspfreacutequencethinspdethinsplathinspmesurethinspdethinspcesthinspparamegravetresthinspetthinspleurthinspenregistrementthinspdoiventthinspecirctrethinspdeacutetermineacutesthinspentrethinspautresthinspenthinspfonctionthinspdethinsplathinspmeacutedicationthinspetthinspdethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsp

Ideacutealementthinsplethinspprofessionnelthinspdoitthinsplesthinspdocumenterthinsp

thinsprsaquo avantthinsplethinspdeacutebutthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsprsaquo apregravesthinsplrsquoadministrationthinspdrsquounthinspagentthinspdethinspseacutedation-analgeacutesiethinspouthinspdrsquounthinspantagonistethinsprsaquo authinsppicthinspdrsquoactionthinspdethinspchacunthinspdesthinspagentsthinspadministreacutesthinspthinsprsaquo agravethinspintervallesthinspreacuteguliersthinsp(pthinspexthinspthinsp5thinspminutes)thinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-thinsp

analgeacutesiethinsprsaquo agravethinspintervallesthinspplusthinsprapprocheacutesthinsplorsquethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsplrsquoexigethinsprsaquo durantthinsplathinsppeacuteriodethinspdethinspreacutecupeacuterationthinspetthinspjusqursquoauthinspretourthinspduthinspniveauthinspdethinspconsciencethinsp

initialethinspselonthinsplathinspconditionthinspcliniquethinspduthinsppatientthinsprsaquo authinspmomentthinspduthinspcongeacute

ILthinspFAUTthinspSAVOIRthinspQUE

LathinspSocieacuteteacutethinspcanadiennethinspdesthinspanestheacutesiologistesthinsp(SCA)thinspindiquethinspquethinsplesthinspthinspdirectivesthinspgeacuteneacuteralesthinspdethinspsoinsthinsp(ythinspcompristhinsplethinspmonitorage)thinsppourthinsplathinspseacutedationthinspconscientethinspsontthinsplesthinspmecircmesthinspquethinsppourthinsplesthinspautresthinspformesthinspdrsquoanestheacutesiethinsp[]thinsp(Merchantthinspetthinspcollabthinsp2014b)thinspDethinspplusthinspellethinspindiquethinspquethinsplethinspcapnographethinspthinspestthinsprequisthinsplorsthinspdethinspseacutedation-analgeacutesiethinspdethinspniveauthinspplusthinspeacuteleveacutethinsp(pthinspexthinspthinspRamsaythinspthinsp4-6)thinsp(Merchantthinspetthinspcollabthinsp2014athinspop cit)

CMQ - OIIQ - OPIQ 29

thinsp16thinspPOSTSEacuteDATION-ANALGEacuteSIEthinsp

Lethinsppatientthinspestthinspagravethinsprisquethinspdethinspdeacutevelopperthinspdesthinspcomplicationsthinspagravethinsplathinspsuitethinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspsurtoutthinspsithinspcettethinspproceacutedurethinspestthinspdethinspcourtethinspdureacuteethinsp(pthinspexthinspthinspdeacutepressionthinsprespiratoirethinsphypotension)thinspEnthinspeffetthinspcertainsthinspmeacutedicamentsthinsptelsthinspquethinsplethinspmidazolamthinspetthinsplethinspfentanylthinspnethinspserontthinsppasthinspcomplegravetementthinspeacutelimineacutesthinspsithinsplathinspdureacuteethinspdethinsplrsquointerventionthinspestthinspmoinsthinspdethinsp30thinspminutesthinspDrsquoautresthinspfacteursthinsptelsthinspquethinsplethinspmanquethinspthinspdethinspstimulationthinspouthinsplrsquoabsorptionthinspretardeacuteethinspdrsquounthinspmeacutedicamentthinsppeuventthinspcontribuerthinspthinspagravethinspunethinspseacutedationthinspprolongeacuteethinspouthinsprebond

Unethinspdeacutepressionthinsprespiratoirethinsppeutthinspsurvenirthinspjusqursquoagravethinspeacuteliminationthinspcomplegravetethinspthinspduthinspmeacutedicamentthinsp

ParthinspconseacutequentthinspjusqursquoagravethinspsonthinspdeacutepartthinsplethinsppatientthinspdoitthinspecirctrethinspsousthinsplathinspsurveillancethinspdrsquounthinspprofessionnelthinsphabiliteacutethinspagravethinspreconnaicirctrethinsplesthinspcomplicationsthinspetthinspagravethinspintervenirthinsprapidementthinspplusthinspparticuliegraverementthinsppourthinspmaintenirthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspetthinspassurerthinsplrsquoassistancethinspventilatoirethinspLethinspmeacutedecinthinspayantthinspproceacutedeacutethinspagravethinsplrsquointerventionthinspsousthinspseacutedation-analgeacutesiethinspouthinspunthinspmeacutedecinthinspdeacutesigneacutethinspdoitthinspecirctrethinspdisponiblethinspenthinsptoutthinsptempsthinspafinthinspdethinsppouvoirthinspintervenirthinspsansthinspdeacutelaithinsplethinspcasthinspeacutecheacuteant

Rappelonsthinspquethinsplesthinspappareilsthinspdethinspmonitoragethinspdoiventthinspecirctrethinspenthinspfonctionthinspmaisthinspthinspenthinspaucunthinsptempsthinspilsthinspnethinspremplacentthinsplathinspsurveillancethinspdirectethinspduthinsppatientthinspparthinspthinsplethinspprofessionnel

Lethinsppatientthinspdoitthinspresterthinspagravethinsplathinspsallethinspdethinspreacutecupeacuterationthinspouthinspdrsquoobservationthinsppendantthinspthinsp30thinspminutesthinspauthinspminimumthinspapregravesthinspavoirthinspreccediluthinsplathinspderniegraverethinspdosethinspdethinspseacutedationthinspouthinspthinspdrsquoanalgeacutesiethinspintraveineusethinsp(Merchantthinspetthinspcollabthinsp2014bthinspop cit)

Sithinspunethinspmeacutedicationthinspantagonistethinspathinspeacuteteacutethinspadministreacuteethinsplethinsppatientthinspserathinspgardeacutethinspsousthinspthinspobservationthinsplethinsptempsthinspneacutecessairethinsp(lethinsptempsthinspserathinspaugmenteacutethinspdethinspgethinsp2thinspheuresthinspthinsp[Merchantthinspetthinspcollabthinsp2014bthinspop cit]thinspenthinspfonctionthinspdethinsplrsquoeacutetatthinspcliniquethinspduthinsppatient)thinsppourthinspsrsquoassurerthinspqursquoilthinspnrsquoythinspathinsppasthinspdethinspseacutedationthinsprebond

Parmithinsplesthinspcritegraveresthinspagravethinsprespecterthinspauthinspmomentthinspduthinspcongeacutethinsp

thinsprsaquo voiesthinspaeacuteriennesthinsppermeacuteablesthinspetthinspventilationthinspadeacutequatethinsprsaquo stabiliteacutethinspcardiovasculairethinspadeacutequatethinsprsaquo niveauthinspdethinspconsciencethinspduthinsppatientthinsprevenuthinspagravethinspsonthinspeacutetatthinspinitialthinsprsaquo douleurthinspreacutesiduellethinsptoleacuterablethinspabsentethinspouthinspcommethinspagravethinspsonthinspeacutetatthinspinitial

CMQ - OIIQ - OPIQ 30

thinsprsaquo mobiliteacutethinsprevenuethinspagravethinspsonthinspeacutetatthinspinitialthinsprsaquo peuthinspouthinsppasthinspdethinspvomissementsthinsprsaquo patientthinspouthinsppersonnethinspresponsablethinspduthinsppatientthinsppeutthinspcomprendrethinsplesthinspdirectivesthinsp

dethinspdeacutepart

thinsprsaquothinsprsaquo Cesthinspcritegraveresthinspdoiventthinspecirctrethinsprespecteacutesthinspdethinspfaccedilonthinspsysteacutematiquethinsp

Lesthinspprofessionnelsthinspdoiventthinspsrsquoassurerthinspquethinspquandthinsplethinsppatientthinspquittethinsplrsquoeacutetablis-sementthinspilthinspestthinspaccompagneacutethinspdrsquounthinspadultethinspresponsablethinspetthinspqursquounthinspdocumentthinsprelatifthinspauthinspcongeacutethinspcomprenantthinspdesthinspconsignesthinspclairesthinsppourthinsplathinspsurveillancethinspagravethinspdomicilethinsp(pthinspexthinspthinspquoithinspfairethinspenthinspcasthinspdrsquourgence)thinspleurthinspsoitthinspremisthinspetthinspexpliqueacutethinsp(annexethinspXII)thinsp

thinspthinsp17thinspDOCUMENTATIONthinspDESthinspSOINSthinspETthinspTENUEthinspthinspDEthinspDOSSIERSthinsp

Commethinsppourthinsptoutethinspautrethinspinterventionthinsplesthinspmecircmesthinspnormesthinspsrsquoappliquentthinsppourthinsplathinspreacutedactionthinspdesthinspnotesthinspenthinspseacutedation-analgeacutesiethinspthinsp

Enthinspplusthinspdesthinspeacuteleacutementsthinspgeacuteneacuteralementthinspverseacutesthinspauthinspdossierthinspcelui-cithinspdoitthinspcontenirthinsptoutesthinsplesthinspinformationsthinsprelativesthinspagravethinsplathinsppeacuteriodethinsppreacutethinspperthinspetthinsppostseacutedation-analgeacutesiethinspAinsithinsplesthinspeacuteleacutementsthinspsuivantsthinspdoiventthinspecirctrethinspdocumenteacutesthinspauthinspdossierthinspduthinsppatientthinsp

(listethinspnonthinsplimitative)thinsp

1 lrsquoidentificationthinspdesthinspfacteursthinspdethinsprisquethinsplieacutesthinspagravethinsplrsquointerventionthinspdiagnostiquethinspthinspouthinsptheacuterapeutiquethinspouthinspagravethinsplathinspseacutedation-analgeacutesie

2 lrsquoheurethinspduthinspdeacutebutthinspetthinspdethinsplathinspfinthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplrsquoheurethinspdrsquoarriveacuteethinspagravethinsplathinspsallethinspdethinspreacutecupeacuterationthinspouthinspdrsquoobservationthinsp(sithinspdiffeacuterente)thinspetthinsplrsquoheurethinspduthinspdeacutepart

3 lesthinspordonnancesthinspmeacutedicalesthinspcomplegravetes4 lathinspmeacutedicationthinspthinspdosagethinspquantiteacutethinspvoiethinspvitessethinspetthinspheurethinspdrsquoadministration5 lathinspconcentrationthinspouthinsplethinspdeacutebitthinspdethinsplrsquooxygegravenethinsp(outhinspduthinspmeacutelangethinspgazeux)thinspadministreacutethinspthinsp

lethinspcasthinspeacutecheacuteant

6 lathinspsurveillancethinspeffectueacuteethinspa lesthinspsignesthinspvitauxthinspavecthinsplrsquoheurethinspdesthinsplecturesb lethinsptauxthinspdethinspsaturationthinspcapillairethinspenthinspoxygegravenethinspavecthinsplrsquoheurethinspdesthinsplecturesc lethinspniveauthinspdethinspCO

2thinspthinsplethinspcasthinspeacutecheacuteantthinspavecthinsplrsquoheurethinspdesthinsplectures

d lathinspdescriptionthinsppeacuteriodiquethinspduthinspniveauthinspdethinspseacutedationagitationthinspetthinspdethinspthinspconsciencethinsplrsquoutilisationthinspdrsquounethinspeacutechellethinspestthinsprecommandeacuteethinsp(annexethinspIX)

e lathinspdescriptionthinsppeacuteriodiquethinspduthinspniveauthinspdethinspdouleurthinsplrsquoutilisationthinspdrsquounethinspeacutechellethinspestthinsprecommandeacuteethinsp(annexethinspX)

CMQ - OIIQ - OPIQ 31

f lathinspdescriptionthinspdethinsptoutethinspreacuteactionthinspdeacutefavorablethinsplethinspcasthinspeacutecheacuteantg lathinspdescriptionthinspdethinsplrsquoeacutetatthinspduthinsppatientthinspagravethinsplathinspfinthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-thinsp

analgeacutesieh lathinspdescriptionthinspdethinsplrsquoeacutetatthinspduthinsppatientthinspauthinspmomentthinspduthinspcongeacutethinspouthinsplathinspreacutefeacuterencethinspthinsp

agravethinspunthinspprotocolethinsp(critegraveresthinspdethinspcongeacute)7 lethinspmonitoragethinspthinspappareilthinspalarmethinspemplacementthinsplethinspcasthinspeacutecheacuteant8 lethinspconsentement9 unethinspcopiethinspdesthinsprecommandationsthinspeacutecritesthinspremisethinspauthinsppatientthinspauthinspmomentthinspduthinsp

congeacutethinsp(annexethinspXII)thinspouthinspagravethinspdeacutefautthinspunethinspnotethinspattestantthinsplathinspremisethinspdethinspcethinspdocumentthinspstandardiseacutethinspdontthinspunethinspcopiethinspestthinspconserveacutee

10 thinsplethinspprotocolethinspopeacuteratoire11 thinsplathinspnotethinspdethinspdeacutepart12 thinsptoutethinspautrethinspinformationthinspjugeacuteethinsppertinentethinsp(pthinspexthinspthinspreacutesultatthinspdrsquoauscultationthinspthinsp

complication)

Enfinthinsptousthinsplesthinspprofessionnelsthinspimpliqueacutesthinspdoiventthinspsrsquoassurerthinspduthinsprespectthinspdethinspleurthinspreacuteglementationthinspouthinspnormesthinsprespectivesthinspenthinspmatiegraverethinspdethinspdocumentationthinspdesthinspsoinsthinspetthinspdethinsptenuethinspdethinspdossiers

CMQ - OIIQ - OPIQ 32

Chapitre 2Patient peacutediatrique

thinspPREacuteAMBULEthinsp

Puisquethinsplrsquoenfantthinsppossegravedethinspdesthinspcaracteacuteristiquesthinspquithinspluithinspsontthinsppropresthinspetthinspquithinspeacutevoluentthinspenthinspfonctionthinspdethinspsonthinspstadethinspdethinspdeacuteveloppementthinspilthinspestthinspdoncthinspopportunthinspdrsquoeacutetablirthinspdesthinsplignesthinspdirectricesthinspparticuliegraveresthinspagravethinspcettethinspclientegravelethinsp

Cesthinsplignesthinspdirectricesthinspvisentthinsplesthinspenfantsthinspacircgeacutesthinspdethinspplusthinspdethinsp3thinspansthinsp

Unethinspseacutedation-analgeacutesiethinspreacuteussiethinspameacuteliorethinsplathinspqualiteacutethinspdesthinspexamensthinspdemandeacutesthinspdiminuethinsplathinspneacutecessiteacutethinspdethinsprecourirthinspagravethinspdesthinspcontentionsthinspphysiquesthinspameacuteliorethinsplathinspcollaborationthinspetthinsplathinspconfiancethinspdethinsplrsquoenfantthinspetthinspdesthinspparentsthinspquantthinspauxthinspsoinsthinspprodigueacutesthinspetthinspauxthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspreacutealiseacuteesthinsp

Lathinspseacutedation-analgeacutesiethinsp(tousthinspniveaux)thinspenthinsppeacutediatriethinspdoitthinspecirctrethinspreacuteserveacuteethinspauthinspmilieuthinsphospitalierthinspouthinspauxthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacuteces-sairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspetthinspcethinspenthinspraisonthinspduthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquithinspestthinspgeacuteneacuteralementthinspneacutecessairethinspEllethinspcomportethinspdesthinsprisquesthinspseacuterieuxthinsppeuthinspimportethinsplrsquoeacutetatthinspdethinspsanteacutethinspdethinsplrsquoenfantthinspLesthinspcomplicationsthinsplesthinspplusthinspfreacutequentesthinspsontthinsplrsquoobstructionthinspdesthinspvoiesthinspaeacuteriennesthinsplrsquoapneacuteethinsplrsquoaspirationthinspdethinspseacutecreacutetionsthinspthinspetthinsplesthinspvomissements

thinsp21thinspOBJECTIFSthinspETthinspCLIENTEgraveLEthinspCIBLEthinsp

OBJECTIFS

Outrethinsplesthinspobjectifsthinspdethinspseacutedation-analgeacutesiethinspdeacutefinisthinsppourthinsplathinspclientegravelethinspadultethinsp(pthinsp8)thinspthinsp

lathinspseacutedation-analgeacutesiethinsppourthinsplathinspclientegravelethinsppeacutediatriquethinspvisethinspeacutegalementthinspagravethinspthinsp

thinsprsaquo eacuteviterthinspunthinsptraumatismethinsppsychologiquethinsprsaquo diminuerthinsplrsquoanxieacuteteacutethinspetthinsplathinsppeurthinspdethinsplrsquoenfantthinspetthinspdesthinspparentsthinsprsaquo obtenirthinsplathinspcollaborationthinspdethinsplrsquoenfant

CMQ - OIIQ - OPIQ 33

CLIENTEgraveLEthinspCIBLE

EnthinsppeacutediatriethinsplethinspniveauthinspdethinspseacutedationthinsprequisthinspestthinsptributairethinspdethinsplrsquoacircgethinspduthinspstadethinspdethinspdeacuteveloppementthinspdethinsplathinspcapaciteacutethinspcognitivethinspetthinspdethinsplathinspcollaborationthinspdethinsplrsquoenfantthinspAinsithinspchezthinsplrsquoenfantthinspdethinsp

thinsprsaquo 3thinspagravethinsp6thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspmodeacutereacutethinspsrsquoavegraverethinsprarementthinspsuffisantethinspLathinspplupartthinspdesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspneacutecessitentthinspunthinspniveauthinspprofondthinsp(voirethinspunethinspanestheacutesiethinspgeacuteneacuterale)thinsp

thinsprsaquo 7thinspagravethinsp13thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspmodeacutereacutethinspsrsquoavegraverethinspgeacuteneacuteralementthinspsuffisantethinspToutefoisthinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinsppeuventthinspneacutecessiterthinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspprofondthinsp

thinsprsaquo gethinsp14thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspleacutegerthinspouthinspmodeacutereacutethinspsrsquoavegraverethinspsuffisantethinspToutefoisthinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinsppeuventthinspneacutecessiterthinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspprofond

Chezthinsplrsquoenfantthinspdethinspmoinsthinspdethinsp3thinspansthinspouthinspdansthinsplethinspcasthinspdrsquounethinspseacutedationthinspprofondethinspviseacuteethinsplethinspmeacutedecinthinspdoitthinspsrsquoassurerthinspdethinsplathinspcollaborationthinspdrsquounthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespira-toirethinsppeacutediatriquethinspavanceacutee

Dethinspplusthinspilthinspestthinsprecommandeacutethinspdrsquoutiliserthinsplathinspclassificationthinspdethinsplrsquoeacutetatthinspphysiquethinspduthinspthinsppatientthinspquethinsplrsquoonthinsptrouvethinspdansthinsplethinsptableauthinspdethinsplathinsppagethinspsuivante

CMQ - OIIQ - OPIQ 34

Tableau 4 Classification de lrsquoeacutetat physique du patient selon lrsquoAmerican Society of Anesthesiologists (ASA) (ASA Physical Status Classification System [En ligne]) (Notre traduction)

Classification Eacutetatthinspdethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp1 Patientthinspenthinspbonnethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp2Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspleacutegegravere

ASAthinspPhysicalthinspStatusthinsp3Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgrave

ASAthinspPhysicalthinspStatusthinsp4Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgravethinspquithinsprepreacutesentethinspunethinspmenacethinspconstantethinsppourthinspsathinspvie

ASAthinspPhysicalthinspStatusthinsp5Patientthinspmoribondthinspquithinspnethinspsurvivrathinsppasthinspthinspagravethinspmoinsthinspdrsquounethinspinterventionthinsp

ASAthinspPhysicalthinspStatusthinsp6Patientthinspdeacuteclareacutethinspenthinspeacutetatthinspdethinspmortthinspceacutereacutebralethinspdontthinsplesthinsporganesthinspontthinspeacuteteacutethinsppreacuteleveacutesthinspagravethinspdesthinspfinsthinspdethinspdon

CMQ - OIIQ - OPIQ 35

Volet organisationnelthinsp22thinspCOMPEacuteTENCESthinspPROFESSIONNELLESthinsp

Outrethinsplesthinspcompeacutetencesthinspprofessionnellesthinspmentionneacuteesthinsppourthinsplethinsppatientthinspadultethinspthinsp(pthinsp11)thinsptousthinsplesthinspprofessionnelsthinspdethinsplathinspsanteacutethinsp(meacutedecinthinspinfirmiegraverethinspetthinspinhalotheacutera-peute)thinspquithinspprocegravedentthinspagravethinspunethinspseacutedation-analgeacutesiethinspaupregravesthinspdethinsppatientsthinsppeacutediatriquesthinspdoiventthinspposseacutederthinsp

athinsp lesthinspconnaissancesthinspetthinsplesthinspcompeacutetences73neacutecessairesthinspagravethinsplathinspreacuteanimationthinspthinspcardiorespiratoirethinsppeacutediatrique84(dethinsppreacutefeacuterencethinspenthinspsoinsthinspavanceacutes)thinspcrsquoest-agrave-direthinspmaicirctriserthinspenthinspprioriteacutethinsplesthinsptechniquesthinspdethinsplathinspprisethinspenthinspchargethinspdethinsplathinspventilationthinspduthinspmassagethinspcardiaquethinspetthinspdethinsplathinspmeacutedicationthinspassocieacutee

bthinspunethinspexpertisethinspcliniquethinspspeacutecifiquethinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspagravethinspreacutealiserthinspthinsp

thinspthinsp23thinspRESSOURCESthinspMATEacuteRIELLESthinsp

Sithinsplesthinspressourcesthinspmateacuteriellesthinspdethinspbasethinspetthinsplrsquoemplacementthinspsontthinspessentiellementthinsplesthinspmecircmesthinspquethinspchezthinsplrsquoadultethinsp(pthinsp11)thinspcelles-cithinspdoiventthinsptoutefoisthinspecirctrethinspadapteacuteesthinspauthinsp

patientthinsppeacutediatriquethinsp(crsquoest-agrave-direthinsptaillethinsppoidsthinspetthinspparticulariteacutes)thinsp

Agravethinsptitrethinspdrsquoexemplethinsp(listethinspnonthinsplimitative)thinsp

thinsprsaquo capteurthinspduthinspsaturomegravetrethinspdethinspmodegravelethinsppeacutediatriquethinsprsaquo reacuteanimateurthinspautogonflantthinsp(Ambuthinspbag)thinspetthinspmasquesthinspdethinspdiffeacuterentesthinsptaillesthinspthinsprsaquo lamesthinspdethinsplaryngoscopethinspsondesthinspendotracheacutealesthinsp(avecthinspouthinspsansthinspballonnet)thinspdethinsp

taillesthinspdiffeacuterentesthinsprsaquo canulesthinsporonasopharyngeacuteesthinspdethinspdiffeacuterentesthinsptaillesthinsprsaquo tubulurethinspagravethinspsoluteacutethinspdethinsptypethinspmicrogouttesthinspavecthinspouthinspsansthinspburettethinsprsaquo outilsthinspsupraglottiquesthinsp(pthinspexthinspthinspmasquethinsplaryngeacute)thinspdethinspdiffeacuterentesthinsptaillesthinsprsaquo deacutefibrillateurthinspavecthinspeacutelectrodesthinsppeacutediatriquesthinsprsaquo steacutethoscopethinspdethinsptaillethinsppeacutediatriquethinsp(preacutecordialthinspouthinsppreacutetracheacutealthinsppourthinspeacutecoutethinspenthinsp

continuethinspsrsquoilthinspythinspathinsplieu)thinsprsaquo appareilthinspagravethinspaspirationthinsppouvantthinspgeacuteneacutererthinspunethinsppressionthinspneacutegativethinspdethinsp40thinspagravethinsp60thinspmmthinsp

Hgthinspouthinspunethinspcapaciteacutethinspdethinspflotthinspdethinsp100thinsplitresthinspparthinspminutethinspetthinsplethinspmateacuterielthinspneacutecessairethinspdethinsptaillethinspadapteacutee

7thinsp Onthinspentendthinspparthinspconnaissancesthinspetthinspcompeacutetencesthinspqursquoellesthinspsoientthinspmisesthinspagravethinspjourthinspselonthinsplesthinsprecommandationsthinspenthinspvigueur

8thinsp Onthinspentendthinspparthinspcertificationthinspenthinspreacuteanimationthinspcardiorespiratoirethinsplesthinspformationsthinspsuivantesthinspthinsp rsaquothinspReacuteanimationthinspcardiorespiratoirethinspdethinspbasethinspthinspSoinsthinspimmeacutediatsthinspenthinspreacuteanimationthinsp(SIR)thinsppourthinspprofessionnelsthinspdethinsplathinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspsanteacutethinspouthinsplrsquoeacutequivalentthinsp rsaquothinspReacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspSoinsthinspavanceacutesthinspenthinspreacuteanimationthinsppeacutediatriquethinsp(SARP)thinspouthinsplrsquoeacutequivalent

CMQ - OIIQ - OPIQ 36

Volet professionnelthinsp24thinspPREacuteSEacuteDATION-ANALGEacuteSIEthinsp

SEacuteLECTIONthinspDESthinspPATIENTS

Sithinspunethinspseacutelectionthinsprigoureusethinspdesthinsppatientsthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinspattentionthinspquethinspchezthinsplrsquoadultethinsp(pthinsp15)thinspcertainesthinspparticulariteacutesthinsppropresthinspagravethinsplrsquoenfantthinspdoiventthinsp

toutefoisthinspecirctrethinspprisesthinspenthinspcomptethinsp

LorsthinspdethinspsituationsthinspparticuliegraveresthinspouthinspcomplexesthinspapregravesthinsplrsquoeacutevaluationthinspduthinsppatientthinsplethinspmeacutedecinthinspdevraitthinspconsulterthinspunthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspCitonsthinspagravethinsptitrethinspdrsquoexemplethinspmaisthinspsansthinspsrsquoythinsplimiterthinsp

thinsprsaquo preacutesencethinspdethinspcertainsthinspsyndromesthinspdontthinsplathinsptrisomiethinsp21thinsprsaquo anomaliethinspdesthinspvoiesthinspaeacuteriennesthinsprsaquo anomaliethinspcranio-facialethinsprsaquo infectionthinsprespiratoirethinspasthmethinsprsaquo maladiethinspneuromusculairethinsprsaquo maladiethinspcardiaquethinsprsaquo troublethinsprespiratoirethinspduthinspsommeilthinspetthinsplathinsptheacuterapiethinspassocieacuteethinsprsaquo obeacutesiteacutethinspimportantethinsprsaquo refluxthinspgastro-œsophagienthinsprsaquo eacutetatthinspdethinspconsciencethinspalteacutereacutethinsprsaquo troublethinspenvahissantthinspduthinspdeacuteveloppementthinsp(pthinspexthinspthinspautisme)

Dethinspmecircmethinsptoutthinspcommethinspchezthinsplrsquoadultethinsplesthinspinterventionsthinspeffectueacuteesthinspsousthinspseacutedation-analgeacutesiethinspdoiventthinspecirctrethinspreacuteserveacuteesthinspprincipalementthinspauxthinsppatientsthinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp1thinspouthinspauxthinsppatientsthinspatteintsthinspdrsquounethinspaffectionthinsp

systeacutemiquethinspleacutegegraverethinspclasseacuteethinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp2thinsp

Notonsthinspquethinsplorsquethinspcestthinspjustifieacutethinspauthinspdossierthinspmeacutedicalthinsplathinspseacutedation-analgeacutesiethinsppeutthinspecirctrethinspeffectueacuteethinspchezthinsplesthinsppatientsthinspstablesthinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp3thinspetthinspexceptionnellementthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp4thinspToutefoisthinspellethinspdoitthinsplrsquoecirctrethinspdansthinspdesthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspDethinspplusthinspcesthinsppatientsthinspdoiventthinsp

fairethinsplrsquoobjetthinspdrsquounethinspeacutevaluationthinspindividualiseacuteethinspetthinspplusthinspapprofondiethinspEacuteVALUATIONthinspDESthinspPATIENTSthinsp

CMQ - OIIQ - OPIQ 37

EacuteVALUATIONthinspDESthinspPATIENTS

Sithinspunethinspeacutevaluationthinsprigoureusethinspdesthinsppatientsthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinspatten-tionthinspquethinspchezthinspladultethinsp(pthinsp15)thinspcettethinspeacutevaluationthinspdoitthinspaussithinspinclurethinspsansthinspsrsquoythinsplimiterthinsplrsquoacircgethinsplathinsptaillethinsplethinsppoidsthinsplethinspstadethinspdethinspdeacuteveloppementthinsplathinspcapaciteacutethinspcognitivethinsplesthinspallergiesthinsplesthinspproblegravemesthinspmeacutedicauxthinspouthinspfamiliauxthinsppertinentsthinsplesthinspmeacutedicamentsthinsp(outhinspautrethinspsubstancethinspnonthinspprescrite)thinsppristhinspreacuteguliegraverementthinspouthinspreacutecemmentthinspetthinsplrsquoheurethinspduthinspdernierthinspingestathinspainsithinspquethinsplethinsptypethinspetthinsplathinspquantiteacutethinspconsommeacutee

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsplrsquoeacutevaluationthinsp(anamnegravesethinspetthinspexamenthinspphysique)thinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinspthinsp

CONSENTEMENTthinsp(REacuteSUMEacute)

LethinsplecteurthinspdoitthinspsethinspreacutefeacutererthinspagravethinsplrsquoannexethinspVIIIthinsppourthinsplethinsptextethinspcomplet

ToutthinspcommethinspchezthinsplrsquoadultethinspilthinspestthinspobligatoirethinspauthinspQueacutebecthinspdrsquoobtenirthinsplethinspconsente-mentthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspinterventionthinspCelathinspditthinsppourthinsplathinspclientegravelethinsppeacutediatriquethinspilthinspfautthinspajouterthinspunethinsppreacutecisionthinspextraitethinspduthinsp

Code civil du QueacutebecthinspthinspSithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsp(traitementsthinspdethinspmeacutedecinethinspetthinspdethinspchirurgiethinspestheacutetiquethinspexpeacuterimentationthinspetthinspdonsthinspdrsquoorganes)thinsplethinsppatientthinspdoitthinspecirctrethinspinformeacutethinspdethinsptousthinsplesthinsprisquesthinsppossiblesthinspmecircmethinspsrsquoilsthinspsontthinspraresthinspthinspetthinsplethinspconsentementthinspdoitthinspecirctrethinspdonneacutethinspparthinspeacutecrit

thinsprsaquo Unethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsp(gethinsp14thinspans)thinsppeutthinspconsentirthinspseulethinspthinspagravethinspmoinsthinspqursquoilthinspsrsquoagissethinspdethinspsoinsthinspnonthinsprequisthinspetthinspcomportantthinspdesthinsprisques

thinsprsaquo Pourthinspunethinsppersonnethinspmineurethinspdethinspmoinsthinspdethinsp14thinspansthinsp(ltthinsp14thinspans)thinsplethinspconsentementthinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentale

Srsquoilthinspsrsquoagitthinspdethinspsoins requisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsplrsquoobligationthinspdrsquoinformerthinsp

croicirctthinspenthinspfonctionthinspdethinsplathinsppreacutevalencethinspetthinspdethinsplathinspgraviteacutethinspdesthinspcomplications

thinsprsaquo Lethinspconsentementthinspdrsquounethinsppersonnethinspmineurethinsp(ltthinsp18thinspans)thinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinsp

thinsprsaquo Unethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsp(gethinsp14thinspans)thinsppeutthinspconsentirthinspmaisthinspnethinsppeutthinsppasthinsprefuserthinspseulethinspdesthinspsoinsthinspquithinspseraientthinspjugeacutesthinsprequisthinsp

DIRECTIVESthinspETthinspCONSEILSthinsp

Toutthinspcommethinsppourthinsplrsquoadultethinsp(pthinsp19)thinsplrsquoenfantthinspetthinspsonthinspparentthinsp(outhinspremplaccedilant)thinspdoiventthinsprecevoirthinsplesthinspdirectivesthinspneacutecessairesthinspCelathinspditthinspauxthinspdirectivesthinsprelativesthinspauthinspjeucircnethinsp

CMQ - OIIQ - OPIQ 38

preacute-interventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspnonthinspurgentethinsp(eacutelective)thinspilthinspfautthinspajouterthinspcecithinsp(Merchantthinspetthinspcollabthinsp2014a op cit)thinsp

thinsprsaquo liquidethinspclairthinsp(pthinspexthinspthinspeauthinspjusthinspdethinspfruitthinsp[sansthinsppulpe])thinspthinspjeucircnethinspdethinsp2thinspheuresthinsprsaquo laitthinspmaternelthinspthinspjeucircnethinspdethinsp4thinspheuresthinsprsaquo formulesthinsplacteacuteesthinspnonthinsphumaniseacuteesthinspouthinsppreacuteparationsthinspcommercialesthinsppourthinsp

nourrissonsthinspthinspjeucircnethinspdethinsp6thinspheuresthinspthinspAucunthinspajoutthinspnrsquoestthinsppermisthinspauthinsplaitthinspmaternelthinsptireacutethinsp

thinsp25thinspPERSEacuteDATION-ANALGEacuteSIEthinsp

APPROCHEthinspPHARMACOLOGIQUEthinsp

Sithinsplathinspmeacutedicationthinspgeacuteneacuteralementthinsputiliseacuteethinspestthinsplathinspmecircmethinspquethinspchezthinsplrsquoadultethinsp(pthinsp20)thinsplathinspdosethinspdoitthinspecirctrethinspadapteacuteethinspnotammentthinspenthinspfonctionthinspduthinsppoidsthinspetthinspdethinsplathinspcondi-tionthinspcliniquethinspdethinsplrsquoenfantthinspParthinspailleursthinspilthinspfautthinspretenirthinspquethinsplathinsppharmacocineacutetiquethinspetthinsplathinsppharmacodynamiquethinspdesthinspagentsthinspdethinspseacutedation-analgeacutesiethinspsontthinspinfluenceacuteesthinspparthinsplrsquoacircgethinspduthinsppatientthinspAgravethinsptitrethinspdrsquoexemplethinsppourthinspunthinspenfantthinspacircgeacutethinspdethinspunthinspagravethinspsixthinspansthinsplathinspclairancethinspdesthinspagentsthinspdethinspseacutedation-analgeacutesiethinspestthinspsupeacuterieurethinspagravethinspcellethinspdethinsplrsquoadultethinspIlthinspfaudrathinspdoncthinspajusterthinsplesthinspdosesthinspchezthinspunthinspenfantthinspdrsquoacircgethinsppreacutescolairethinsp(Saunderthinspetthinsp

collabthinsp2008)thinsp

Lrsquoutilisationthinspdrsquounethinsppommadethinspanalgeacutesiquethinsp(pthinspexthinspthinsplathinspcregravemethinspEMLAreg)thinsppeutthinspecirctrethinspavantageusethinsppourthinspcontrerthinsplathinspdouleurthinspassocieacuteethinspagravethinsplathinspposethinspdrsquounthinspcatheacuteterthinspintra-veineuxthinspparthinspexemplethinsp(lethinsptempsthinspdrsquoattentethinspdethinsp60thinspagravethinsp90thinspminutesthinspdoitthinspecirctrethinsppristhinspenthinspconsideacuteration)thinsp

APPROCHEthinspNONthinspPHARMACOLOGIQUE

Pourthinsplrsquoenfantthinspquithinspnethinspbeacuteneacuteficiethinspquethinspdrsquounethinspanalgeacutesiethinsp(aucunethinspseacutedation)thinspilthinspfautthinspretenirthinspquethinsplathinspdistractionthinsp(attirerthinsplrsquoattentionthinspversthinspquelquethinspchosethinspdethinsppositif)thinsppen-dantthinspunthinspsointhinspdouloureuxthinsp(outhinspquithinspinquiegravete)thinsppeutthinspsrsquoaveacutererthinspunthinspmoyenthinspefficacethinsppourthinspdiminuerthinspsonthinspanxieacuteteacutethinspetthinsplathinspperceptionthinspdethinspsathinspdouleurthinsp(AssociationthinspSparadrapthinspthinsp[Enthinspligne])

Agravethinsptitrethinspdrsquoexemplethinspetthinspsansthinspsrsquoythinsplimiterthinsp

thinsprsaquo discuterthinspavecthinsplrsquoenfantthinspouthinsplrsquoadolescentthinspdethinspsesthinsppreacutefeacuterencesthinsprsaquo utiliserthinspunthinspjouetthinspchanterthinspunethinspchansonthinspouthinspraconterthinspunethinsphistoirethinspagravethinsplrsquoenfantthinspthinsp

plusthinspjeunethinsprsaquo lathinsppreacutesencethinspetthinsplathinspcollaborationthinspdrsquounthinspparentthinsppeuventthinspecirctrethinsppertinentes

CMQ - OIIQ - OPIQ 39

SURVEILLANCEthinspCLINIQUE

Lathinspsurveillancethinspcliniquethinspcomprendthinspplusieursthinspeacuteleacutementsthinspquithinspconcernentthinspnotam-mentthinsplesthinspsystegravemesthinsprespiratoirethinspcardiaquethinspetthinspneurologiquethinspetthinspellethinspdoitthinsptenirthinspcomptethinspentrethinspautresthinsp

thinsprsaquo dethinsplathinspconditionthinspduthinsppatientthinspavantthinspetthinsppendantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

thinsprsaquo dethinsplathinspcomplexiteacutethinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinsprsaquo dethinsplathinspmeacutedicationthinsputiliseacuteethinsp(dosethinspdureacuteethinspetthinsppicthinspdrsquoactionthinspvoiethinspetthinspvitessethinsp

drsquoadministrationthinspcombinaisonthinspetthinspantagonistes)thinsprsaquo dethinsplrsquoassistancethinspagravethinspapporterthinspauthinspmeacutedecin

Lethinspmeacutedecinthinspquithinsppratiquethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspchezthinspunthinspenfantthinspsousthinspseacutedation-analgeacutesiethinspdoitthinspcompterthinspsurthinsplathinsppreacutesencethinspdrsquoauthinspmoinsthinspunthinspautrethinspprofessionnelthinsphabiliteacutethinspduthinspmilieuthinspdethinsplathinspsanteacutethinsp(infirmiegraverethinspinhalotheacuterapeutethinspouthinspautrethinspmeacutedecin)thinsp(annexethinspII)thinspEnthinspeacutetroitethinspcollaborationthinspavecthinsplethinspmeacutedecinthinspreacuteali-santthinsplrsquointerventionthinspceux-cithinspassurentthinsplathinspgestionthinspdethinsplathinspseacutedationthinspetthinspdethinsplrsquoanalgeacutesiethinsp

qui comprend entre autres la surveillance clinique de lrsquoenfantthinspresponsabiliteacutethinspthinspagravethinsplaquellethinspilsthinspdoiventthinspenthinsptoutthinsptempsthinspsethinspconsacrerthinspen prioriteacutethinsp

Dansthinspcertainsthinspcasthinsplethinspprofessionnelthinspquithinspassurethinspen prioriteacutethinsplathinspsurveillancethinspthinspcliniquethinspdethinsplrsquoenfantthinsppeutthinspecirctrethinspappeleacutethinspagravethinspassisterthinsplethinspmeacutedecinthinspdansthinsplathinspreacutealisationthinspthinspdethinspsonthinspinterventionthinspCettethinspassistancethinspquithinspdoitthinspsrsquoeffectuerthinspdansthinsplathinspmecircmethinsppiegravecethinspdoitthinspecirctrethinspdethinsptregravesthinspcourtethinspdureacuteethinspDethinspplusthinspellethinspdoitthinsppouvoirthinspecirctrethinspinterrompuethinspagravethinsptoutthinspmomentthinsppourthinspintervenirthinspimmeacutediatementthinspaupregravesthinspdethinsplrsquoenfantthinspenthinspcasthinspdethinspcomplicationsthinspouthinspdethinspbesoin

Parthinspailleursthinsplorsquethinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspneacutecessitentthinspunethinspassistancethinsptechniquethinspcontinuellethinspauthinspmeacutedecinthinsplrsquoajoutthinspdrsquounthinsptroisiegravemethinspprofessionnelthinspdethinsplathinspsanteacutethinsphabiliteacutethinsp(meacutedecinthinspinfirmiegraverethinspouthinspinhalotheacutera-peute)thinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspdethinsplrsquoenfantthinspestthinsprequisthinsp

CMQ - OIIQ - OPIQ 40

Tableau 5 Tableau reacutecapitulatif du nombre de professionnels habiliteacutes requis en seacutedation-analgeacutesie - Clientegravele peacutediatrique

Toutthinspauthinsplongthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinspdoitthinspecirctrethinspcontinuethinspetthinsplathinspcommunicationthinspavecthinspcelui-cithinspmaintenuethinsp

Proceacutederthinspagravethinsplathinspsurveillancethinspcliniquethinspcrsquoestthinspeacutevaluerthinspqualitativementthinspetthinspquanti-tativementthinspdethinspfaccedilonthinspsoutenuethinspetthinspenthinspcontinuthinsplrsquoensemblethinspdesthinspparamegravetresthinspsui-vantsthinsp(listethinspnonthinsplimitative)thinsp(tableauthinsp6)thinsp

thinsprsaquo mesurethinspdethinsplathinsppressionthinsparteacuteriellethinspduthinsppouls95etthinspdethinsplathinsprespiration106

thinsprsaquo lecturethinspdethinsplathinspsaturationthinspcapillairethinspenthinspoxygegraveneLathinsptonaliteacutethinspdethinsppoulsthinspdoitthinspecirctrethinspactiveacuteethinspenthinsptoutthinsptempsthinspetthinspsonthinspniveauthinspdoitthinspecirctrethinspajusteacutethinspdethinspfaccedilonthinspagravethinspecirctrethinspentenduthinspclairement

thinsprsaquo eacutevaluationthinspdethinsplrsquoeacutetatthinspdethinsplathinspcolorationthinspetthinspdethinsplathinsptempeacuteraturethinspdethinsplathinsppeauthinsprsaquo niveauthinspdrsquoO

2thinspdethinspCO

2thinspetthinspmonitoragethinspcardiaquethinspselonthinsplethinspcasthinsp

Enthinspplusthinspdesthinspparamegravetresthinspdethinspmonitoragethinspcliniquethinsp(mentionneacutesthinsppreacuteceacutedemment)thinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsppeacutediatriquethinspdoitthinspcomprendrethinspthinsp

thinsprsaquo lrsquoeacutevaluationthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsp(pthinspexthinspthinspbradycardiethinsphypoxiquethinsppreacutecocethinspsithinspobstruction)

thinsprsaquo lrsquoapportthinspliquidienthinsprsaquo lathinsppertethinspdethinspchaleurthinsp(selonthinsplathinspdureacuteethinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesie)

9thinspthinspthinspthinspthinspLethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp10thinspthinspthinspthinspLathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinspetthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

Nombrethinspdethinspprofessionnelsthinsphabiliteacutesthinsprequis

2 Nombrethinspmimimalthinsprequis

3 Sithinsputilisationthinspdethinsppropofolthinspkeacutetaminethinspouthinspdethinspdexmeacutedeacutetomidine

3 SithinsputilisationthinspconcomitantethinspdethinspN2Othinspetthinspdrsquounthinspagentthinspseacutedatifthinspouthinspthinsp

dunthinspopioiumldethinspouthinspsithinspconcentrationthinspdethinspN2Othinspmodifiable

3 Sithinsplassistancethinsptechniquethinspauthinspmeacutedecinthinspestthinspcontinuelle

CMQ - OIIQ - OPIQ 41

thinsprsaquo lrsquoeacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplrsquoanalgeacutesiethinspetthinspdethinsplathinspseacutedationthinspagravethinsplrsquoaidethinspdrsquooutilsthinspadapteacutesthinspagravethinsplathinspconditionthinspetthinspagravethinsplrsquoacircgethinspdethinsplrsquoenfantthinsp(annexesthinspIXthinspetthinspX)

thinsprsaquo lathinsppositionthinspduthinsppatientthinspetthinsplesthinsppointsthinspdrsquoappuithinsp(compression)

Tableau 6 Surveillance des paramegravetres cliniques en seacutedation-analgeacutesie - Clientegravele peacutediatrique

Paramegravetrethinspdethinspthinspsurveillancethinspclinique

PatientNiveauthinspdethinspthinspseacutedation

MeacutedicationInterventionthinspdiagnostiquethinspouthinsptheacuterapeutique

TAthinspRC11thinspthinspRR12thinspthinspetthinspsaturationthinspdrsquoO

2thinspthinsp

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

Niveauthinspdethinspthinsp-thinspseacutedationagitationthinspthinspthinspthinspconscience-thinspdouleur

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

NiveauthinspdethinspCO2

SelonthinsplesthinspcaracteacuteristiquesthinspAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)thinsp

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspmeacutedication Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire rsaquothinspAccegravesthinspindirectthinspouthinspthinspthinspthinspthinsprestreintthinspauthinsppatientthinspthinspthinsp(pthinspexthinspthinspIRM)

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetaminethinsp

rsaquothinspRecommandeacute rsaquothinspASAthinspgethinsp3thinsprsaquothinspApneacuteethinspobstructivethinspthinspthinspduthinspsommeilthinsprsaquothinspMaladiethinspthinspthinsprespiratoirethinsprsaquothinspObeacutesiteacutethinspmorbide

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

Monitoragethinspcardiaque

SelonthinsplesthinspcaracteacuteristiquesAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspmeacutedication Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire rsaquothinspASAthinspgethinsp3thinsprsaquothinspMaladiethinspcardiaque

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

Interventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspprolongeacuteethinsp(effetthinspcumulatifthinspdethinsplathinspmeacutedication)

rsaquothinspRecommandeacute Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

thinspthinsp IlthinspnethinspsrsquoagitthinsppasthinspdrsquounethinsplistethinsplimiteacuteethinspdesthinspsituationsthinspcliniquesthinspDrsquoautresthinspsituationsthinspcliniquesthinsppeuventthinspneacutecessiterthinspthinsplethinspmonitoragethinspcardiaquethinspouthinspduthinspCO

2thinspIlthinsprevientthinspauxthinspprofessionnelsthinspdethinspjugerthinspdethinsplathinspsituationthinspenthinspfonctionthinspdethinspthinsp

chaquethinsppatient

11thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp12thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

CMQ - OIIQ - OPIQ 42

ILthinspFAUTthinspSAVOIRthinspQUE

LathinspSocieacuteteacutethinspcanadiennethinspdesthinspanestheacutesiologistesthinsp(SCA)thinspindiquethinspquethinsplesthinspthinspdirectivesthinspgeacuteneacuteralesthinspdethinspsoinsthinsp(ythinspcompristhinsplethinspmonitorage)thinsppourthinsplathinspseacutedationthinspthinspconscientethinspsontthinsplesthinspmecircmesthinspquethinsppourthinsplesthinspautresthinspformesthinspdrsquoanestheacutesiethinsp[]thinspthinsp(Merchantthinspetthinspcollabthinsp2014bthinspopthinspcit)thinspDethinspplusthinspellethinspindiquethinspquethinsplethinspthinspcapnographethinspestthinsprequisthinsplorsthinspdethinspseacutedation-analgeacutesiethinspdethinspniveauthinspplusthinspeacuteleveacutethinspthinsp(pthinspexthinspthinspRamsaythinsp4-6)thinsp(Merchantthinspetthinspcollabthinsp2014athinspop cit)

LethinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspimpliqueacutesthinspestthinspprimordialthinspetthinspcethinspmecircmethinspsithinsplrsquoappareillagethinspenthinspplacethinspestthinspcompletthinspetthinspfonctionnelthinspUnethinspbonnethinspcommunica-tionthinspentrethinspcesthinspderniersthinspestthinspdoncthinspessentiellethinspafinthinspdethinspbienthinspcoordonnerthinsplathinspseacutedationthinspetthinsplrsquoanalgeacutesiethinspavecthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspLes alarmes (audibles et visuelles) de chaque appareil doivent ecirctre en fonction et les paramegravetres ajusteacutes agrave lrsquoacircge et agrave la condition clinique de chaque enfant

IlthinspfautthinspsrsquoassurerthinspdethinsplathinsptraccedilabiliteacutethinspdethinsplrsquoeacutevaluationthinspetthinspdethinsplathinspsurveillancethinspcliniquethinspthinspeffectueacuteesthinspparthinspunethinsptenuethinspdethinspdossiersthinspconformethinspauxthinspnormesthinspenthinspvigueurthinspthinspLesthinspoutilsthinspdrsquoeacutevaluationthinsputiliseacutesthinspdoiventthinspecirctrethinspsimplesthinspstandardiseacutesthinspvalideacutesthinspdethinsppreacutefeacuterencethinspetthinspadapteacutesthinspauthinspcontextethinspetthinspauxthinspcaracteacuteristiquesthinspduthinsppatientthinspnotam-mentthinsppourthinsplrsquoeacutevaluationthinspduthinspniveauthinspdethinspseacutedationagitationthinspdethinspconsciencethinspetthinspdethinspdouleurthinsp(annexesthinspIXthinspetthinspX)

Lathinspfreacutequencethinspdethinsplathinspmesurethinspdethinspcesthinspparamegravetresthinspetthinspleurthinspenregistrementthinspdoiventthinspecirctrethinspdeacutetermineacutesthinspentrethinspautresthinspenthinspfonctionthinspdethinsplathinspmeacutedicationthinspetthinspdethinsplathinspconditionthinsp

cliniquethinspduthinsppatientthinsp

Ideacutealementthinsplethinspprofessionnelthinspdoitthinsplesthinspdocumenterthinsp

thinsprsaquo avantthinsplethinspdeacutebutthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsprsaquo apregravesthinsplrsquoadministrationthinspdrsquounthinspagentthinspdethinspseacutedation-analgeacutesiethinspouthinspdrsquounthinspantagonistethinsprsaquo authinsppicthinspdrsquoactionthinspdethinspchacunthinspdesthinspagentsthinspadministreacutesthinspthinsprsaquo agravethinspintervallesthinspreacuteguliersthinsp(pthinspexthinspthinsp5thinspminutes)thinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-

analgeacutesiethinsprsaquo agravethinspintervallesthinspplusthinsprapprocheacutesthinsplorsquethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsplrsquoexigethinsprsaquo durantthinsplathinsppeacuteriodethinspdethinspreacutecupeacuterationthinspetthinspjusqursquoauthinspretourthinspduthinspniveauthinspdethinspconsciencethinsp

initialthinspselonthinsplathinspconditionthinspcliniquethinspduthinsppatientthinsprsaquo authinspmomentthinspduthinspcongeacutethinsp

CMQ - OIIQ - OPIQ 43

thinsp26thinspPOSTSEacuteDATION-ANALGEacuteSIEthinsp

Commethinsppourthinsplethinsppatientthinspadultethinsp(pthinsp29)thinsplathinspsurveillancethinspcliniquethinspdoitthinspecirctrethinspcons-tantethinspetthinsprigoureusethinsptoutthinspauthinsplongthinspdethinsplathinsppeacuteriodethinsppostseacutedation-analgeacutesiethinspetthinspcethinspjusqursquoauthinspretourthinspdethinsplrsquoeacutetatthinspinitialthinspdethinsplrsquoenfantthinspenthinspfonctionthinspdethinspsonthinspstadethinspdethinspdeacutevelop-pement

Rappelonsthinspquethinsplesthinspappareilsthinspdethinspmonitoragethinspdoiventthinspecirctrethinspenthinspfonctionthinspthinspmaisthinspenthinspaucunthinsptempsthinspilsthinspnethinspremplacentthinsplathinspsurveillancethinspdirectethinspduthinsppatientthinspthinspparthinsplethinspprofessionnelthinsp

LathinsppeacuteriodethinspdrsquoobservationthinspenthinspeacutetablissementthinspdoitthinspecirctrethinspsuffisammentthinspprolongeacuteethinsppourthinsppreacutevenirthinsplesthinspproblegravemesthinsppendantthinspetthinspauthinspretourthinspagravethinsplathinspmaisonthinspComptethinsptenuthinspdethinspsonthinspacircgethinspetthinspdethinspsathinspconditionthinsplrsquoenfantthinspdoitthinspecirctrethinspcapablethinspdethinspsrsquoasseoirthinspdethinspboirethinspdethinspparlerthinspetthinspdethinspmarcherthinspavecthinspunethinspaidethinspminimalethinsp

Selonthinsplathinspdistancethinspagravethinspparcourirthinspauthinspretourthinspilthinsppeutthinspecirctrethinspjudicieuxthinspdethinspprolongerthinsplathinsppeacuteriodethinspdrsquoobservation

Unthinspdocumentthinsprelatifthinspauthinspcongeacutethinspcomprenantthinspdesthinspconsignesthinspclairesthinsppourthinsplathinspthinsp

surveillancethinspagravethinspdomicilethinspdoitthinspecirctrethinspremisthinspetthinspexpliqueacutethinspauxthinspparentsthinsp(annexethinspXII)

thinsp27thinspDOCUMENTATIONthinspDESthinspSOINSthinspETthinspTENUEthinspDEthinspDOSSIERSthinsp

Lathinsptenuethinspdethinspdossiersthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinsprigueurthinspetthinsplathinspmecircmethinsppreacutecisionthinspquethinspchezthinsplrsquoadultethinsp(pthinsp30)thinspCertainesthinspinformationsthinsppropresthinspagravethinsplrsquoenfantthinspdoiventthinspecirctrethinspajouteacuteesthinspnotammentthinsp

thinsprsaquo sithinsppreacutesencethinspdrsquounthinspparentthinsprsaquo lethinsppoidsthinspetthinsplrsquoacircgethinspdethinsplrsquoenfantthinsprsaquo lathinsptaillethinspouthinsplrsquoIMCthinspsrsquoilthinspythinspathinsplieu

CMQ - OIIQ - OPIQ 44

CONCLUSION

Lathinspseacutedation-analgeacutesiethinspvisethinspagravethinspalteacutererthinsplethinspniveauthinspdethinspconsciencethinspainsithinspqursquoagravethinspsoulagerthinsplrsquoanxieacuteteacutethinspetthinsplathinspdouleurthinspdrsquounthinsppatientthinspauthinspcoursthinspdrsquounethinspinterventionthinsptheacuterapeutiquethinspouthinspdiagnostiquethinspCettethinspproceacutedurethinspbienthinspquethinspfreacutequemmentthinsputiliseacuteethinspcomportethinspcependantthinspcertainsthinsprisques

On doit y recourir de faccedilon seacutecuritaire pour le patient et en tout temps preacutevenir et reconnaicirctre les complica-tions lieacutees agrave la seacutedation-analgeacutesie afin drsquoeffectuer rapidement et efficace-ment les manœuvres neacutecessaires

LethinsprespectthinspdesthinsplignesthinspdirectricesthinspeacutenonceacuteesthinspdansthinspcethinspdocumentthinspaiderathinsplesthinspprofessionnelsthinspagravethinspmenerthinspadeacutequatementthinspcettethinspproceacutedurethinspCeux-cithinspdemeurentthinsptoutefoisthinspresponsablesthinspdethinsplathinspmisethinspagravethinspjourthinspdethinspleursthinspconnaissancesthinspetthinspduthinspdeacuteveloppementthinspdethinspleursthinspcompeacutetencesthinsprespectivesthinsp

Parthinspailleursthinsplesthinspeacutetablissementsthinspdethinspsanteacutethinspetthinsplesthinspcliniquesthinspouthinspcabinetsthinsppriveacutesthinspdevraientthinspsrsquoinspirerthinspdethinspcesthinsplignesthinspdirectricesthinsppourthinspeacutelaborerthinspthinspdesthinspproceacuteduresthinsprelativesthinspagravethinsplathinspthinspseacutedation-analgeacutesiethinspetthinspenthinspassurerthinsplrsquoeacutevaluationthinsppeacuteriodiquethinspdethinsplathinspqualiteacutethinsp

CMQ - OIIQ - OPIQ 45

mdash Annexe

thinspANNEXEthinspIthinspndashthinspDEacuteFINITIONthinspDEthinspLrsquoANESTHEacuteSIEthinspGEacuteNEacuteRALEthinspETthinspthinsp

DESthinspNIVEAUXthinspDEthinspSEacuteDATION-ANALGEacuteSIEthinspSELONthinspLrsquoAMERICANthinspSOCIETYthinspOFthinsp

ANESTHESIOLOGISTSthinsp(ASA)thinsp(AMERICANthinspSOCIETYthinspOFthinspANESTHESIOLOGISTSthinsp

ASAthinspHOUSEthinspOFthinspDELEGATEthinsp2014AthinspOP CIT)thinsp(NOTREthinspTRADUCTION)

Seacutedationthinspminimalethinspthinspanxiolyse

Seacutedation-thinspthinspanalgeacutesiethinspthinspmodeacutereacutee(consciente)

Seacutedation-thinspanalgeacutesiethinspthinspprofonde

Anestheacutesiethinspthinspgeacuteneacuterale

Reacuteponse Reacuteponsethinspnormalethinspagravethinsplathinspstimulationthinspverbale

Reacuteponsethinspvolontairethinspagravethinsplathinspstimulationthinspverbalethinspouthinsptactile

Reacuteponsethinspvolontairethinspsuivantthinspunethinspstimulationthinspreacutepeacuteteacuteethinspouthinspdouloureuse

Nonthinspeacuteveillablethinspmecircmethinspavecthinspstimulusthinspdouloureux

Voiesthinspthinspaeacuteriennes

Nonthinspaffecteacutees Pasthinspdrsquointerventionthinsprequise

Interventionthinsppeutthinspecirctrethinsprequise

Interventionthinspthinspsouventthinsprequise

Ventilationspontaneacutee

Nonthinspaffecteacuteethinsp Adeacutequate Peutthinspecirctrethinspinadeacutequate

Freacutequemmentthinspinadeacutequate

Fonctionthinspcardio-thinspvasculaire

Nonthinspaffecteacutee Geacuteneacuteralementthinspthinspmaintenue

Geacuteneacuteralementthinspthinspmaintenue

Peutthinspecirctrethinspthinspcompromise

thinspthinspLethinspreacuteflexethinspdethinspretraitthinspagravethinsplathinspsuitethinspdrsquounethinspstimulationthinspdouloureusethinspnrsquoestthinsppasthinspconsideacutereacutethinspcommethinspunethinspreacuteponsethinspvolontaire

Rappelonsthinspquethinsplathinspseacutedation-analgeacutesiethinspprofondethinspchezthinsplrsquoadultethinspetthinsplrsquoanestheacutesiethinspgeacuteneacuteralethinsp(adultethinspetthinsppeacutediatrique)thinspthinspnethinspfontthinsppasthinsplrsquoobjetthinspdethinspcettethinsppublication

CMQ - OIIQ - OPIQ 46

mdash Annexe

thinspANNEXEthinspIIthinspndashthinspINFORMATIONthinspCOMPLEacuteMENTAIREthinsp-thinspLECTURESthinspDrsquoINTEacuteREcircT

COLLEgraveGEthinspDESthinspMEacuteDECINSthinspDUthinspQUEacuteBECthinsp(CMQ)

thinsprsaquo Proceacutedures et interventions en milieu extrahospitalier (2011)thinsprsaquo Code de deacuteontologie des meacutedecinsthinsp(2015)

ORDREthinspDESthinspINFIRMIEgraveRESthinspETthinspINFIRMIERSthinspDUthinspQUEacuteBECthinsp(OIIQ)thinsp

thinsprsaquo EacutediteurthinspofficielthinspduthinspQueacutebec Code de deacuteontologie des infirmiegraveres et infirmiers (2014)

thinsprsaquo Le champ drsquoexercice et les activiteacutes reacuteserveacutees des infirmiegraveresthinsp(2013)thinsp2ethinspeacutedthinspthinsprsaquo Mosaiumlque des compeacutetences cliniques de lrsquoinfirmiegravere Compeacutetences initiales

(2009)thinsp2ethinspeacutedthinspthinsprsaquo Les obligations deacuteontologiques de lrsquoinfirmiegravere et le consentement aux soins

(2005)

ORDREthinspPROFESSIONNELthinspDESthinspINHALOTHEacuteRAPEUTESthinspDUthinspQUEacuteBECthinsp(OPIQ)

thinsprsaquo Profil national des compeacutetencesthinspLrsquoalliancethinspdesthinsporganismesthinspdethinspregraveglementationthinspenthinsptheacuterapiethinsprespiratoirethinsp(2011)

thinsprsaquo Les notes au dossier dans le secteur de lrsquoassistance anestheacutesique et de la seacutedation analgeacutesiethinsp-thinspGuidethinspdethinsppratiquethinsp(2008)

thinsprsaquo Compeacutetences relatives agrave lrsquoentreacutee dans la pratique (2003)thinsprsaquo Regraveglement sur les dossiers les autres effets les cabinets et la cessation

drsquoexercice des membres de lrsquoOrdre professionnel des inhalotheacuterapeutes du Queacutebecthinsp(2002)thinsp

thinsprsaquo Code de deacuteontologie des inhalotheacuterapeutes du Queacutebec

CMQ - OIIQ - OPIQ 47

thinspANNEXEthinspIIIthinspndashthinspPROCEacuteDURESthinspPROTOCOLESthinspOUthinspALGORITHMESthinsp

Dansthinsptousthinsplesthinsplieuxthinspougravethinspsethinsppratiquethinsplathinspseacutedation-analgeacutesiethinspagravethinspdesthinspfinsthinspdiagnos-tiquesthinspouthinsptheacuterapeutiquesthinsplethinspmeacutedecinthinspresponsablethinspdoitthinspeacutelaborerthinspenthinspcollabora-tionthinspavecthinsplesthinspmembresthinspdethinspsonthinspeacutequipethinspsoignantethinsplesthinspproceacuteduresthinspprotocolesthinspouthinsp

algorithmesthinspconcernantthinspnotammentthinsplesthinspsujetsthinspsuivantsthinsp

PARMIthinspLESthinspPROCEacuteDURESthinspOUthinspPROTOCOLESthinsp(ADULTEthinspETthinspPEacuteDIATRIQUE)thinsp

thinsprsaquo allergiethinspauthinsplatexchocthinspanaphylactiquethinsprsaquo antagonistethinsprsaquo bradycardiethinsprsaquo critegraveresthinspcliniquesthinspdethinspcongeacutethinsprsaquo hypertensionthinspmalignethinsprsaquo seacutedation-analgeacutesiethinsprsaquo transfertthinspdrsquourgence

PARMIthinspLESthinspALGORITHMESthinsp(ADULTEthinspETthinspPEacuteDIATRIQUE)thinsp

thinsprsaquo gestionthinspdesthinspvoiesthinspaeacuteriennesthinspdifficilesthinsp(ventilationintubation)thinsprsaquo reacuteanimationthinspcardiorespiratoirethinsp

thinspthinspthinspILthinspFAUTthinspPENSERthinspAgravethinsp

thinsprsaquo Lrsquoaffichagethinspdesthinspproceacuteduresthinspprotocolesthinspouthinspalgorithmesthinspdrsquourgencethinspquithinsppermettrathinspdrsquoythinspavoirthinspaccegravesthinsprapidementthinspenthinspcasthinspdrsquourgencethinspetthinspdethinsplesthinspconsulterthinspreacuteguliegraverementthinspparthinsplathinspmecircmethinspoccasionthinsp

thinsprsaquo Lrsquoeacutelaborationthinspdrsquounthinspprogrammethinsppeacuteriodiquethinspdrsquoexercicethinsp(pthinspexthinspthinspsimulation)thinspquithinsppermettrathinspdethinsprevoirthinsplesthinspdiffeacuterentesthinspproceacuteduresthinspenthinspplacethinspavecthinsptousthinsplesthinspmembresthinspdethinsplrsquoeacutequipethinspsoignantethinspetthinspdrsquoinitierthinsplethinspnouveauthinsppersonnelthinspassurantthinspainsithinspunethinspmeilleurethinsprelegravevethinspDethinspmecircmethinspmettrethinsplethinspplanthinspenthinsppratiquethinsppermetthinspdrsquooptimiserthinsplathinsprapiditeacutethinspetthinsplathinsppreacutecisionthinspdesthinspgestesthinspposeacuteesthinspetthinspdrsquoidentifierthinspdesthinspproblegravemesthinsppotentielsthinsp(avecthinspdethinsplrsquoeacutequipementthinspparthinspexemple)thinspetthinspcethinspavantthinspqursquoilthinspythinspaitthinspurgencethinspdrsquoagirthinsp

mdash Annexe

CMQ - OIIQ - OPIQ 48

thinspANNEXEthinspIVthinspndashthinspEacuteVALUATIONthinspDESthinspVOIESthinspAEacuteRIENNESthinspSUPEacuteRIEURESthinspAUthinsp

thinspMOYENthinspDUthinspSCOREthinspDEthinspMALLAMPATIthinsp(DIEMUNSCHthinspETthinspCOLLABthinsp2008)thinsp

(Agravethinsptitrethinspinformatifthinspseulement)

Objectifthinspthinspthinsp Eacutevaluerthinsplathinspvisibiliteacutethinspdesthinspstructuresthinsporopharyngeacuteesthinspetthinsplathinsptaillethinspthinsp

dethinsplathinsplangue

Lesthinsp4thinspclassesthinspdethinspMallampatithinspmodifieacuteesthinsp(SamsoonthinspandthinspYoung)thinspsontthinsp

thinsprsaquo ClassethinspIthinspthinspluettethinsppiliersthinspduthinspvoilethinspduthinsppalaisthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIIthinspthinsppiliersthinspduthinspvoilethinspduthinsppalaisthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIIIthinspthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIVthinspthinsppalaisthinspdurthinspseulthinsp

LesthinspclassesthinspIthinspetthinspIIthinsppreacutesagentthinspdrsquounethinspintubationthinspathinsppriorithinspfacilethinsplesthinspclassesthinspIIIthinspetthinspIVthinspdrsquounethinspintubationthinspdifficile

ClassesthinspdethinspMallampatithinspmodifieacuteesthinsp(Jmarchnthinsp[Enthinspligne])

LrsquoinsuffisancethinspdethinsplathinspclassificationthinspdethinspMallampatithinspathinspeacuteteacutethinspspeacutecifiquementthinspmon-treacuteethinspchezthinsplrsquoobegravesethinspEllethinspnethinsppeutthinspecirctrethinspconsideacutereacuteethinspcommethinspunthinsppreacutedicteurthinspisoleacute-mentthinspsuffisantthinspdethinsplathinspdifficulteacutethinspdethinsplathinsplaryngoscopiethinspouthinspathinspfortiorithinspdethinsplrsquointuba-tionthinspdifficilethinsp

mdash Annexe

CMQ - OIIQ - OPIQ 49

ANNEXEthinspVthinspndashthinspOUTILthinspDrsquoEacuteVALUATIONthinspDEthinspLrsquoAPNEacuteEthinspOBSTRUCTIVEthinspDUthinspSOMMEILthinsp

(AOS)thinspADAPTEacutethinspAgravethinspLAthinspCONSULTATIONthinspPREacuteANESTHESIQUESEacuteDATION-thinsp

ANALGEacuteSIEthinspthinsp(ADAPTEacutethinspDEthinspCHUNGthinspETthinspSEETthinsp2010)thinsp(NOTREthinspTRADUCTION)

(Agravethinsptitrethinspinformatifthinspseulement)

mdash Annexe

Exemplethinspdethinspquestionnairethinspstop-bang

Question Reacuteponse

Sthinspnore PreacutesencethinspdethinspronflementVosthinspronflementsthinspsont-ilsthinspbruyants(suffisammentthinsppourthinspecirctrethinspentendusthinspagravethinsptraversthinspunethinspportethinspfermeacutee)

OuithinspouthinspNon

Tthinspiredthinspfatiguethinsporthinspsleepy PreacutesencethinspdethinspsomnolencethinspouthinspfatigueVousthinspsentez-vousthinspsouventthinspfatigueacutethinspeacutepuiseacutethinspouthinspsomnolentthinsppendantthinsplathinspjourneacutee

OuithinspouthinspNon

Othinspbservedthinspapnea ApneacuteethinspobserveacuteethinspQuelqursquounthinspa-t-ilthinspdeacutejagravethinspobserveacutethinspquethinspvousthinspthinsparrecirctiezthinspdethinsprespirerthinspenthinspdormant

OuithinspouthinspNon

Pthinspressure PreacutesencethinspdrsquoHTAAvez-vousthinspouthinspecirctes-vousthinsptraiteacutepourthinspunethinsptensionthinsparteacuteriellethinspeacuteleveacutee

OuithinspouthinspNon

BthinspMI IMCthinspgtthinsp35thinspkgm2 OuithinspouthinspNon

Athinspge Acircgethinspgtthinsp50thinspans OuithinspouthinspNon

Nthinspeck Circonfeacuterencethinspduthinspcouthinspgtthinsp40thinspcm OuithinspouthinspNon

Gthinspender Sexethinspmasculin OuithinspouthinspNon

INTERPREacuteTATIONthinspCLINIQUE

ltthinsp3thinspreacuteponsesthinsppositivesthinsp=thinspfaiblethinsprisquethinspdrsquoAOS

ge 3 reacuteponses positives = risque eacuteleveacute drsquoAOS

CMQ - OIIQ - OPIQ 50

thinspANNEXEthinspVIthinspndashthinspANAMNEgraveSEthinspthinspAIDEthinspMNEacuteMOTECHNIQUEthinsp

(Agravethinsptitrethinspinformatifthinspseulement)

ObjectifthinspthinspthinspthinspCetthinspoutilthinspdrsquoaidethinspmneacutemotechniquethinspsertthinspagravethinspstructurerthinsplathinspfaccedilonthinspdontthinspthinsponthinspprocegravedethinspagravethinsplathinspcollectethinspsommairethinspdesthinspdonneacuteesthinspdansthinsplethinspcadrethinspdethinsplrsquoeacutevaluationthinspcliniquethinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinspfacilitethinsplathinspcompreacutehensionthinspetthinsplathinspreacutealisationthinspdethinsplrsquoanamnegravesethinspchezthinsplrsquoadultethinspetthinsplrsquoenfant

SAMPLEthinsp(AdapteacutethinspdethinspAltonthinspetthinspcollabthinsp2007thinsp[Notrethinsptraduction])thinsp(outhinspvariante)

SthinspthinspSignesthinspetthinspsymptocircmes

AthinspthinspAllergiesthinspetthinspreacuteactionthinsp

MthinspthinspMeacutedicamentsthinspetthinspautresthinspsubstancesthinsp(prescritsthinspouthinspnon)thinspetthinsptraitement

PthinspthinspPasseacutethinspmeacutedicalfamilialthinsp

LthinspthinspLastthinspmeallunchthinsp(dernierthinsprepas)

EthinspthinspEnvironnementeacuteveacutenement

thinsp

mdash Annexe

CMQ - OIIQ - OPIQ 51

thinspANNEXEthinspVIIthinsp-thinspEXAMENthinspPHYSIQUEthinspthinspAIDEthinspMNEacuteMOTECHNIQUE

(Agravethinsptitrethinspinformatifthinspseulement)

Objectifthinspthinspthinsp Lrsquoexamenthinspphysiquethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinspcherchethinspagravethinspmettrethinspenthinspeacutevidencethinspcertainsthinspcritegraveresthinspreconnusthinsppourthinspecirctrethinspassocieacutesthinspagravethinspunethinspassis-tancethinspventilatoirethinspdifficilethinspquithinsppeutthinspsurvenirthinspdansthinsplethinspcasthinspdrsquounthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquethinspceluithinspviseacutethinspparthinspexemple

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinspfacilitethinsplathinspcompreacutehensionthinspetthinsplathinspreacutealisationthinspdethinsplrsquoexamenthinspphysiquethinsprelativementthinspauxthinspvoiesthinspaeacuteriennesthinspdethinsplrsquoadulte

1thinspIndicateursthinspdrsquounethinsppossiblethinspventilationthinspdifficilethinsp(MOANSthinsp[AdapteacutethinspdethinspWallsthinspetthinspthinspthinspthinspthinspMurphythinsp2012]thinsp[Notrethinsptraduction]thinspouthinspvariante)

Mthinspthinspmask sealthinsp(eacutetancheacuteiteacutethinspduthinspmasque)thinspthinspeacutetancheacuteiteacutethinspcompromisethinspenthinspraisonthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspdrsquounethinspbarriegraverethinspmeacutecaniquethinsp(barbethinspfourniethinsptraumatismethinspfacialthinspetc)

OthinspthinspobeacutesiteacuteobstructionthinspthinsppatientthinspdontthinsplrsquoIMCthinspestthinspgtthinsp25thinsp(kgm2)thinspfemmethinspenceintethinspthinspthinspthinspthinspthinspthinspthinspgtthinsp6thinspmoisthinsp(2ethinsptrimestre)thinspangio-œdegravemethinspabcegravesthinspetc

Athinspthinspacircgethinspthinsppatientthinspgethinsp55thinspansthinsp(variablethinspselonthinsplesthinspauteurs)thinspenthinspraisonthinspnotammentthinspthinspthinspthinspthinspthinspthinspdethinsplathinsppertethinspdrsquoeacutelasticiteacutethinspdesthinsptissus

Nthinspthinspno teeththinsp(eacutedenteacute)thinspthinspdifficulteacutethinsplorsthinspdethinsplrsquoassistancethinspventilatoire

Sthinspthinspstiffthinsp(rigiditeacute)thinspthinsppathologiesthinspagravethinspconseacutequencesthinspsurthinsplathinspcompliancethinspetthinsplathinspthinspthinspthinspthinspthinspreacutesistancethinsppulmonairethinsp(asthmethinspMPOCthinsppneumoniethinspdethinspstadethinspavanceacutethinspetc)

thinspthinspVentilationthinspdifficilethinsp(masquethinspouthinspoutilthinspextraglottiquethinsptelthinspquethinspmasquethinspthinspthinspthinspthinspthinsplaryngeacute)thinsp(AdapteacutethinspdethinsplrsquoAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinsp[Notrethinspthinspthinspthinspthinspthinsptraduction])thinspImpossiblethinspdrsquoeffectuerthinspunethinspventilationthinspdethinspfaccedilonthinspadeacutequatethinspthinspthinspthinspthinspthinspenthinspraisonthinspdethinsplrsquounethinspetouthinspdethinsplrsquoautrethinspdesthinspsituationsthinspsuivantesthinsp

athinspMauvaisethinspeacutetancheacuteiteacutethinspduthinspmasquethinspouthinspdethinsplrsquooutilthinspextraglottiquebthinspFuitethinspdethinspgazthinspexcessivecthinspReacutesistancethinspexcessivethinspagravethinsplrsquoinspirationthinspouthinspagravethinsplrsquoexpiration

thinsp

mdash Annexe

CMQ - OIIQ - OPIQ 52

2thinspIndicateursthinspdrsquounethinsppossiblethinsplaryngoscopiethinspouthinspintubationthinspdifficilethinsp(thinspLEMONthinspthinspthinspthinspthinspthinsp[WallsthinspetthinspMurphythinsp2012thinspopthinspcit]thinsp[Notrethinsptraduction]thinspouthinspvariante)

Lthinspthinspthinsplook externallythinsp(apparencethinspphysique)thinspthinspmicrognathiethinspmacroglossiethinspdenti-tionthinspirreacuteguliegraverethinspcirconfeacuterencethinspduthinspcouthinspgethinspgrossessethinspetc

thinspEthinspthinspthinspeacutevaluationthinspthinspregraveglethinspduthinsp3-3-2thinsp(variantethinsppossiblethinspselonthinsplesthinspauteurs)thinsp-thinspthinsp

consideacuterationsthinspgeacuteomeacutetriquesthinsp(agravethinsplrsquoaidethinspdesthinspdoigtsthinspduthinsppatient)3thinspthinsp ouverturethinspdethinspbouchethinspthinspinsertionthinspdethinsp3thinspdethinspsesthinspdoigts3thinspthinsp taillethinspduthinsplarynxthinsp(longueurthinspmandibulaire)thinspthinsp3thinspdoigtsthinspsousthinsplethinspmentonthinsp

(boutthinspdethinspsonthinspmentonthinspjusqursquoagravethinsplathinspjonctionthinspduthinspcouthinspauthinspniveauthinspdethinspthinsplrsquoosthinsphyoiumlde)

2thinspthinsp positionthinspduthinsplarynxthinspthinsp2thinspdethinspsesthinspdoigtsthinspentrethinsplathinspjonctionthinspcou-mentonthinsp(osthinspthinsphyoiumlde)thinspetthinsplethinspcartilagethinspthyroiumlde

thinspMthinspthinspthinspMallampatithinsp(annexethinspIV)thinspOthinspthinspthinspobeacutesiteacuteobstructionthinspthinspIMCthinspthinspœdegravemethinspduthinsplarynxthinspneacuteoplasiethinspdethinsplathinspsphegraverethinsp

ORLthinspcompressionthinspextrinsegravequethinspparthinspheacutematomethinspcervicalthinspdifficulteacutethinspagravethinspavalerthinspdyspneacutee

thinspNthinspthinspthinspneck mobilitythinsp(mobiliteacutethinspcervicale)thinspthinspimmobilisationthinspauthinspmoyenthinspdrsquounthinspcol-

lierthinspcervicalthinsppreacutesencethinspdrsquounethinsppathologiethinspouthinspdrsquounethinspsituationthinspcliniquethinspagravethinspconseacutequencethinspsurthinsplrsquoassistancethinspventilatoirethinspouthinspdethinsplrsquointubationthinsp(pthinspexthinspthinspthinsparthrosethinspouthinsparthritethinspimportantethinsptrisomiethinsp21thinspetc)

thinspthinsp Lanryngoscopiethinspdifficilethinspthinspimpossibiliteacutethinspdethinspvisualiserthinspnrsquoimportethinspquellethinsppartiethinspdesthinspcordesthinspvocalesthinspapregravesthinspdethinspmultiplesthinsptentativesthinspavecthinspunthinsplaryngoscopethinspconventionnelthinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinspop citthinsp[Notrethinsptraduction])thinsp

thinspthinspIntubationthinspendotracheacutealethinspdifficilethinspthinspintubationthinspquithinsprequiertthinspdethinspmultiplesthinspthinsptentativesthinspenthinsppreacutesencethinspouthinspenthinsplrsquoabsencethinspdrsquounethinsppathologiethinsptracheacutealethinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinspop citthinspthinsp[Notrethinsptraduction])

IlthinspfautthinspnoterthinspquethinsplrsquoinsuffisancethinspdethinsplathinspclassificationthinspdethinspMallampatithinspathinspeacuteteacutethinspspeacutecifiquementthinspmontreacuteethinspchezthinsplrsquoobegravesethinspellethinspnethinsppeutthinspecirctrethinspconsideacutereacuteethinspcommethinspunthinsppreacutedicteurthinspisoleacutementthinspsuffisantthinspdethinsplathinspdifficulteacutethinspdethinsplathinsplaryngoscopiethinspouthinspathinspfortiorithinspdethinsplrsquointubationthinspdifficile

mdash Annexe

ge

ge

CMQ - OIIQ - OPIQ 53

thinspANNEXEthinspVIIIthinsp-thinspLEthinspCONSENTEMENT

SelonthinsplethinspdroitthinspenthinspvigueurthinspilthinspestthinspobligatoirethinspauthinspQueacutebecthinspdrsquoobtenirthinsplethinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspintervention

LethinspCode civil du Queacutebec eacutetablitthinspdesthinspregraveglesthinspgeacuteneacuteralesthinspconcernantthinsplethinspconsente-mentthinspauxthinspsoinsthinspquithinspsrsquoappliquentthinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspOnthinspythinspfaitthinspcependantthinspcertainesthinspdistinctionsthinspselonthinspquethinsplesthinspsoinsthinspsontthinsprequisthinspouthinspnonthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspetthinspselonthinspquethinsplethinsppatientthinspestthinspaptethinspagravethinspconsentirthinspouthinspnon

Sithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsp(traitementsthinspdethinspmeacutedecinethinspetthinspdethinspchirurgiethinspestheacutetiquethinspexpeacuterimentationthinspetthinspdonsthinspdrsquoorganes)thinsplethinsppatientthinspdoitthinspecirctrethinspinformeacutethinspdethinsptousthinsplesthinsprisquesthinsppossiblesthinspmecircmethinspsrsquoilsthinspsontthinspraresthinspetthinsplethinspconsentementthinspdoitthinspecirctrethinspdonneacutethinspparthinspeacutecritthinspHabituellementthinspilthinspnethinsppeutthinspecirctrethinspdonneacutethinspquethinspparthinspunthinsppatientthinspaptethinspetthinspacircgeacutethinspdethinsp14thinspansthinspetthinspplusthinspparthinsplethinspmandatairethinsplethinsptuteurthinspouthinsplethinspcurateurthinspdrsquounethinsppersonnethinspinaptethinspouthinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinspdrsquounethinsppersonnethinspdethinspmoinsthinspdethinsp14thinspansthinspLrsquoautorisationthinspdethinsplathinspcourthinspestthinspenthinspoutrethinspneacutecessairethinspsithinsplesthinspsoinsthinsppreacutesententthinspunthinsprisquethinspseacuterieuxthinsppourthinsplathinspsanteacutethinspdethinspcesthinsppersonnesthinspouthinspsrsquoilsthinsppeuventthinspcauserthinspdesthinspeffetsthinspgravesthinspetthinsppermanentsthinspUnethinsppersonnethinspmineurethinspdethinspthinsp14thinspansthinspetthinspplusthinsppeutthinspconsentirthinspseulethinspagravethinspmoinsthinspqursquoilthinspsrsquoagissethinspdethinspsoinsthinspnonthinsprequisthinspetthinspthinspcomportantthinspdesthinsprisques

SrsquoilthinspsrsquoagitthinspdethinspsoinsthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsplrsquoobligationthinspdrsquoinformerthinspcroicirctthinspenthinspfonctionthinspdethinsplathinsppreacutevalencethinspetthinspdethinsplathinspgraviteacutethinspdesthinspcomplicationsthinspSithinsplethinsppatientthinspestthinspinaptethinspetthinspqursquoilthinspnrsquoestthinsppasthinsprepreacutesenteacutethinspparthinspunthinspmandatairethinspunthinsptuteurthinspouthinspunthinspcura-teurthinsplethinspconsentementthinsppeutthinspecirctrethinspdonneacutethinspparthinspunthinspconjointthinspouthinspagravethinspdeacutefautthinspduthinspconjointthinspparthinspunthinspprochethinspouthinspunethinsppersonnethinspquithinspdeacutemontrethinspunthinspinteacuterecirctthinspparticulierthinsppourthinsplathinspper-sonnethinspinaptethinspIlthinspnrsquoythinspathinsppasthinspdrsquoobligationthinspagravethinspcethinspquethinspcethinspconsentementthinspsoitthinspdonneacutethinspparthinspeacutecritthinspLethinspconsentementthinspauxthinspsoinsthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspdrsquounethinsppersonnethinspmi-neurethinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinspouthinsplethinsptuteurthinspUnethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsppeutthinspconsentirthinspmaisthinspnethinsppeutthinsppasthinsprefuserthinspseulethinspdesthinspsoinsthinspquithinspseraientthinspjugeacutesthinsprequisthinspEnthinspcasthinspdrsquourgencethinsplethinspconsentementthinspauxthinspsoinsthinspmeacutedicauxthinspnrsquoestthinsppasthinspneacutecessairethinsplorsquethinsplathinsppersonnethinspouthinspsonthinspinteacutegriteacutethinspestthinspmenaceacuteethinspetthinspquethinsplethinspconsentementthinspnethinsppeutthinspecirctrethinspobtenuthinspagravethinsptemps

LathinspLoi sur les servicesthinspdethinspsanteacutethinspetthinsplesthinspservicesthinspsociauxthinsp(LSSS)thinspeacutetablitthinspquantthinspagravethinspellethinspcertainesthinspregraveglesthinspenthinspmatiegraverethinspdethinspconsentementthinspauxthinspinterventionsthinspchirurgicalesthinspetthinspagravethinsplrsquoanestheacutesiethinsp

mdash Annexe

CMQ - OIIQ - OPIQ 54

Selonthinspcettethinsploithinsplethinspconsentementthinspagravethinspunethinspanestheacutesiethinspouthinspagravethinspunethinspinterventionthinspchirurgi-calethinspdoitthinspecirctrethinspattesteacutethinspparthinspunthinspdocumentthinspeacutecritthinspsigneacutethinspparthinsplethinsppatientthinspouthinspsonthinsprepreacutesen-tantthinspetthinspcethinspdocumentthinspdoitthinspfairethinspeacutetatthinspdesthinspinformationsthinspapproprieacuteesthinspconcernantthinspnotammentthinsplesthinsprisquesthinspouthinsplesthinspeffetsthinsppossiblesthinspCetthinspeacutecritthinspdoitthinspecirctrethinspcontresigneacutethinspparthinsplethinspmeacutedecinthinspouthinsplethinspdentistethinsptraitantthinspetthinspconserveacutethinspdansthinsplethinspdossierthinspduthinsppatientthinspLethinspdossierthinspdoitthinspcontenirthinspunthinspdocumentthinspattestantthinsplethinspconsentementthinsppourthinsplesthinspsoinsthinspetthinsplesthinspservicesthinspdispenseacutesthinspdansthinspunthinspcentrethinsphospitalierthinsp(CH)thinspunthinspcentrethinspdrsquoheacutebergementthinspetthinspdethinspsoinsthinspdethinsplonguethinspdureacuteethinsp(CHSLD)thinspetthinspunthinspcentrethinsplocalthinspdethinspservicesthinspcommunau-tairesthinsp(CLSC)

CesthinspdispositionsthinspnethinspsrsquoappliquentthinspqursquoauxthinspsoinsthinspdispenseacutesthinspenthinspeacutetablissementthinspthinspMaintenantthinspquethinspplusieursthinspinterventionsthinspautrefoisthinspreacuteserveacuteesthinspauxthinspeacutetablissementsthinsppeuventthinspecirctrethinspeffectueacuteesthinspenthinspdehorsthinspdethinspceux-cithinsplathinspquestionthinspsethinspposethinsptoutefoisthinspdethinspsavoirthinspsithinsplesthinspmecircmesthinspexigencesthinspdevraientthinspsrsquoappliquerthinsppartoutthinsp

Qursquoenthinspest-ilthinspparthinspexemplethinspdethinsplathinspsignaturethinspdrsquounthinspformulairethinspdethinspconsentementthinspEnthinsppratiquethinspetthinspagravethinsplrsquousagethinspilthinspsrsquoestthinspaveacutereacutethinspqursquounthinspformulairethinspdethinspconsentementthinspducircmentthinspsigneacutethinspnethinsppeutthinspagravethinspluithinspseulthinspprouverthinspquethinsplethinspconsentementthinspathinspeacuteteacutethinsplibrethinspetthinspeacuteclaireacutethinspUnethinspcourtethinspnotethinspverseacuteethinspauthinspdossierthinspreacutesumantthinsplesthinspinformationsthinsptransmisesthinspetthinsplesthinspeacutechangesthinspauxquelsthinspellesthinspontthinspdonneacutethinsplieuthinspestthinsppreacutesentementthinspjugeacuteethinspbeaucoupthinspplusthinsppertinentethinspagravethinspcetthinspeacutegardthinspLethinspformulairethinspdethinspconsentementthinspcomplegravetethinsplesthinsprenseigne-mentsthinspfournisthinspverbalementthinspIlthinspsrsquoagitthinspdrsquounthinspajoutthinspagravethinsplrsquoinformationthinspverbalethinsptransmisethinspthinsp

etthinspnonthinspdrsquounethinspmesurethinspvisantthinspagravethinsplathinspremplacer

LethinspCode de deacuteontologiethinspdes meacutedecinsthinsppreacutecisethinsplesthinspobligationsthinspdesthinspmeacutedecinsthinsp

quantthinspauthinspconsentementthinsp

Article 28Le meacutedecin doit sauf urgence avant drsquoentreprendre un examen une investiga-tion un traitement ou une recherche obtenir du patient ou de son repreacutesentant leacutegal un consentement libre et eacuteclaireacute

Article 29Le meacutedecin doit srsquoassurer que le patient ou son repreacutesentant leacutegal a reccedilu les explications pertinentes agrave leur compreacutehension de la nature du but et des conseacutequences possibles de lrsquoexamen de lrsquoinvestigation du traitement ou de la recherche qursquoil srsquoapprecircte agrave effectuer Il doit faciliter la prise de deacutecision du patient et la respecter

mdash Annexe

CMQ - OIIQ - OPIQ 55

DansthinspsesthinspguidesthinspdrsquoexercicethinspportantthinspsurthinsplathinsptenuethinspdesthinspdossiersthinsplethinspCollegravegethinspestimethinspdrsquoailleursthinspquethinsplethinspdossierthinspdrsquounthinsppatientthinspdoitthinspcontenirthinspunethinspnotethinspattestantthinspquethinsplesthinspin-formationsthinspneacutecessairesthinspagravethinspunethinspprisethinspdethinspdeacutecisionthinspeacuteclaireacuteethinspontthinspeacuteteacutethinsptransmisesthinspparthinsplethinspmeacutedecinthinspetthinspcomprisesthinspparthinsplethinsppatientthinspouthinspsonthinsprepreacutesentantthinsplorsquethinsplathinspchosethinspestthinspjugeacuteethinsppertinentethinspathinspfortiorithinsplorsqursquoilthinspsrsquoagitthinspdrsquounethinspinterventionthinspchirurgicalethinspdrsquounethinspinterventionthinspchirurgicalethinspsousthinspseacutedation-analgeacutesiethinspdrsquoanestheacutesiethinspreacutegionalethinspouthinspgeacuteneacuteralethinsp

DansthinsplethinspCode de deacuteontologie des infirmiegraveres et infirmiersthinsponthinsppreacutevoitthinspquethinsp

thinspArticle 40 Lrsquoinfirmiegravere ou lrsquoinfirmier doit fournir agrave son client toutes les explications neacuteces-saires agrave la compreacutehension des soins et des services qursquoil lui prodigue

Article 41Lorsque lrsquoobligation drsquoobtenir un consentement libre et eacuteclaireacute incombe agrave lrsquoin-firmiegravere ou agrave lrsquoinfirmier ce dernier doit fournir au client toutes les informations

requises

LethinspCode de deacuteontologie des inhalotheacuterapeutes du Queacutebecthinspnethinspcontientthinsppasthinspdethinsp

dispositionthinsptouchantthinsppreacuteciseacutementthinsplethinspconsentementthinspOnthinsppreacutecisethinspcependantthinspquethinsp

Article 13En plus des avis et des conseils lrsquoinhalotheacuterapeute doit fournir agrave son client les explications neacutecessaires agrave la compreacutehension et agrave lrsquoappreacuteciation des services qursquoil

lui rend

EnthinspcompleacutementthinspdansthinspsesthinspnormesthinspdethinsppratiquethinspportantthinspsurthinsplathinsptenuethinspdesthinspdossiersthinsplrsquoOrdrethinspprofessionnelthinspdesthinspinhalotheacuterapeutesthinspduthinspQueacutebecthinspdemandethinspquethinsplethinspdos-sierthinspdrsquounthinsppatientthinspcomportethinspunethinspmentionthinspdesthinspsoinsthinspetthinspdesthinspservicesthinspprodigueacutesthinspagravethinspsonthinspeacutegardthinspAgravethinspcetthinspeffetthinsptoutethinspactiviteacutethinspexerceacuteethinspparthinsplrsquoinhalotheacuterapeutethinsptellethinspquethinsplrsquoinformationthinsptransmisethinspauthinsppatientthinspeuthinspeacutegardthinspagravethinsplathinspseacutedation-analgeacutesiethinspdoitthinspecirctrethinspinscritethinspauthinspdossierthinspduthinsppatientthinspetthinspcethinspauthinspfurthinspetthinspagravethinspmesurethinspquethinsplesthinspactiviteacutesthinspsontthinspexerceacutees

EnthinspsommethinsplathinsploithinspexigethinspunthinspconsentementthinspeacutecritthinspsithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspainsithinspquethinsppourthinsplesthinspanestheacutesiesthinsplesthinspinterventionsthinspchirurgicalesthinspetthinsplesthinspsoinsthinspdispenseacutesthinspenthinspeacutetablissementthinspDansthinspsesthinspguidesthinspportantthinspsurthinsplesthinspproceacuteduresthinspetthinspinterventionsthinspenthinspmilieuthinspextrahospitalierthinspnotammentthinsplethinspCollegravegethinsprecommandethinsptoutefoisthinspquethinsplethinspmeacutedecinthinspversethinspunethinspnotethinspexplicativethinspauthinspdossierthinspetthinspobtiennethinspunthinspconsentementthinspeacutecritthinsppourthinsptoutethinspinterventionthinspmeacutedicalethinspouthinsp

mdash Annexe

CMQ - OIIQ - OPIQ 56

chirurgicalethinspeffractivethinspqursquoellethinspsoitthinspeffectueacuteethinspdansthinspunthinspbutthinspdiagnosticthinsptheacuterapeu-tiquethinspouthinspestheacutetiquethinspLorsquethinsplethinspconsentementthinspportethinspagravethinsplathinspfoisthinspsurthinsplathinspseacutedation-thinspthinspanalgeacutesiethinspetthinspsurthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsplrsquoinformationthinsptrans-misethinspdoitthinspinclurethinsplesthinsprisquesthinspdethinsplrsquointerventionthinspetthinspceuxthinspdethinsplathinspseacutedation-analgeacutesiethinspcelle-cithinsppouvantthinspcomporterthinspdesthinsprisquesthinspimportantsthinspmecircmethinspsithinsplrsquointerventionthinspestthinspmineure

Lrsquoobtentionthinspdrsquounthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspdemeurethinspunethinspobligationthinspthinspinheacuterentethinspagravethinsplrsquointerventionthinspmeacutedicalethinspelle-mecircmethinspIlthinsprelegravevethinspdoncthinspdethinsplathinspresponsabiliteacutethinspduthinspmeacutedecinthinspdethinspsrsquoassurerthinspdethinsplathinsptransmissionthinspdethinsplrsquoinformationthinsppertinentethinspauthinsppatientthinspetthinspdethinspsathinspcompreacutehensionthinspdethinsplathinspnaturethinspduthinspbutthinspetthinspdesthinsprisquesthinsprelatifsthinspagravethinsplrsquointerventionthinspToutefoisthinsplathinsptacircchethinspdethinsptransmettrethinspdethinsplrsquoinfor-mationthinspcompleacutementairethinspouthinspdethinspfairethinsplrsquoenseignementthinspauxthinsppatientsthinsppeutthinspecirctrethinspconfieacuteethinspagravethinspdrsquoautresthinspprofessionnelsthinspetthinspcellethinspdethinsprecueillirthinsplathinspsignaturethinspdrsquounthinspthinspformulairethinspdethinspconsentementthinspagravethinspdrsquoautresthinspmembresthinspdethinsplrsquoeacutequipethinspdethinspsoins

mdash Annexe

CMQ - OIIQ - OPIQ 57

mdash Annexe

thinspANNEXEthinspIXthinsp-thinspEacuteVALUATIONthinspDEthinspLrsquoEFFICACITEacutethinspDEthinspLAthinspSEacuteDATIONthinsp(EXEMPLES)thinsp

(Listethinspnonthinsplimitative)thinsp

1 Eacutechelle de seacutedation de Ramsay modifieacuteethinsp(Adapteacute de Merchant et collab 2014b op cit)

Instruction Descriptiondeacutefinition Valeur

thinspObserverthinsplethinsppatientEacuteveilleacutethinspthinsplethinsppatientthinspestthinspanxieuxthinspetthinspagiteacutethinspouthinspnerveuxthinspouthinsplesthinspdeux 1

ObserverthinsplethinsppatientLethinsppatientthinspeacutetablit-ilthinspunthinspcontactthinspvisuelthinspetthinspreacutepond-ilthinspauxthinspordres

Eacuteveilleacutethinspthinsplethinsppatientthinspestthinspcoopeacuteratifthinspthinsporienteacutethinspetthinspcalme 2

ParlerthinspauthinsppatientthinspLethinsppatientthinspeacutetablit-ilthinspunthinspcontactthinspvisuelthinspetthinspreacutepond-t-ilthinspauxthinspordres

Eacuteveilleacutethinspthinsplethinsppatientthinspreacutepondthinspseulementthinspauxthinspordres 3

StimulerthinspphysiquementthinsplethinsppatientthinspenthinspagitantthinspsonthinspeacutepaulethinsptoutthinspenthinspparlantthinspfortthinspLethinsppatientthinspreacuteagit-ilthinspdansthinsplesthinsp10thinspsecon-des

Endormithinspthinsplethinsppatientthinspreacuteagitthinspparthinspunethinspreacuteponsethinspvivethinspagravethinsplathinspstimulationthinspdethinsplathinspgla-bellethinspouthinspagravethinspunthinspstimulusthinspauditifthinspintense 4

StimulerthinspphysiquementthinsplethinsppatientthinspenthinspagitantthinspsonthinspeacutepaulethinsptoutthinspenthinspparlantthinspfortthinspLethinsppatientthinspreacuteagit-ilthinspapregravesthinsp10thinspsecondes

Endormithinspthinsplethinsppatientthinspreacuteagitthinspparthinspunethinspreacuteponsethinspfaiblethinspagravethinsplathinspstimulationthinspdethinsplathinspglabellethinspouthinspagravethinspunthinspstimulusthinspauditifthinspintense

5

UtiliserthinspdesthinspstimulithinspdouloureuxAucunethinspreacuteaction

Endormithinspthinsplethinsppatientthinspnethinspreacuteagitthinsppasthinspagravethinsplathinspdouleur 6

thinsp Peuthinspimportethinsplrsquoeacutechellethinsputiliseacuteethinspcelle-cithinspdoitthinspecirctrethinspchoisiethinspselonthinsplathinspclientegravelethinspetthinsplethinspcontextethinspdonneacutethinspDethinspmecircmethinspsonthinsputilisationthinspdoitthinspecirctrethinspuniformethinspetthinspstandardiseacuteethinspauthinspseinthinspdrsquounethinspmecircmethinspeacutequipethinsp

CettethinspeacutechellethinsppeutthinspecirctrethinsputiliseacuteethinspchezthinsplrsquoenfantthinspToutefoisthinspellethinspserathinspdavantagethinsputilethinspdansthinsplethinspcadrethinspdrsquounethinspeacutevaluationthinsppostseacutedationthinsp(soinsthinsppostproceacutedures)thinspcarthinspilthinsppeutthinspecirctrethinspcliniquementthinspinapproprieacutethinspdethinspstimulerthinspphysiquementthinspunthinspenfantthinspsousthinspseacutedationthinspprofondethinsp

CMQ - OIIQ - OPIQ 58

2 Eacutechelle de vigilance-agitation de Richmond (Richmond Agitation Sedation Scale - RASS) (Tireacute et adapteacute de Chanques et collab 2006)

Lathinsptraductionthinspfranccedilaisethinspdethinspcettethinspeacutechellethinspathinspfaitthinsplrsquoobjetthinspdrsquounethinspvalidationthinspdethinspsathinspthinspreproductibiliteacutethinspinterobservateurthinsp

mdash Annexe

Instruction DescriptionDeacutefinition Niveau

Observerthinsplethinsppatientthinspsansthinspfairethinspdethinspbruit

Srsquoilthinspmanifestethinspunethinspactiviteacutethinspmotricethinspspon-taneacuteethinspquantifierthinsplethinspniveauthinspdrsquoagitationthinsp

Combatifthinspthinspdangerthinspimmeacutediatthinspenversthinsplrsquoeacutequipe + 4Tregraves agiteacutethinspthinsptirethinsparrachethinsptuyauxthinspouthinspcatheacutetersthinspetouthinspagressifthinspenversthinsplrsquoeacutequipe + 3Agiteacutethinspthinspmouvementsthinspfreacutequentsthinspsansthinspbutthinsppreacutecisthinspetouthinspdeacutesadaptationthinspauthinsprespirateur + 2Ne tient pas en placethinspthinspanxieuxthinspouthinspcraintifthinspmaisthinspmouvementsthinsporienteacutesthinsppeuthinspfreacutequentsthinspnonthinspvigoureuxthinspnonthinspagressifs

+ 1

Srsquoilthinspestthinspcalmethinspetthinspreacutepondthinspouthinspnonthinspauxthinspordresthinspsimplesthinsp

Eacuteveilleacute et calmethinspthinspcalmethinspetthinsplesthinspyeuxthinspouvertsConscientthinspthinspRASSthinsp0thinsp+thinspreacutepondthinspauxthinspordresthinspsimples

0

Srsquoilthinspestthinspcalmethinsplesthinspyeuxthinspfermeacutesthinspthinspquan-tifierthinsplethinspniveauthinspdrsquohypovigilancethinsp(outhinspdrsquoendormissement)thinspenthinspsrsquoadressantthinspauthinsppatientthinspparthinspsonthinspnomthinspsansthinsplethinsptoucherthinspenthinsputilisantthinspunethinspvoixthinspdethinspplusthinspenthinspplusthinspfortethinspetthinspdrsquoautantthinspplusthinspfortethinspquethinsplethinsppatientthinspestthinspsusceptiblethinspdrsquoecirctrethinspsourdthinsp(sujetthinspacircgeacutethinspseacutejourthinspprolongeacutethinspenthinspreacuteanimationthinspthinspbouchonthinspdethinspceacuterumenthinsptoxiciteacutethinspdesthinspantibiotiquesthinspetthinspduthinspfuroseacutemide)thinsp

Somnolentthinspthinsppasthinspcomplegravetementthinspeacuteveilleacutethinspmaisthinsprestethinspeacuteveilleacutethinspauthinspcontactthinspvisuelthinspagravethinsplrsquoappelthinspthinsp(gtthinsp10thinsps)

- 1

Diminution leacutegegravere de la vigilancethinspthinsprestethinspeacuteveilleacutethinspbriegravevementthinspavecthinspcontactthinspvisuelthinspagravethinsplrsquoappelthinsp(ltthinsp10thinsps)

- 2

Diminution modeacutereacutee de la vigilancethinspthinspnrsquoimportethinspquelthinspmouvementthinspagravethinsplrsquoappelthinsp(ouverturethinspdesthinspyeux)thinspmaisthinsppasthinspdethinspcon-tactthinspvisuel

- 3

Sithinsplethinsppatientthinspnethinspfaitthinspaucunthinspmouvementthinspythinspcompristhinspenthinsplrsquoappelantthinspdrsquounethinspvoixthinspfortethinspthinspfrictionnerthinspdrsquoabordthinsplrsquoeacutepaulethinsppuisthinsplethinspster-numthinspsansthinspecirctrethinspnociceptifthinsp

Diminution profonde de la vigilancethinspthinspau-cunthinspmouvementthinspagravethinsplrsquoappelthinspnrsquoimportethinspquelthinspmouvementthinspagravethinsplathinspstimulationthinspphysiquethinsp(frictionthinspnonthinspnociceptivethinspdethinsplrsquoeacutepaulethinspouthinspduthinspsternum)

- 4

Non reacuteveillablethinspthinspaucunethinspmouvementthinspnithinspagravethinsplrsquoappelthinspnithinspagravethinsplathinspstimulationthinspphysiquethinsp(frictionthinspnonthinspnociceptivethinspdethinsplrsquoeacutepaulethinspouthinspduthinspsternum)

- 5

CMQ - OIIQ - OPIQ 59

thinspANNEXEthinspXthinsp-thinspEacuteVALUATIONthinspDEthinspLrsquoEFFICACITEacutethinspDEthinspLrsquoANALGEacuteSIEthinsp(EXEMPLES)

(Listethinspnonthinsplimitative)thinsp

Selonthinsplrsquoacircgethinspduthinsppatientthinspsathinspconditionthinspetthinsplethinspcontextethinspcliniquethinspdeuxthinspstrateacutegiesthinspdrsquoeacuteva-luationthinsppeuventthinspecirctrethinsputiliseacuteesthinspsoitthinsplrsquoauto-eacutevaluationthinsp(parthinspdesthinspmotsthinspdesthinspchiffresthinspthinspouthinspdesthinspdessins)thinspouthinsplrsquoheacuteteacutero-eacutevaluationthinspcomportementalethinspCelathinspditthinspsithinsplrsquoauto-thinspeacutevaluationthinspestthinspagravethinspprivileacutegierthinspcrsquoestthinsptoutefoisthinsplrsquoacircgethinspduthinsppatientthinsp(patientthinsppeacutediatrique)thinspetthinspsathinspcapaciteacutethinspcognitivethinspquithinspguiderontthinsplethinspchoixthinspduthinspclinicienthinspdansthinsplathinspseacutelectionthinspduthinspmeilleurthinspoutilthinsp

Pourthinsplethinsppatientthinspnrsquoayantthinsppasthinsplathinspcapaciteacutethinsp(pthinspexthinspthinsphabiliteacutethinspverbalethinspouthinspcognitivethinsplimiteacutee)thinspdrsquoeacutevaluerthinsplui-mecircmethinsplrsquointensiteacutethinspdethinsplathinspdouleurthinspunethinspreacuteponsethinspverbalethinsp(ouinon)thinspouthinspgestuellethinspsignifiantthinsplathinsppreacutesencethinspouthinsplrsquoabsencethinspdethinspdouleurthinspconstituethinspunethinspformethinspdrsquoauto-eacutevaluationthinspacceptablethinspenthinsppratiquethinspcliniquethinspaupregravesthinspdethinspcertainesthinsppopulationsthinsptellesthinspquethinsplethinspjeunethinspenfantthinsplethinsppatientthinspdeacutementthinspouthinspceluithinspvivantthinspavecthinspunethinspdeacuteficiencethinspintellectuellethinsp(McCafferythinspciteacutethinspdansthinspHerrthinspetthinspcollabthinsp2011thinsp[Notrethinsptraduc-

tion])

thinspthinsp Peuthinspimportethinsplrsquoeacutechellethinsputiliseacuteethinspcelle-cithinspdoitthinspecirctrethinspchoisiethinspselonthinsplathinspclientegravelethinspetthinsplethinspcontextethinspdonneacutethinspDethinspmecircmethinspsonthinsputilisationthinspdoitthinspecirctrethinspuniformethinspetthinspstandardiseacuteethinspauthinspseinthinspdrsquounethinspmecircmethinspeacutequipethinspsoignantethinsp

ADULTE-AIcircNEacutethinsp

AUTO-EacuteVALUATIONthinsp(DOULEURthinspAIGUEuml)

thinsprsaquo Eacutechellethinspnumeacuteriquethinsp(0thinspagravethinsp10)thinsp(EN)thinsprsaquo Eacutechellethinspverbalethinspsimplethinsp(EVS)thinsprsaquo Eacutechellethinspvisuellethinspanalogiquethinsp(EVA)

HEacuteTEacuteRO-EacuteVALUATIONthinspCOMPORTEMENTALEthinsp(DOULEURthinspAIGUEuml)

thinsprsaquo ALGOPLUSthinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspdesthinsptroublesthinspdethinsplathinspcommunicationthinspverbale)

thinsprsaquo PACSLACthinspouthinspPACSLAC-Fthinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspunethinspcapaciteacutethinsplimiteacuteethinspagravethinspcommuniquer

thinsprsaquo PAINADthinsp(anglais)thinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspunethinspdeacutemencethinspouthinspautrethinsptroublethinspcognitifthinspetthinspquithinspnethinsppeutthinspcommuniquerthinspdethinspmaniegraverethinspfiable

Les hyperliens concernant ces eacutechelles sont fournis agrave titre informatif seulement

mdash Annexe

CMQ - OIIQ - OPIQ 10

Notonsthinspquethinspdansthinspdesthinspsituationsthinspparticuliegraveresthinspetthinspjustifieacuteesthinspauthinspdossierthinspmeacutedi-calthinsplathinspseacutedation-analgeacutesiethinsppeutthinspecirctrethinspeffectueacuteethinspchezthinsplesthinsppatientsthinspstablesthinspdethinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp3thinspetthinspexceptionnellementthinspdethinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp4thinspToutefoisthinspellethinspdoitthinsplrsquoecirctrethinspdansthinspdesthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspopti-malethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespira-toirethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspDethinspplusthinspcesthinsppatientsthinspdoiventthinspfairethinsplrsquoobjetthinspdrsquounethinspeacutevaluationthinspindividualiseacuteethinspetthinspplusthinspapprofondiethinsp

Lathinspprofondeurthinspdethinsplathinspseacutedationthinspetthinsplethinspniveauthinspdrsquoanalgeacutesiethinsprechercheacutethinspenthinspseacutedation-analgeacutesiethinspdoiventthinspcorrespondrethinspauxthinspniveauxthinsppermettantthinsplrsquoatteintethinspdesthinspobjectifsthinspviseacutesthinspetthinspecirctrethinspmesureacutesthinspagravethinsplrsquoaidethinspdrsquoeacutechellesthinspstandardiseacuteesthinspvalideacuteesthinspdethinsppreacutefeacuterencethinspetthinspadapteacuteesthinspauthinspcontextethinspetthinspagravethinsplathinspconditionthinspduthinsppatientthinspLesthinspniveauxthinspdethinspseacutedation-analgeacutesiethinspviseacutesthinsptelsthinspquethinspdeacutefinisthinspdansthinsplathinspclassificationthinspdethinsplrsquoASAthinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinspASAthinspHousethinspofthinspDelegatethinsp2014a)thinsp(annexethinspI)thinspdoiventthinspcorrespondentthinspagravethinsplrsquounthinspouthinsplrsquoautrethinspdesthinspdeuxthinspniveauxthinspsuivantsthinsp(CMQthinsp2009)thinsp

thinsprsaquo seacutedationthinspminimalethinspouthinsplaquothinspanxiolysethinspraquothinspougravethinsplrsquoappreacutehensionthinspduthinsppatientthinspestthinspdiminueacuteethinspsansthinspchangementthinspdethinspsonthinspniveauthinspdethinspconsciencethinspetthinspsansthinspalteacutererthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsplathinspventilationthinspetthinsplathinspfonctionthinspcardiovasculaire

thinsprsaquo seacutedationthinspmodeacutereacuteethinspougravethinsplathinspreacuteponsethinspauxthinspstimulithinspverbauxthinspouthinsptactilesthinspleacutegersthinspestthinspvolontairethinspsansthinspaffecterthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsplathinspventilationthinspspontaneacuteethinspetthinsplathinspfonctionthinspcardiovasculaire

Notonsthinsptoutefoisthinspquethinsplrsquoeacutequipethinspsoignantethinspparticipantthinspagravethinsplathinspproceacutedurethinspdoitthinspconnaicirctrethinsplethinspniveauthinspdethinspseacutedation-analgeacutesiethinspgeacuteneacuteralementthinspneacutecessairethinsppourthinspunethinspinterventionthinspdonneacuteethinspDethinspmecircmethinspellethinspdoitthinspecirctrethinsppreacutepareacuteethinspagravethinspgeacutererthinsplethinsppassagethinspmomentaneacutethinspagravethinspunthinspniveauthinspdethinspseacutedationthinspsupeacuterieurthinspagravethinspceluithinspquithinspathinspeacuteteacutethinspplanifieacutethinsp(crsquoest-agrave-direthinspplusthinspprofondthinspquethinsppreacutevu)thinspcethinspquithinsppeutthinspsurvenirthinspenthinsptoutthinsptempsthinsplorsthinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsp

CMQ - OIIQ - OPIQ 11

Volet organisationnel

thinsp12thinspCOMPEacuteTENCESthinspPROFESSIONNELLESthinsp

Consideacuterantthinspquethinsplathinspseacutedation-analgeacutesiethinspsrsquoinscritthinspdansthinspunethinsppratiquethinspdethinspcollabo-rationthinspentrethinsplethinspmeacutedecinthinspetthinspdrsquoautresthinspprofessionnelsthinspdethinsplathinspsanteacutethinsp(infirmiegraveresthinspetthinspinhalotheacuterapeutes)thinspilthinspimportethinspdethinsppreacuteciserthinspqursquounethinsputilisationthinspjudicieusethinspdethinspleursthinspcompeacutetencesthinspestthinspdethinspmisethinsppourthinspassurerthinsplathinspqualiteacutethinspetthinsplrsquoefficiencethinspdesthinspsoinsthinspAinsithinsptousthinspdoiventthinspavoirthinsplesthinspqualificationsthinsprequisesthinspdansthinsplethinspdomainethinspdethinsplathinspseacutedation-thinspanalgeacutesie

Dethinspplusthinsplrsquoeacutequipethinspsoignantethinspquithinspreacutealisethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacutera-peutiquethinspsousthinspseacutedation-analgeacutesiethinspdoitthinsp

a ecirctrethinspenthinspmesurethinspdrsquoeacutevaluerthinspadeacutequatementthinsplathinspconditionthinspdethinspsanteacutethinspduthinsppatientthinspetthinspdrsquoenthinspassurerthinsplathinspsurveillancethinspclinique

b connaicirctrethinspetthinsputiliserthinspjudicieusementthinsplathinspmeacutedicationthinspainsithinspquethinspsesthinspantagonistes

c posseacutederthinsplesthinspconnaissancesthinspetthinsplesthinspcompeacutetences1thinspneacutecessairesthinsppourthinspintervenirthinspenthinspsituationthinspdrsquourgencethinsptellethinspquethinsplathinspreacuteanimationthinspcardiorespiratoire2thinsp(dethinsppreacutefeacuterencethinspenthinspsoinsthinspavanceacutes)thinspcrsquoest-agrave-direthinspmaicirctriserthinspenthinspprioriteacutethinsplesthinsptechniquesthinspdethinsplathinspprisethinspenthinspchargethinspdethinsplathinspventilationthinspduthinspmassagethinspcardiaquethinspetthinspdethinsplathinspmeacutedicationthinspassocieacutee

d avoirthinsplrsquoexpertisethinsprequisethinspselonthinsplathinspclientegravelethinspviseacuteethinspetthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspagravethinspreacutealiserthinsp

thinsp13thinspRESSOURCESthinspMATEacuteRIELLESthinsp

1thinspLOCAUX

LrsquoameacutenagementthinspdesthinsplocauxthinspdoitthinsppermettrethinspdethinspreacutealiserthinspdethinspfaccedilonthinspadeacutequatethinspetthinspenthinsptoutthinsptempsthinspunethinspreacuteanimationthinspcardiorespiratoirethinspainsithinspqursquounethinspeacutevacuationthinspdrsquourgencethinsplethinspcasthinspeacutecheacuteantthinspEntrethinspautresthinsplathinspsuperficiethinspdoitthinsppermettrethinspauthinsppersonnelthinspdethinspcircu-lerthinsplibrementthinsplrsquoeacuteclairagethinspdoitthinspecirctrethinspsuffisantthinsplethinspmateacuterielthinspdrsquourgencethinsp(pthinspexthinspthinspdethinspreacuteani-mation)thinspdoitthinspecirctrethinspfacilementthinspaccessiblethinspetthinspentreposeacutethinspdansthinspunthinsplieuthinspconnuthinspdethinsptousthinsp

Selonthinsplesthinspmodaliteacutesthinspdethinspfonctionnementthinspetthinsplethinsptypethinspdrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsppratiqueacutethinspilthinspestthinspdrsquousagethinspdethinspdisposerthinspdrsquounethinspsallethinspdethinspreacutecupeacutera-tionthinspouthinspdrsquoobservation

1thinspthinspthinspthinspOnthinspentendthinspparthinspconnaissancesthinspetthinspcompeacutetencesthinspqursquoellesthinspsoientthinspmisesthinspagravethinspjourthinspselonthinsplesthinsprecommandationsthinspenthinspvigueur2thinspthinspthinspOnthinspentendthinspparthinspcertificationthinspenthinspreacuteanimationthinspcardiorespiratoirethinsplesthinspformationsthinspsuivantesthinspthinsp thinsprsaquothinspReacuteanimationthinspcardiorespiratoirethinspdethinspbasethinspthinspSoinsthinspimmeacutediatsthinspenthinspreacuteanimationthinsp(SIR)thinsppourthinspprofessionnelsthinspdethinsplathinspsanteacutethinspthinspthinspthinspthinspthinspthinspthinspthinspouthinsplrsquoeacutequivalentthinsp thinsprsaquothinspReacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspSoinsthinspavanceacutesthinspenthinspreacuteanimationthinspcardiovasculairethinsp(SARC)thinspouthinsplrsquoeacutequivalent

CMQ - OIIQ - OPIQ 12

Pourthinspinformationthinspcompleacutementairethinsp(annexethinspII)thinspProceacutedures et interventions en milieu extrahospitalierthinsp(CMQthinsp2011)

2thinspEacuteQUIPEMENTthinsp(INTRAthinspETthinspEXTRAHOSPITALIER)

OBLIGATOIRE

Enthinspplusthinspduthinspmateacuterielthinspdirectementthinsplieacutethinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspjustifiantthinsplathinspseacutedation-analgeacutesiethinsponthinspdoitthinsptrouverthinspminimalementthinsplrsquoeacutequipe-

mentthinspsuivant

Dansthinsplathinspsallethinsp

thinsprsaquo tablethinspdrsquoexamenthinspciviegraverethinspouthinsptablethinspdethinspchirurgiethinsprsaquo tablethinsppourthinsplesthinspinstrumentsthinsprsaquo soluteacutesthinspetthinspmateacuterielthinspneacutecessairethinsppourthinsplrsquoinstallationthinspetthinsplethinspmaintienthinspdrsquounethinspvoiethinsp

endoveineusethinsprsaquo saturomegravetrethinsp(oxymegravetrethinspdethinsppouls)thinsp

Lethinspmonitoragethinspdethinsplathinspsaturationthinspenthinspoxygegravenethinsppermetthinsplrsquoeacutevaluationthinspdethinsplrsquooxy-geacutenationthinsp(deacutetectionthinsppreacutecocethinspdrsquounethinsphypoxeacutemie)thinspmaisthinspilthinspnethinsppeutthinsppasthinspdeacutetecterthinsppreacutecocementthinspunethinspobstructionthinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(AmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2012)thinspthinsp

thinsprsaquo steacutethoscopethinspthinsprsaquo sphygmomanomegravetrethinspouthinspappareilthinspautomatiseacutethinspnonthinspinvasifthinsppourthinsplathinspprisethinspdethinsplathinsp

pressionthinsparteacuteriellethinsprsaquo sourcethinspdrsquooxygegravenethinspcomprimeacutethinspenthinspquantiteacutethinspsuffisantethinsppourthinspenthinsppermettrethinsp

llsquoadministrationthinspagravethinspunthinspdeacutebitthinspdethinsp15thinsplitresthinspparthinspminutethinsppendantthinsp60thinspminutesthinspetthinspthinsplethinspmateacuterielthinspneacutecessairethinspagravethinsplrsquooxygeacutenotheacuterapie

thinsprsaquo appareilthinspagravethinspaspirationthinsppouvantthinspgeacuteneacutererthinspunethinsppressionthinspneacutegativethinspdethinsp40ndash60thinspmmthinspHgthinspouthinspunethinspcapaciteacutethinspdethinspflotthinspdethinsp100thinsplitresthinspparthinspminutethinspetthinsplethinspmateacuterielthinspneacutecessairethinspthinspagravethinsplrsquoaspiration

thinsprsaquo lethinspmateacuterielthinspneacutecessairethinspagravethinsplathinspprisethinspenthinspchargethinspventilatoirethinspentrethinspautresthinspreacuteanimateurthinspmanuelthinspautogonflablethinsp(Ambuthinspbag)thinspmasquethinspcanulesthinspnasothinspthinspetthinsporopharyngeacuteesthinspdethinsptaillesthinspvarieacutees

Ce mateacuteriel doit ecirctre disponible agrave porteacutee de la main

CMQ - OIIQ - OPIQ 13

thinsprsaquo appareilthinspdrsquoalimentationthinspeacutelectriquethinspdethinspsecoursthinsppourthinsplethinspfonctionnementthinspdesthinspeacutequipementsthinspdrsquourgence

Peutthinspecirctrethinspagravethinsplrsquoexteacuterieurthinspdethinsplathinspsallethinsp(maisthinspfacilethinspdrsquoaccegravesthinspetthinsprapidementthinspdisponible)thinsp

thinsprsaquo thinsparmoirethinspfermeacuteethinsppourthinspentreposerthinspsousthinspcleacutethinspauthinspbesointhinsplethinspmateacuterielthinspetthinsplesthinspsubstancesthinspcontrocircleacuteesthinspainsithinspquethinsplesthinspbenzodiazeacutepines

thinsprsaquo mateacuterielthinspneacutecessairethinspagravethinsplrsquointubationthinspendotracheacutealethinspentrethinspautresthinspsondesthinspendotracheacutealesthinspetthinsplamesthinspdethinsplaryngoscopethinspdethinsptaillesthinspvarieacuteesthinspainsithinspquethinspdesthinspalternativesthinspagravethinsplrsquointubationthinspdifficilethinsp(pthinspexthinspthinspoutilsthinspextraglottiquesthinsptelsthinspquethinspmasquesthinsplaryngeacutes)

thinsprsaquo deacutefibrillateurthinspcardiaquethinsp(dethinsppreacutefeacuterencethinspunthinspdeacutefibrillateurthinspexternethinspautomatiseacutethinsp[DEA])

thinsprsaquo pharmaciethinsp(troussethinspouthinspchariot)thinspcontenantthinsplesthinspmeacutedicamentsthinspneacutecessairesthinspauthinsptraitementthinspdesthinspsituationsthinspdrsquourgencethinsptellesthinspquethinspthinspsurdosagethinspauxthinspopioiumldesthinspouthinspauxthinspbenzodiazeacutepinesthinspurgencethinspcardiaquethinspreacuteactionthinspallergiquethinspcrisethinspdrsquoasthmethinspcrisethinspconvulsivethinspchocthinspvagalthinsphypoglyceacutemiethinspetc

RECOMMANDEacutethinspSELONthinspLAthinspSITUATION

thinsprsaquo moniteurthinspcardiaquethinspthinspdansthinspcertainsthinspcasthinspbienthinspdeacutefinisthinsplethinspmonitoragethinspcardiaquethinsppeutthinspecirctrethinsprecommandeacutethinspouthinspobligatoirethinsp(tableauthinsp3)

thinsprsaquo capnographethinspthinspdansthinspcertainsthinspcasthinspbienthinspdeacutefinisthinsplethinspmonitoragethinspduthinspCO2thinsppeutthinspecirctrethinsp

recommandeacutethinspouthinspobligatoirethinsp(tableauthinsp3)thinspthinspLethinspmonitoragethinspduthinspCO

2thinsppermetthinspdrsquoidentifierthinsppreacutecocementthinsplesthinspcomplicationsthinsp

tellesthinsplathinspseacutedationthinspexcessivethinsplrsquohypoventilationthinspetthinsplrsquoapneacuteethinspenthinspplusthinspdethinsppermettrethinspdethinspmieuxthinspcontrocirclerthinsplethinspniveauthinspdethinspseacutedationthinspenthinspfonctionthinspdethinsplrsquointerventionthinspthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinspSonthinsputilisationthinsppermetthinspeacutegalementthinspthinspdethinspsuivrethinsplethinspmonitoragethinspventilatoirethinspCelathinspestthinspparticuliegraverementthinspapproprieacutethinspthinsplorsqursquoilthinspnrsquoexistethinsppasthinspdrsquoantagonistesthinspagravethinsplathinspmeacutedicationthinsputiliseacuteethinsp(pthinspexthinspthinsppropofol)thinsp

OPTIONNEL

thinsprsaquo moniteurthinspdethinsptempeacuteraturethinspetthinspdispositifthinspdethinspreacutechauffementthinspduthinsppatientthinspselonthinsplethinsppatientthinspetthinsplathinspdureacuteethinspdethinsplrsquointerventionthinsp

thinsprsaquo systegravemethinspdrsquoantipollutionthinsp(eacutevacuationthinspduthinspprotoxydethinspdrsquoazote)thinspsrsquoilthinspythinspathinsplieuthinsprsaquo analyseurthinspdrsquooxygegravenethinsplorsqursquounthinspmeacutelangethinspestthinsputiliseacutethinsp(pthinspexthinspthinspO

2thinspetthinspprotoxydethinsp

drsquoazote)thinsprsaquo steacutethoscopethinsppreacutecordialthinspouthinsppreacutetracheacutealthinsppourthinspeacutecoutethinspenthinspcontinu

CMQ - OIIQ - OPIQ 14

LrsquoensemblethinspdethinspcesthinspeacutequipementsthinspdoitthinspecirctrethinspadapteacutethinspauthinsppatientthinspIlsthinspdoiventthinspecirctrethinspenthinspeacutetatthinspdethinspfonctionnerthinspetthinsplesthinspattestationsthinspdesthinspveacuterificationsthinsppeacuteriodiquesthinspdoiventthinspecirctrethinspconserveacuteesthinspdansthinspunthinspregistrethinsppreacutevuthinspagravethinspcettethinspfin

Pendantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplesthinspprofessionnelsthinspdoiventthinspthinsprespecterthinsplesthinspregraveglesthinspdethinsppreacuteventionthinspetthinspdethinspcontrocirclethinspdesthinspinfections

Unethinspproceacutedurethinsprelativethinspauxthinspsituationsthinspdrsquourgencethinsp(annexethinspIII)thinspagravethinsplrsquoaccegravesthinspauxthinspser-vicesthinspdrsquourgencethinsppreacutehospitaliersthinspetthinspdethinsptransfertthinspselonthinspunethinspententethinspintereacutetablisse-mentsthinspdoitthinspecirctrethinspeacutelaboreacuteethinspmaintenuethinspagravethinspjourthinspfacilementthinspdisponiblethinspenseigneacuteethinspagravethinsptoutthinsplethinsppersonnelthinspetthinspfairethinsplrsquoobjetthinspdrsquounthinsprappelthinspaupregravesthinspdethinspcethinspdernierthinspsurthinspunethinspbasethinsp

peacuteriodiquethinsp

CMQ - OIIQ - OPIQ 15

Volet professionnel

thinsp14thinspPREacuteSEacuteDATION-ANALGEacuteSIEthinsp

SEacuteLECTIONthinspDESthinspPATIENTS

Lathinspseacutelectionthinspdesthinsppatientsthinspdoitthinsptenirthinspcomptethinspnotammentthinspdethinsplrsquoeacutevaluationthinspdesthinspvoiesthinspaeacuteriennesthinspetthinspdethinsplrsquoeacutetatthinspdethinspsanteacutethinspgeacuteneacuteralthinspduthinsppatientthinspquithinspaurontthinspmisthinspenthinspeacutevi-dencethinsplathinsppreacutesencethinspouthinsplrsquoabsencethinspdrsquoindicateursthinspdethinsppossiblesthinspcomplicationsthinsplorsthinspdethinsplathinspseacutedation-analgeacutesiethinspIlthinspexistethinspdeuxthinsptypesthinspdethinsprisquesthinspenthinspseacutedation-analgeacutesiethinspthinsplesthinsprisquesthinsppreacutevisiblesthinsp(difficulteacutethinsppotentiellethinsplieacuteethinspagravethinsplathinspgestionthinspdesthinspvoiesthinspaeacuteriennesthinspouthinspinstabiliteacutethinspduthinsppatient)thinspetthinsplesthinsprisquesthinspimpreacutevisiblesthinsp(incidentaccidentthinsperreurthinsphu-mainethinspetc)thinspUnethinspeacutevaluationthinspinitialethinsp(histoirethinspexamenthinspphysique)thinspadeacutequatethinspavantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspdiminuethinspdethinsptelsthinsprisques

Agravethinsppartirthinspdethinsplrsquoensemblethinspdesthinspeacutevaluationsthinspeffectueacuteesthinsplethinspmeacutedecinthinspseacutelectionnethinsplesthinsppatientsthinspaptesthinspagravethinsprecevoirthinspunethinspseacutedation-analgeacutesiethinspselonthinspnotammentthinsp

thinsprsaquo lesthinspfacteursthinspdethinsprisquethinspidentifieacutesthinspagravethinsplathinspsuitethinspdethinsplrsquoeacutevaluationthinsp(cardiovasculairethinsprespiratoirethinspheacutepatiquethinspneurologique)thinspdethinsplathinsppossibiliteacutethinspdethinspgrossessethinspchezthinsplathinspfemmethinspenthinspacircgethinspdethinspprocreacuteerthinspouthinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspenvisageacutee

thinsprsaquo lrsquoeacutevaluationthinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(annexethinspIV)thinspafinthinspdethinsppreacuteciserthinsplethinsprisquethinspdrsquoassistancethinspventilatoirethinspetthinspdrsquointubationthinspdifficilethinsp

thinsprsaquo lesthinspanteacuteceacutedentsthinspanestheacutesiquesthinspetthinspchirurgicauxthinspafinthinspdrsquoidentifierthinsplesthinspcomplicationsthinsppotentielles

thinsprsaquo lesthinspcomorbiditeacutesthinspdontthinsplesthinsptroublesthinsprespiratoiresthinspduthinspsommeilthinsp(annexethinspV)thinsprsaquo lathinspmeacutedicationthinspouthinspautresthinspsubstancesthinsp(prescritesthinspouthinspenthinspventethinsplibre)thinspafinthinsp

drsquoidentifierthinsplesthinsprisquesthinspdrsquointeractionsthinspavecthinsplesthinspmeacutedicamentsthinsputiliseacutesthinsplorsthinspdethinsplrsquointerventionthinspouthinspdethinsplathinspseacutedation-analgeacutesie

thinsprsaquo lrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspquithinsppourraitthinspneacutecessiterthinspunethinspseacutedation-analgeacutesiethinspdrsquounthinspniveauthinspsupeacuterieurthinspagravethinspceluithinspdontthinspilthinspestthinspquestionthinspdansthinspcesthinsplignesthinspdirectrices

thinsprsaquo lesthinspcaracteacuteristiquesthinsppropresthinspauthinsppatientthinsp(fonctionsthinspcognitivesthinspisolementthinspsocialthinspautonomiethinspetc)

EacuteVALUATIONthinspDESthinspPATIENTS

Cettethinspeacutevaluationthinspdoitthinspsethinspfairethinsppeuthinspdethinsptempsthinsp(moinsthinspdethinsp3thinspmoisthinspenthinsplrsquoabsencethinspdethinspchangementthinspnotablethinspdansthinsplathinspconditionthinspcliniquethinspduthinsppatient)thinspavantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspetthinspdoitthinspnotammentthinsppreacuteciserthinspcethinspquithinspsuit

CMQ - OIIQ - OPIQ 16

AgravethinspLrsquoANAMNEgraveSEthinspthinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsp

lrsquoeacutevaluationthinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinsp(annexethinspVI)thinsp

thinsprsaquo raison(s)thinspdethinspconsultationthinspetthinsphistoirethinspdethinsplathinspmaladiethinspactuellethinsprsaquo anteacuteceacutedentsthinsprsaquo reacuteactionthinspanteacuterieurethinspagravethinsplathinspseacutedation-analgeacutesiethinspagravethinsplrsquoanestheacutesiethinspetthinspagravethinsplathinspchirurgiethinsprsaquo allergiesthinsprsaquo momentthinspduthinspdernierthinspingestathinsp(preacuteciserthinsplethinsptypethinspetthinsplathinspquantiteacute)thinsprsaquo meacutedicationthinspetthinspautresthinspsubstancesthinsp(prescritesthinspouthinspnon)thinsprsaquo preacutemeacutedicationthinspreccediluethinsp(pthinspexthinspthinspadministrationthinspdethinspmorphinethinspchezthinspunthinsppatientthinspenthinsp

attentethinspdrsquounethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutique)thinsprsaquo habitudesthinspdethinspviethinsp(tabacthinspalcoolthinspouthinspdrogues)thinsprsaquo troublethinsprespiratoirethinspduthinspsommeilthinspetthinsplathinsptheacuterapiethinspassocieacutee

AgravethinspLrsquoEXAMENthinspPHYSIQUEthinsp

Lrsquoexamenthinspphysiquethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinspcherchethinspagravethinspmettrethinspenthinspeacutevi-dencethinspcertainsthinspcritegraveresthinspreconnusthinsppourthinspecirctrethinspassocieacutesthinspagravethinspunethinspassistancethinspventila-toirethinspdifficilethinspquithinsppeutthinspsurvenirthinspdansthinsplethinspcasthinspdrsquounthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquethinspceluithinspviseacutethinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsplrsquoeacutevaluationthinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinsp(annexethinspVII)thinsp

Lrsquoexamenthinspphysiquethinspdoitthinspecirctrethinspadapteacutethinspagravethinspchaquethinsppatientthinspetthinspporterthinspnotammentthinspsurthinspdesthinspeacuteleacutementsthinsptelsthinspquethinspceux-cithinsp

thinsprsaquo preacutesencethinspdrsquoobeacutesiteacutethinsprsaquo tecirctethinspetthinspcouthinsp

thinsprsaquo mobiliteacutethinspcervicalethinspcompromisethinsprsaquo couthinspcourtthinspouthinsplargethinsp(circonfeacuterencethinsp )thinsprsaquo pathologiethinspouthinspanomaliethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinsp(pthinspexthinspthinspmassethinsp

cervicale)thinspthinsprsaquo bouchethinsp

thinsprsaquo petitethinspouverturethinsprsaquo dentitionthinsp(pthinspexthinspthinspbouchethinspeacutedenteacuteethinspdentsthinspinstablesthinspincisivesthinspproeacuteminentesthinsp

outhinspappareilthinspdentairethinspmalocclusionthinspimportante)thinsp

LethinspscorethinspdethinspMallampatithinspmodifieacutethinspestthinspunthinspoutilthinspagravethinspprivileacutegierthinsp(annexethinspIV)

CMQ - OIIQ - OPIQ 17

UnethinspbonnethinspeacutevaluationthinspdethinsptousthinsplesthinspaspectsthinsprelatifsthinspauthinspmaintienthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspestthinspessentiellethinspDethinspplusthinspchezthinsplethinsppatientthinspsymptomatiquethinspthinsp(pthinspexthinspthinspdyspneacutee)thinspcettethinspeacutevaluationthinspdoitthinspecirctrethinspcompleacuteteacuteethinspparthinsplrsquoauscultation cardiorespiratoirethinspFinalementthinspsithinspdrsquoautresthinspexamensthinspdoiventthinspecirctrethinspfaitsthinspleurthinspchoixthinspserathinspguideacutethinspparthinsplesthinspproblegravemesthinspmeacutedicauxthinspsous-jacents

Bienthinspquethinsplathinspseacutedation-analgeacutesiethinspnethinsppreacutevoitthinspnormalementthinsppasthinspdethinspprisethinspenthinspchargethinspcomplegravetethinspdethinsplathinspventilationthinsp(assistancethinspventilatoirethinspouthinspintubationthinspthinspendotracheacuteale)thinspilthinspestthinspimportantthinspdrsquoeffectuerthinspcettethinspeacutevaluationthinsppuisqursquoagravethinspthinsptoutthinspmomentthinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspunethinspventilationthinspthinspassisteacuteethinspavecthinspouthinspsansthinspintubationthinspendotracheacutealethinsppeutthinspsrsquoaveacutererthinspneacutecessairethinspthinspsithinsplathinsprespirationthinspestthinspcompromisethinsp

Lorsthinspdethinspsituationsthinspparticuliegraveresthinspouthinspcomplexesthinsplethinspmeacutedecinthinspdevraitthinspconsulterthinspunthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinsp

cardiorespiratoirethinspavanceacutee

CONSENTEMENTthinsp(REacuteSUMEacute)

LethinsplecteurthinspdoitthinspsethinspreacutefeacutererthinspagravethinsplrsquoannexethinspVIIIthinsppourthinsplethinsptextethinspcomplet

SelonthinsplethinspdroitthinspenthinspvigueurthinspauthinspQueacutebecthinspilthinspestthinspobligatoirethinspdrsquoobtenirthinsplethinspconsentementthinspdrsquounthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspintervention

LethinspCode civil du QueacutebecthinspeacutetablitthinspdesthinspregraveglesthinspgeacuteneacuteralesthinspconcernantthinsplethinspconsentementthinspauxthinspsoinsthinspquithinspsrsquoappliquentthinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspdispenseacutesthinspOnthinspythinspfaitthinspcependantthinspcertainesthinspdistinctionsthinspselonthinspquethinsplethinsppatientthinspestthinspaptethinspouthinspnonthinspagravethinspconsentirthinspetthinspselonthinspquethinsplesthinspsoinsthinspsontthinsprequisthinspouthinspnonthinsp

parthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspLathinspLoi sur les services de santeacute et les services sociaux (LSSSS)thinspeacutetablitthinspquantthinspagravethinspellethinsplesthinspregraveglesthinspapplicablesthinspenthinspeacutetablissementthinspenthinspmatiegraverethinspdethinspconsentementthinspauxthinspinterventionsthinspchirurgicalesthinspetthinspagravethinsplrsquoanestheacutesiethinsp

LethinspCode de deacuteontologie des meacutedecinsthinspstipulethinspquethinsplethinspmeacutedecinthinspdoitthinspobtenirthinspunthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspavantthinsptoutethinspinterventionthinspilthinspestthinsppreacuteciseacutethinspquethinsplethinspmeacutedecinthinspdoitthinspsrsquoassurerthinspquethinsplrsquoinformationthinsppertinentethinspathinspeacuteteacutethinsptransmisethinspfaciliterthinsplathinspprisethinspdethinspdeacutecisionthinspduthinsppatientthinspetthinsplathinsprespecterthinspLethinspCode de deacuteontologie

des infirmiegraveres et infirmiersthinspstipulethinspquantthinspagravethinspluithinspquethinsplrsquoinfirmiegraverethinspouthinsplrsquoinfirmierthinspdoitthinspfournirthinspauthinspclientthinsptoutesthinsplesthinspinformationsthinsprequisesthinsplorsquethinsplrsquoobligationthinspdrsquoobtenirthinspunthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspincombethinspagravethinsplrsquoinfirmiegraverethinspouthinspagravethinsplrsquoinfirmierthinspIlthinspnrsquoythinspathinsppasthinspdethinspdispositionthinsptouchantthinsppreacuteciseacutementthinsplethinspconsentementthinspdansthinsplethinspCode de

CMQ - OIIQ - OPIQ 18

deacuteontologie des inhalotheacuterapeutes du QueacutebecthinspCependantthinspilthinspestthinsppreacuteciseacutethinspqursquoenthinspplusthinspdesthinspavisthinspetthinspdesthinspconseilsthinsplrsquoinhalotheacuterapeutethinspdoitthinspfournirthinspagravethinspsonthinspclientthinsplesthinspexplicationsthinspneacutecessairesthinspagravethinsplathinspcompreacutehensionthinspetthinspagravethinsplrsquoappreacuteciationthinspdesthinspservicesthinspqursquoilthinspluithinsprend

TousthinsplesthinspprofessionnelsthinspsontthinspeacutevidemmentthinsptenusthinspdethinsprespecterthinsplesthinspdispositionsthinspleacutegalesthinspexistantesthinspndashthinspincluantthinspleurthinspcodethinspdethinspdeacuteontologiethinsprespectifthinspndashthinspetthinsplesthinspnormesthinspdethinsppratiquethinspeacutetabliesthinspparthinspleurthinspordrethinspprofessionnelthinspToutefoisthinsplathinspquestionthinspsethinspposethinspdethinspsavoirthinspcommentthinspcesthinspexigencesthinspdoiventthinspsrsquoappliquerthinspmaintenantthinspquethinspplusieursthinspinterventionsthinspreacutealiseacuteesthinspautrefoisthinspenthinspeacutetablissementthinspsontthinspeffectueacuteesthinspenthinspdehorsthinspthinspdethinspceux-cithinspetthinspquethinsplesthinspprofessionnelsthinsppartagentthinspcertainesthinspactiviteacutesthinspetthinsptravaillentthinsp

enthinspeacutetroitethinspcollaboration

Mecircmethinspsithinsplathinsploithinspnethinsplrsquoexigethinsppasthinsptoujoursthinspilthinspestthinsprecommandeacutethinsp

thinsprsaquo quethinsplethinsppatientthinspdonnethinspunthinspconsentementthinspeacutecritthinsplorsqursquoilthinspythinspathinspseacutedation-analgeacutesiethinspthinspetthinspcethinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspprodigueacutes

thinsprsaquo quethinsplethinspconsentementthinspportethinspagravethinsplathinspfoisthinspsurthinsplathinspseacutedation-analgeacutesiethinspetthinspsurthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspquethinspcettethinspderniegraverethinsppermet

thinsprsaquo quethinsplrsquoinformationthinsptransmisethinspauthinsppatientthinspverbalementthinspouthinspparthinspeacutecritthinspcomprennethinsplesthinsprisquesthinspdethinsplathinspseacutedation-analgeacutesiethinspetthinsplesthinsprisquesthinspdethinsplrsquointerventionthinspelle-mecircme

thinsprsaquo quethinsplethinspmeacutedecinthinspouthinsplethinspprofessionnelthinspagravethinspquithinspilthinspathinspconfieacutethinsplathinsptacircchethinspversethinspauthinspdossierthinspduthinsppatientthinspunethinspnotethinspexplicativethinspsurthinsplesthinspinformationsthinspfourniesthinspetthinsplethinspconsentementthinspobtenu

Lrsquoobtentionthinspdrsquounthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspdemeurethinspunethinspobligationthinspthinspinheacuterentethinspagravethinsplrsquointerventionthinspmeacutedicalethinspelle-mecircmethinspIlthinsprelegravevethinspdoncthinspdethinsplathinspresponsabiliteacutethinspduthinspmeacutedecinthinspdethinspsrsquoassurerthinspdethinsplathinsptransmissionthinspdethinsplrsquoinformationthinsppertinentethinspauthinsppatientthinspetthinspdethinspsathinspcompreacutehensionthinspdethinsplathinspnaturethinspduthinspbutthinspetthinspdesthinsprisquesthinsprelatifsthinspagravethinsplrsquointerventionthinspToutefoisthinsplathinsptacircchethinspdethinsptransmettrethinspdethinsplrsquoinformationthinspcompleacutementairethinsppeutthinspecirctrethinspconfieacuteethinspagravethinspdrsquoautresthinspprofessionnelsthinspthinspetthinspcellethinspdethinsprecueillirthinsplathinspsignaturethinspdrsquounthinspformulairethinspdethinspconsentementthinspagravethinspdrsquoautresthinspmembresthinspdethinsplrsquoeacutequipethinspdethinspsoins

CMQ - OIIQ - OPIQ 19

DIRECTIVESthinspETthinspCONSEILSthinsp

Avantthinspdethinspsubirthinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspsousthinspseacutedationthinsp-analgeacutesiethinsplethinsppatientthinspdoitthinsprecevoirthinsplesthinspdirectivesthinspneacutecessairesthinspdethinsppreacutefeacuterencethinspdansthinsp

unthinspdocumentthinspcontenantthinspentrethinspautresthinsplesthinsprecommandationsthinspsuivantesthinsp

a eacuteviterthinspdethinspconsommerthinsptoutethinspboissonthinspalcooliseacuteethinspdroguethinspouthinspsubstancethinspenthinspventethinsplibrethinsp(agravethinspmoinsthinspqursquoellethinspsoitthinspprescrite)thinsppouvantthinspalteacutererthinsplethinspniveauthinspdethinspconsciencethinspthinsp24thinspheuresthinspavantthinspetthinspapregravesthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

b observerthinspunethinsppeacuteriodethinspdethinspjeucircnethinspquithinspsrsquoappliquethinspagravethinsptoutthinspacircgethinspauxthinspcasthinspeacutelectifsthinsp(nonthinspurgents)thinspetthinspselonthinsplrsquoeacutevaluationthinspduthinsplaquothinsprapportthinsprisquebeacuteneacuteficethinspraquothinsppourthinsplesthinspcasthinspurgents

c suivrethinsplesthinsprecommandationsthinspduthinspmeacutedecinthinspquithinsppreacutecisethinspsithinsplesthinspmeacutedicamentsthinspprescritsthinspsurthinspunethinspbasethinspreacuteguliegraverethinsppeuventthinspecirctrethinspadministreacutesthinspcommethinspagravethinsplrsquoaccoutumeacuteethinspetthinspquithinspfaitthinsppartthinspdesthinspexceptionsthinsp(pthinspexthinspthinspanticoagulantthinsppsychotropethinspetc)thinspsrsquoilthinspythinspathinsplieuthinsp

Unethinspseacutedation-analgeacutesiethinspleacutegegraverethinspougravethinsplesthinspreacuteflexesthinspdethinspprotectionthinspdesthinspvoiesthinspthinspaeacuteriennesthinspsontthinsppreacuteserveacutesthinspestthinsppeuthinspsusceptiblethinspdrsquoinduirethinspunethinspaspirationthinspduthinspcon-tenuthinspgastriquethinspcontrairementthinspagravethinspunethinspseacutedationthinspplusthinspprofondethinspIlthinspestthinsptoutthinspdethinspmecircmethinspraisonnablethinspdethinsppenserthinspquethinsplethinsprisquethinspdrsquoaspirationthinspestthinspdiminueacutethinsplorsquethinsplrsquoestomacthinspestthinspvidethinspetthinspqursquounethinsppeacuteriodethinspdethinspjeucircnethinspavantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacutera-peutiquethinspestthinsppreacutefeacuterablethinspToutefoisthinspdansthinsptousthinsplesthinspcasthinsplrsquourgencethinspdethinsplrsquointerventionthinspetthinsplethinspniveauthinspdeacutesireacutethinspdethinspseacutedation-analgeacutesiethinspdoiventthinspecirctrethinspsoupeseacutesthinspauthinspregardthinspdesthinsprisquesthinspassocieacutesthinspagravethinspunthinspjeucircnethinspinadeacutequatthinspAinsithinsplethinspdeacutelaithinspentrethinsplrsquoheurethinspduthinspdernierthinsprepasthinspetthinsplethinspmomentthinspdethinsplathinspblessureaccidentthinspdoitthinspecirctrethinsppristhinspenthinspconsideacuterationthinsppourthinspestimerthinsplrsquoeacutetatthinspdethinspjeucircnethinspetthinspcethinspenthinspraisonthinspdethinsplrsquoileacuteusthinspreacuteflexethinsp

Avantthinsplathinspseacutedation-analgeacutesiethinspdrsquounethinspinterventionthinspnonthinspurgentethinsp(eacutelective)thinsplethinsppatientthinspdoitthinsprespecterthinsplesthinspdeacutelaisthinspsuivantsthinspselonthinsplathinspnaturethinspetthinsplathinspquantiteacutethinspingeacutereacuteethinspdethinspthinsp(Merchantthinspetthinspcollabthinsp2014a)thinsp

thinsprsaquo liquidethinspclairthinsp(pthinspexthinspthinspeauthinspjusthinspdethinspfruitthinsp[sansthinsppulpe]thinsptheacutethinspetthinspcafeacutethinspnoir)thinspthinspjeucircnethinspdethinsp2thinspheures

thinsprsaquo repasthinspleacutegerthinsp(pthinspexthinspthinsppainthinspgrilleacutethinsp+thinspliquidethinspclair)thinspthinspjeucircnethinspdethinsp6thinspheuresthinsprsaquo repasthinspcomposeacutethinspdethinspviandethinspouthinspdrsquoalimentsthinspfritsthinspouthinspgrasthinspthinspjeucircnethinspdethinsp8thinspheuresthinsp

CMQ - OIIQ - OPIQ 20

15thinspPERSEacuteDATION-ANALGEacuteSIEthinsp

APPROCHEthinspPHARMACOLOGIQUE

Lrsquoadministrationthinspdethinsptoutthinspmeacutedicamentthinspneacutecessitethinsplrsquoobtentionthinspdrsquounethinspordonnancethinsp

faitethinspenthinspvertuthinspdethinsplrsquoarticlethinsp393thinspduthinspCode des professions du QueacutebecthinspDrsquoailleursthinspthinsplathinspmeilleurethinspfaccedilonthinspdrsquoencadrerthinsplathinsppratiquethinspdethinsplrsquoinfirmiegraverethinspetthinspdethinsplrsquoinhalotheacuterapeutethinspestthinsplrsquoadoptionthinspdrsquounthinspprotocoleordonnancethinspcollectivethinspcomprenantthinspunthinspeacuteventailthinsptheacuterapeutiquethinspquithinsplaissethinspplacethinspauthinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspthinspUnthinsptelthinspdocumentthinspdoitthinspparthinspcontrethinspecirctrethinspenteacuterineacutethinspparthinsplesthinspresponsablesthinspmeacutedicauxthinspthinspdethinsplrsquoeacutetablissementthinspqursquoilthinspsoitthinsppublicthinspouthinsppriveacutethinsp

Soulignonsthinsplrsquoimportancethinspdrsquounthinspaccegravesthinspveineuxthinspfonctionnelthinspquithinspfaciliterathinsplrsquoadmi-nistrationthinspdesthinspagentsthinspseacutedatifsthinspetthinspanalgeacutesiquesthinspainsithinspquethinsplesthinsptraitementsthinsppharma-cologiquesthinspdesthinspcomplications

LethinspmeacutedecinthinsplrsquoinfirmiegraverethinspetthinsplrsquoinhalotheacuterapeutethinspdoiventthinsputiliserthinspunethinspmeacutedicationthinspqursquoilsthinspconnaissentthinspetthinspquithinspestthinspreconnuethinspRappelonsthinspqursquoilsthinspdoiventthinspecirctrethinspenthinspmesurethinspdethinspprendrethinspenthinspchargethinsptoutethinspcomplicationthinsppotentiellethinspythinspcompristhinsplathinspgestionthinspdrsquounthinsppassagethinspmomentaneacutethinspagravethinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspsupeacuterieurthinspagravethinspceluithinspquithinspthinspathinspeacuteteacutethinspplanifieacute

LethinspchoixthinspdethinsplathinspmeacutedicationthinsppeutthinspvarierthinspselonthinsplathinspsituationthinspcliniquethinspetthinsplesthinspfacteursthinsppropresthinspauthinsppatientthinspParthinspexemplethinspcertainsthinsppatientsthinspnethinsptolegraverentthinsppasthinsplesthinspdosagesthinsphabituelsthinspouthinsppreacutesententthinspdesthinspcontre-indications

Ilthinspestthinspimportantthinspdethinspretenirthinspquethinsplethinsptitragethinspdethinsptoutethinspmeacutedicationthinspdoitthinspecirctrethinspthinspprivileacutegieacutethinspetthinspquethinspsonthinspadministrationthinspdoitthinspsethinspfairethinspparthinsppetitesthinspdosesthinspdethinspthinspfaccedilonthinspprogressivethinspjusqursquoagravethinsplrsquoobtentionthinspduthinspniveauthinspdethinspseacutedationthinspetthinspdrsquoanalgeacutesiethinspthinspdeacutesireacutethinsptoutthinspenthinsplaissantthinspsrsquoeacutecoulerthinspsuffisammentthinspdethinsptempsthinspentrethinspdeuxthinspdosesthinsppourthinspquethinsplethinspmeacutedicamentthinspproduisethinspsesthinspeffetsthinsp

Lesthinspmeacutedicamentsthinsputiliseacutesthinspenthinspseacutedation-analgeacutesiethinspontthinspunthinspeffetthinspsynergiquethinspthinspParthinspexemplethinsplrsquoassociationthinspdrsquounethinspbenzodiazeacutepinethinspavecthinspunthinspopioiumldethinspaugmentethinspthinsplesthinsprisquesthinspdethinspdeacutepressionthinsprespiratoirethinspLeurthinspdosagethinspdoitthinspdoncthinspecirctrethinspajusteacutethinspenthinspconseacutequencethinspSithinsplrsquoobstructionthinspdesthinspvoiesthinspaeacuteriennesthinsplrsquoapneacuteethinspetthinsplrsquohypotensionthinspthinspsontthinsplesthinspcomplicationsthinsplesthinspplusthinspfreacutequentesthinspenthinspseacutedation-analgeacutesiethinspilthinspfautthinspretenirthinspquethinspcertainesthinspcomplicationsthinsppeuventthinspecirctrethinspparticuliegraveresthinspagravethinsplathinspmeacutedicationthinsputiliseacuteethinspthinspCitonsthinspagravethinsptitrethinspdrsquoexemplethinsplrsquoassociationthinsplaryngospasmethinspetthinspkeacutetaminethinsp

CMQ - OIIQ - OPIQ 21

Lorsquethinspdesthinspbenzodiazeacutepinesthinspouthinspdesthinspopioiumldesthinspsontthinspadministreacutesthinspparthinspvoiethinspthinspintraveineusethinspleursthinspantagonistesthinsprespectifsthinsp(pthinspexthinspthinspflumazeacutenilthinsp[Anexatereg]thinspthinspnaloxonethinsp[Narcanreg])thinspdoiventthinspecirctrethinsprapidementthinspdisponiblesthinspIlsthinspserontthinsputiliseacutesthinspthinspauthinspmomentthinspdrsquounethinspdeacutepressionthinsprespiratoirethinspinduitethinspparthinsplathinspmeacutedicationthinspet non en prophylaxiethinspchezthinsplethinsppatientthinspstablethinspIlthinspestthinsphabituellementthinsppreacutefeacuterablethinspdethinspthinsprenverserthinspdrsquoabordthinsplrsquoagentthinspseacutedatifthinspafinthinspdethinspmaintenirthinspintactthinsplrsquoeffetthinspanalgeacutesiquethinspthinspSithinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspdemeurethinspcompromisethinspilthinspserathinspalorsthinspthinspneacutecessairethinspdethinsprenverserthinsplrsquoeffetthinspanalgeacutesique

IlthinspfautthinspsethinsprappelerthinspquethinsplathinspdureacuteethinspdrsquoactionthinspdesthinspantagonistesthinspestthinspbienthinspinfeacuterieurethinspthinspagravethinsplathinspdureacuteethinspdrsquoactionthinspduthinspmeacutedicamentthinspdevantthinspecirctrethinspneutraliseacutethinspParthinspconseacutequentthinspthinsplathinspreacuteapparitionthinspdethinsplrsquoeffetthinspindeacutesirablethinspestthinspagravethinspsurveillerthinspchezthinsplethinsppatientthinspquithinspreccediloitthinspunthinspantagonistethinsp

VousthinsptrouverezthinspunethinspfichethinspinformativethinspsurthinsplrsquoutilisationthinspdethinsplathinspnaloxonethinspetthinspduthinspflumazeacutenilthinspagravethinsplrsquoannexethinspXI

Lesthinspdirectivesthinspeacutenonceacuteesthinspdansthinspcesthinsplignesthinspdirectricesthinspnrsquoontthinsppasthinsppourthinspobjectifthinspdethinspdeacutecrirethinspdansthinsplethinspdeacutetailthinsplathinspmeacutedicationthinsputiliseacuteethinspenthinspseacutedation-analgeacutesiethinspleursthinspagentsthinsp

antagonistesthinspetthinsplesthinspmeacutedicamentsthinspdrsquourgencethinspIlthinsprevientthinspauthinspmeacutedecinthinspdethinspbienthinsp

connaicirctrethinsplathinspmeacutedicationthinspetthinspdethinspchoisirthinspunethinspmeacutedicationthinspouthinspunethinspcombinaisonthinspdethinspmeacutedicamentsthinspreconnuethinspEtthinspilthinsprevientthinspauxthinspprofessionnelsthinspquithinsplesthinspadministrentthinsp

dethinspbienthinsplesthinspconnaicirctrethinspeacutegalementthinsp(eacuteleacutementsthinspdethinspsurveillancethinspcliniquethinsptechniquethinspdrsquoadministrationthinspeffetsthinspsecondairesthinspinteractionsthinspcontre-indicationsthinspseuilsthinspthinsptoxiquesthinspetc)thinspetthinspdethinspmaintenirthinspagravethinspjourthinspleursthinspconnaissancesthinspdansthinspcethinspdomaine

thinspPRINCIPALESthinspCLASSESthinspPHARMACOTHEacuteRAPEUTIQUESthinspUTILISEacuteESthinspthinspthinspENthinspSEacuteDATION-ANALGEacuteSIEthinsp

Lathinsplistethinspdesthinspmeacutedicamentsthinspabordeacutesthinspci-dessousthinspnrsquoestthinsppasthinsplimitativethinsp

a BenzodiazeacutepinesthinspProprieacuteteacutesthinspthinspanxiolytiquethinspamneacutesiquethinsphypnotiquethinsprelaxantthinspmusculairethinspetthinspanticonvulsivantthinspthinspIlthinspfautthinspprivileacutegierthinsplesthinspmoleacuteculesthinspagravethinspcourtethinspdemi-viethinsp(pthinspexthinspthinspmidazolamthinsp[Versedreg])thinspenthinspretenantthinspqursquoilthinspfautthinspajusterthinsplethinspdosagethinspchezthinspcertainsthinsppatientsthinsp(pthinspexthinspthinspacircgeacutesthinspouthinspaffaiblis)thinspetthinsplorsthinspdethinsplrsquoutilisationthinspconcomitantethinspdrsquoautresthinspmeacutedicamentsthinspaffectantthinsplethinspsystegravemethinspnerveuxthinspcentralthinspDethinspplusthinsplathinspdemi-viethinsp

CMQ - OIIQ - OPIQ 22

dethinspcesthinspmeacutedicamentsthinsppeutthinspecirctrethinspaugmenteacuteethinsplorsthinspdethinspleurthinspadministrationthinspenthinspperfusionthinspcontinuethinsp(context sensitive half-life)thinsp

b OpioiumldesthinspProprieacuteteacutesthinspthinspanalgeacutesiquethinspetthinspseacutedativethinspLathinspmorphinethinspconstituethinspunthinspopioiumldethinspdontthinsplrsquoefficaciteacutethinspestthinspreconnuethinspCependantthinspellethinspfavorisethinsplathinsplibeacuterationthinspdrsquohistaminethinspcethinspquithinsppeutthinspcauserthinspduthinsppruritthinspetthinspdethinsplrsquohypotensionthinspUnethinspdysfonctionthinspreacutenalethinspseacutevegraverethinspentraicircnethinsplrsquoaccumulationthinspdethinspsesthinspmeacutetabolitesthinspactifsthinsp

thinsprsaquo lethinspfentanylthinsp(Sublimazereg)thinspestthinspunthinspopioiumldethinspsyntheacutetiquethinsppuissantthinspetthinspdethinspcourtethinspdureacuteethinspdrsquoactionthinspIlthinspnethinspdeacuteclenchethinsppasthinspdethinsplibeacuterationthinspdrsquohistaminethinsp(doncthinsppeuthinspdrsquoeffetthinspheacutemodynamique)thinspIlthinspfautthinspcependantthinspsethinspmeacutefierthinspdesthinspdosesthinspeacuteleveacuteesthinspetthinspdesthinspinjectionsthinsprapidesthinspquithinsppeuventthinspprovoquerthinspunethinsprigiditeacutethinspmusculairethinspthinspetthinspunethinspdeacutepressionthinsprespiratoire

thinsprsaquo lrsquohydromorphonethinsp(Dilaudidreg)thinspestthinspunthinspopioiumldethinspsemi-syntheacutetiquethinspdontthinsplesthinspmeacutetabolitesthinspconnusthinspsontthinsprarementthinspprobleacutematiquesthinspMoinsthinsputiliseacuteethinspenthinspthinspseacutedation-analgeacutesiethinspellethinspestthinspauthinspmoinsthinsp5thinspfoisthinspplusthinsppuissantethinspquethinsplathinspmorphinethinspthinspcethinspquithinspestthinspparfoisthinspsous-estimeacute

thinsprsaquo lathinspmeacutepeacuteridinethinsp(Demerolreg)thinspestthinspunthinspopioiumldethinspsyntheacutetiquethinspposseacutedantthinspunthinspmeacuteta-bolitethinspactifthinspneurotoxiquethinspEllethinspnrsquoestthinsphabituellementthinsppasthinsprecommandeacuteethinsp

c Anestheacutesiques geacuteneacuterauxthinspLethinspmeacutedecinthinspquithinspprocegravedethinspagravethinspunethinspinterventionthinspsousthinspseacutedation-analgeacutesiethinspenthinsputilisantthinspunthinspouthinspdesthinspanestheacutesiquesthinspgeacuteneacuterauxthinspdoitthinspecirctrethinspexpeacuterimenteacutethinspenthinspseacutedation-analgeacutesiethinspetthinspenthinspreacuteanimationthinspcardiorespiratoirethinspDansthinsplethinspcasthinspcontrairethinspilthinspdoitthinspsrsquoassurerthinspdethinsplathinspcollaborationthinspdrsquounthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspParthinspailleursthinsplethinspmeacutedecinthinspdoitthinspenthinsptoutthinsptempsthinspecirctrethinspsoutenuthinspparthinspunthinspouthinspdesthinspprofessionnelsthinspqualifieacutesthinsp

thinsprsaquo propofolthinsp(Diprivanreg)thinspProprieacuteteacutesthinspseacutedativethinsphypnotiquethinspamneacutesiquethinspanxiolytiquethinspAgravethinspnoterthinspqursquoilthinspnrsquoathinspaucune proprieacuteteacute analgeacutesiquethinsp

thinspIlthinsppossegravedethinspunethinspdemi-viethinspcourtethinsppeutthinspecirctrethinspcumulatifthinspetthinspnrsquoathinsppas drsquoantago-nistethinspIlthinspnrsquoestthinsppasthinsprecommandeacutethinspchezthinsplathinspfemmethinspenceintethinspouthinspquithinspallaitethinspEnthinspregraveglethinspgeacuteneacuteralethinspetthinspselonthinsplethinsptypethinspdrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspilthinsppeutthinspecirctrethinspplusthinspjudicieuxthinspdethinsplrsquoadministrerthinspenthinspinfusionthinspIVthinspplutocirctthinspthinspqursquoenthinspbolusthinspthinspthinspIlthinsppeutthinsprapidementthinspcauserthinspunethinspdiminutionthinspmarqueacuteethinspduthinspniveauthinspdethinspcon-sciencethinspetthinspunethinspdeacutepressionthinsprespiratoirethinsppouvantthinspconduirethinspmomentaneacute-

CMQ - OIIQ - OPIQ 23

mentthinspagravethinspunethinspanestheacutesiethinspgeacuteneacuteralethinspnonthinspdeacutesireacuteethinspLesthinspprofessionnelsthinspenthinspplacethinspdoiventthinspecirctrethinspenthinspmesurethinspdethinspprendrethinspenthinspchargethinspunethinsptellethinspsituationthinspLrsquoASAthinsp(AmericanthinspSocietythinspofthinspAnesthesiologiststhinspASAthinspHousethinspofthinspDelegatesthinsp2004bthinsp[Notrethinsptraduction])thinsprecommandethinspnotammentthinspquethinsplethinsppatientthinspagravethinspquithinsplrsquoonthinspadministrethinspduthinsppropofolthinspreccediloivethinspdesthinspsoinsthinspenthinsplienthinspavecthinspunethinspseacutedationthinsppro-fondethinsp(niveauthinspnonthinspviseacutethinspdansthinspcesthinsplignesthinspdirectrices)thinspetthinspquethinsplethinspprofessionnelthinsp(nonthinspanestheacutesiologiste)thinspadministrantthinsplethinsppropofolthinsppossegravedethinsplathinspformationthinsptheacuteoriquethinspetthinsppratiquethinspneacutecessairethinspagravethinsplrsquoidentificationthinspetthinspagravethinsplathinspprisethinspenthinspchargethinspdesthinspvoiesthinspaeacuteriennesthinspetthinspdesthinspchangementsthinspcardiovasculairesthinspquithinspsurvien-nentthinspchezthinspunthinsppatientthinspeacutevoluantthinspversthinspunthinspeacutetatthinspdrsquoanestheacutesiethinspgeacuteneacuteralethinsp(niveauthinspnonthinspviseacutethinspdansthinspcesthinsplignesthinspdirectrices)thinsp

thinspthinspLorsquethinsplethinsppropofolthinspestthinspadministreacutethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspthinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspthinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspthinspobligatoirethinsp(tableauthinsp3)thinspthinspthinsp

thinsprsaquo keacutetaminethinsp(Ketalarreg)thinspProprieacuteteacutesthinspthinspseacutedativethinspetthinspanalgeacutesiquethinspthinspUtiliseacuteethinspenthinsppeacutediatriethinspetthinspchezthinsplrsquoadultethinspEllethinspproduitthinspaussithinspunethinspbroncho-thinspdilatationthinspparfoisthinspsouhaiteacuteethinsplorsthinspdrsquointerventionsthinspdiagnostiquesthinspouthinsptheacutera-peutiquesthinspchezthinsplesthinsppatientsthinspasthmatiquesthinspEllethinspsrsquoaccompagnethinspdrsquounethinsplibeacutera-tionthinspdethinspcateacutecholaminesthinspetthinspdrsquoeffetsthinspsympathomimeacutetiquesthinsp(augmentationthinspdethinsplathinspsalivation)thinspEllethinsppeutthinspprovoquerthinspdesthinspsymptocircmesthinsppsychotiquesthinspouthinspdesthinspcomportementsthinspanormauxthinspCesthinspsymptocircmesthinsppeuventthinspnuirethinspagravethinsplrsquoeacutevaluationthinspdesthinsppatientsthinspsousthinspseacutedationthinspEllethinspabaissethinsplethinspseuilthinspconvulsifthinsp

Lorsquethinsplathinspkeacutetaminethinspestthinspadministreacuteethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspobligatoirethinsp(tableauthinsp3)thinspthinsp

thinsprsaquo protoxydethinspdrsquoazotethinsp(N2O)thinsp

ProprieacuteteacutesthinspthinspgazthinspseacutedatifthinspetthinspanalgeacutesiquethinspthinspActionthinspanalgeacutesiquethinspsemblablethinspagravethinspcellethinspdethinsplathinspmorphinethinspIlthinsppotentialisethinsplesthinspanalgeacutesiquesthinspcentrauxthinspetthinsplesthinspagentsthinsphypnotiquesthinspetthinsppeutthinspaussithinspdiminuerthinsplesthinspreacuteservesthinspenthinspoxygegravenethinspduthinsppatientthinspUtiliseacutethinspenthinspcombinaisonthinspavecthinsplrsquooxygegravenethinspIlthinsppeutthinsppolluerthinsplrsquoenvironnementthinspdethinsptravailthinsp(voirthinspnormesthinspCSST)thinspIlthinsppeutthinspecirctrethinsp

CMQ - OIIQ - OPIQ 24

utiliseacutethinspenthinsppeacutediatriethinspchezthinsplrsquoadultethinspetthinspchezthinsplathinspfemmethinspenceintethinsp(saufthinspauthinspthinsppremierthinsptrimestre)thinsp

thinspDansthinsplethinspcasthinspougravethinsplethinspprotoxydethinspdrsquoazotethinspestthinsputiliseacutethinspenthinspcombinaisonthinspavecthinspunthinspagentthinspseacutedatifthinspouthinspunthinspopioiumldethinspouthinspsithinsplrsquoappareilthinsputiliseacutethinsppermetthinspdethinspmodifierthinsplathinspconcentrationthinspdrsquooxygegravenethinspunthinspprofessionnelthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivement agravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsp(tableauthinsp2)thinspthinsp

thinsprsaquo dexmeacutedeacutetomidinethinsp(PreacuteceacutedexMC)thinsp(Agonistethinspalpha2-adreacutenergique)thinspProprieacuteteacutesthinspthinspseacutedativethinspanalgeacutesiquethinspetthinspanxiolytiquethinspthinspLathinspdexmeacutedeacutetomidinethinspenthinspperfusionthinspintraveineusethinspcontinuethinspestthinspindiqueacuteethinspnotammentthinsppourthinsplathinspseacutedationthinspdethinsppatientsthinspnonthinspintubeacutesthinspavantthinspetouthinsppendantthinspunethinspinterventionthinspchirurgicalethinspouthinspdrsquoautresthinsptypesthinspdrsquointerventionsthinspthinspNethinspcausethinspaucunethinspdeacutepressionthinsprespiratoirethinspmaisthinsppeutthinspcauserthinspunethinspbradycar-diethinspetthinspunethinsphypotensionthinspthinsp

thinspLrsquoutilisationthinspdethinspdexmeacutedeacutetomidinethinspdevraitthinspecirctrethinspreacuteserveacuteethinspauthinspmilieuthinspthinsphospitalierthinspouthinspauxthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspthinspEllethinspdevraitthinspecirctrethinspadministreacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspthinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspetthinsprapidementthinspdisponiblethinspthinspLorsquethinspdethinsplathinspdexmeacutedeacutetomidinethinspestthinspadministreacuteethinspunthinspprofessionnelthinspthinsphabiliteacutethinspdoitthinspecirctrethinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspthinspduthinsppatientthinsp(tableauthinsp2)thinspDethinspplusthinsplrsquoutilisationthinspdrsquounthinspcapnographethinspetthinspthinspdrsquounthinspmoniteurthinspcardiaquethinspestthinspobligatoirethinsp(tableauthinsp3)thinspthinsp

Agravethinspnoterthinspqursquoilthinspestthinspobligatoirethinspdethinsptenirthinspunthinspregistrethinspdesthinspsubstancesthinspcontrocircleacuteesthinspetthinspdesthinspbenzodiazeacutepinesthinspcomportantthinspdesthinspsignatures

thinsp

CMQ - OIIQ - OPIQ 25

SURVEILLANCEthinspCLINIQUEthinspLathinspsurveillancethinspcliniquethinspcomprendthinspplusieursthinspeacuteleacutementsthinspquithinspconcernentthinspthinspnotammentthinsplesthinspsystegravemesthinsprespiratoirethinspcardiaquethinspetthinspneurologiquethinspEllethinspdoitthinspthinsptenirthinspcomptethinspentrethinspautresthinsp

thinsprsaquo dethinsplathinspconditionthinspduthinsppatientthinspavantthinspetthinsppendantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

thinsprsaquo dethinsplathinspcomplexiteacutethinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinsprsaquo dethinsplathinspmeacutedicationthinsputiliseacuteethinsp(dosethinspdureacuteethinspetthinsppicthinspdrsquoactionthinspvoiethinspetthinspvitessethinspthinsp

drsquoadministrationthinspcombinaisonthinspetthinspantagonistes)

thinsprsaquo dethinsplrsquoassistancethinspagravethinspapporterthinspauthinspmeacutedecin

Lethinspmeacutedecinthinspquithinsppratiquethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspchezthinspunthinsppatientthinspsousthinspseacutedation-analgeacutesiethinspdoitthinspcompterthinspsurthinsplathinsppreacutesencethinspdrsquoauthinspmoinsthinspunthinspautrethinspprofessionnelthinsphabiliteacutethinspduthinspmilieuthinspdethinsplathinspsanteacutethinsp(infirmiegraverethinspinhalotheacuterapeutethinspouthinspautrethinspmeacutedecin)thinsp(annexethinspII)thinspEnthinspeacutetroitethinspcollaborationthinspavecthinsplethinspmeacutedecinthinspreacuteali-santthinsplrsquointerventionthinspceux-cithinspassurentthinspthinsplathinspgestionthinspdethinsplathinspseacutedationthinspetthinspdethinsplrsquoanalgeacutesiethinspqui comprend entre autres la surveillance clinique du patientthinspresponsabiliteacutethinspthinspagravethinsplaquellethinspilsthinspdoiventthinspenthinsptoutthinsptempsthinspsethinspconsacrerthinspenthinspprioriteacutethinsp

Dansthinspcertainsthinspcasthinsplethinspprofessionnelthinspquithinspassurethinspen prioriteacutethinsplathinspsurveillancethinspthinspcliniquethinspduthinsppatientthinsppeutthinspecirctrethinspappeleacutethinspagravethinspassisterthinsplethinspmeacutedecinthinspdansthinsplathinspreacutealisationthinspthinspdethinspsonthinspinterventionthinspCettethinspassistancethinspquithinspdoitthinspsrsquoeffectuerthinspdansthinsplathinspmecircmethinsppiegravecethinspdoitthinspecirctrethinspdethinsptregravesthinspcourtethinspdureacuteethinspDethinspplusthinspellethinspdoitthinsppouvoirthinspecirctrethinspinterrompuethinspthinspagravethinsptoutthinspmomentthinsppourthinspintervenirthinspimmeacutediatementthinspaupregravesthinspduthinsppatientthinspenthinspcasthinspdethinsp

complicationsthinspouthinspdethinspbesoin

Parthinspailleursthinsplorsquethinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspthinspneacutecessitentthinspunethinspassistancethinsptechniquethinspcontinuellethinspauthinspmeacutedecinthinsplrsquoajoutthinspdrsquounthinsptroisiegravemethinspprofessionnelthinspdethinsplathinspsanteacutethinsphabiliteacutethinsp(meacutedecinthinspinfirmiegraverethinspouthinspinhalotheacuterapeute)thinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinspestthinsprequisthinsp

CMQ - OIIQ - OPIQ 26

Tableau 2 Tableau reacutecapitulatif du nombre de professionnels habiliteacutes requis en seacutedation-analgeacutesie - Clientegravele adulte

Toutthinspauthinsplongthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplathinspsurveillancethinspcliniquethinspthinspduthinsppatientthinspdoitthinspecirctrethinspcontinuethinspetthinsplathinspcommunicationthinspavecthinspcelui-cithinspmaintenue

Proceacutederthinspagravethinsplathinspsurveillancethinspcliniquethinspcrsquoestthinspeacutevaluerthinspqualitativementthinspetthinspquantitative-mentthinspdethinspfaccedilonthinspsoutenuethinspetthinspenthinspcontinuthinsplrsquoensemblethinspdesthinspparamegravetresthinspsuivantsthinsp(listethinsp

nonthinsplimitative)thinsp(tableauthinsp3)thinsp

thinsprsaquo mesurethinspdethinsplathinsppressionthinsparteacuteriellethinspduthinsppouls3thinspetthinspdethinsplathinsprespiration4thinsprsaquo lecturethinspdethinsplathinspsaturationthinspcapillairethinspenthinspoxygegravene

Ilthinspfautthinspnoterthinspquethinsplathinsptonaliteacutethinspdethinsppoulsthinspdoitthinspecirctrethinspactiveacuteethinspenthinsptoutthinsptempsthinspetthinspsonthinspniveauthinspdoitthinspecirctrethinspajusteacutethinspdethinspfaccedilonthinspagravethinspecirctrethinspentenduthinspclairement

thinsprsaquo eacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplathinspseacutedationthinsp(eacutevaluationthinspdethinsplathinspseacutedationagitationthinspetthinspduthinspniveauthinspdethinspconscience)thinsp(annexethinspIX)thinsp

thinsprsaquo eacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplrsquoanalgeacutesiethinsp(eacutevaluationthinspdethinsplathinspdouleur)thinspdethinsplrsquoanxieacuteteacutethinspetthinspdethinsplathinspreacuteactionthinspduthinsppatientthinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsp(annexethinspX)

thinsprsaquo eacutevaluationthinspdethinsplrsquoeacutetatthinspdethinsplathinspcolorationthinspetthinspdethinsplathinsptempeacuteraturethinspdethinsplathinsppeauthinsprsaquo eacutevaluationthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsprsaquo niveauthinspdrsquoO

2thinspdethinspCO

2thinspetthinspmonitoragethinspcardiaquethinspselonthinsplethinspcas

3thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp4thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

Nombrethinspdethinspprofessionnelsthinsphabiliteacutesthinsprequis

2 Nombrethinspmimimalthinsprequis

3 Sithinsputilisationthinspdethinsppropofolthinspkeacutetaminethinspouthinspdethinspdexmeacutedeacutetomidine

3 SithinsputilisationthinspconcomitantethinspdethinspN2Othinspetthinspdrsquounthinspagentthinspseacutedatifthinspouthinspthinsp

dunthinspopioiumldethinspouthinspsithinspconcentrationthinspdethinspN2Othinspmodifiable

3 Sithinsplassistancethinsptechniquethinspauthinspmeacutedecinthinspestthinspcontinuelle

CMQ - OIIQ - OPIQ 27

Tableau 3 Surveillance des paramegravetres cliniques en seacutedation-analgeacutesie - Clientegravele adulte

Paramegravetrethinspdethinspthinspsurveillancethinspthinspclinique

PatientNiveauthinspdethinspthinspseacutedation

MeacutedicationInterventionthinspdiagnostiquethinspouthinsptheacuterapeutique

TAthinspRC5thinspthinspRR6thinspthinspetthinspsaturationthinspdrsquoO

thinsp2thinspthinsp

rsaquothinspObligatoireChezthinsptousthinsplesthinsppatients

Niveauthinspdethinspthinsp-thinspseacutedationthinspthinspthinspagitationthinspthinspthinspthinspconscience-thinspdouleur

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

NiveauthinspdethinspCO2

SelonthinsplesthinspthinspcaracteacuteristiquesthinspAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspthinspmeacutedication

Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire

rsaquothinspAccegravesthinspindirectthinspthinspthinspthinspthinspouthinsprestreintthinspthinspthinspthinspauthinsppatientthinspthinspthinspthinsp(pthinspexthinspthinspIRM)

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

rsaquothinspRecommandeacute

rsaquothinspASAthinspgethinsp3thinsprsaquothinspApneacuteethinspthinspobstructivethinspthinspthinspthinspduthinspsommeilthinsprsaquothinspMaladiethinspthinspthinspthinsprespiratoirethinsprsaquothinspObeacutesiteacutethinspmorbide

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

Monitoragethinspcardiaque

SelonthinsplesthinspcaracteacuteristiquesAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

SelonthinsplathinspmeacutedicationSelonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoirersaquothinspASAthinspgethinsp3thinsprsaquothinspMaladiethinspthinspthinspthinspcardiaque

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

Interventionthinspdiagnostiquethinspthinspouthinsptheacuterapeutiquethinspprolongeacuteethinsp(effetthinspcumulatifthinspdethinsplathinspmeacutedication)

rsaquothinspRecommandeacute

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

thinspthinspthinspthinspthinspIlthinspnethinspsrsquoagitthinsppasthinspdrsquounethinsplistethinsplimiteacuteethinspdesthinspsituationsthinspcliniquesthinspDrsquoautresthinspsituationsthinspcliniquesthinsppeuventthinspneacutecessiterthinsplethinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspmonitoragethinspcardiaquethinspouthinspduthinspCO

2thinspIlthinsprevientthinspauxthinspprofessionnelsthinspdethinspjugerthinspdethinsplathinspsituationthinspenthinspfonctionthinspdethinspchaquethinspthinspthinsp

thinspthinspthinspthinspthinspthinsppatient5thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp6thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

CMQ - OIIQ - OPIQ 28

LethinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspimpliqueacutesthinspestthinspprimordialthinspetthinspcethinspmecircmethinspsithinsplrsquoappareillagethinspenthinspplacethinspestthinspcompletthinspetthinspfonctionnelthinspUnethinspbonnethinspcommunica-tionthinspentrethinspcesthinspderniersthinspestthinspdoncthinspessentiellethinspafinthinspdethinspbienthinspcoordonnerthinsplathinspseacutedationthinsp

etthinsplrsquoanalgeacutesiethinspavecthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspLes alarmes (audibles et visuelles) de chaque appareil doivent ecirctre en fonction et les paramegravetres ajusteacutes aux caracteacuteristiques du patient et agrave sa condition clinique

IlthinspfautthinspsrsquoassurerthinspdethinsplathinsptraccedilabiliteacutethinspdethinsplrsquoeacutevaluationthinspetthinspdethinsplathinspsurveillancethinspcliniquethinspthinspeffectueacuteesthinspparthinspunethinsptenuethinspdethinspdossiersthinspconformethinspauxthinspnormesthinspenthinspvigueurthinspLesthinspoutilsthinspdrsquoeacutevaluationthinsputiliseacutesthinspdoiventthinspecirctrethinspsimplesthinspstandardiseacutesthinspvalideacutesthinspdethinsppreacutefeacuterencethinspetthinspadapteacutesthinspauthinspcontextethinspetthinspauxthinspcaracteacuteristiquesthinspduthinsppatientthinspnotam-mentthinsppourthinsplrsquoeacutevaluationthinspduthinspniveauthinspdethinspseacutedationagitationthinspdethinspconsciencethinspetthinspdethinspdouleurthinsp(annexesthinspIXthinspetthinspX)

Lathinspfreacutequencethinspdethinsplathinspmesurethinspdethinspcesthinspparamegravetresthinspetthinspleurthinspenregistrementthinspdoiventthinspecirctrethinspdeacutetermineacutesthinspentrethinspautresthinspenthinspfonctionthinspdethinsplathinspmeacutedicationthinspetthinspdethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsp

Ideacutealementthinsplethinspprofessionnelthinspdoitthinsplesthinspdocumenterthinsp

thinsprsaquo avantthinsplethinspdeacutebutthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsprsaquo apregravesthinsplrsquoadministrationthinspdrsquounthinspagentthinspdethinspseacutedation-analgeacutesiethinspouthinspdrsquounthinspantagonistethinsprsaquo authinsppicthinspdrsquoactionthinspdethinspchacunthinspdesthinspagentsthinspadministreacutesthinspthinsprsaquo agravethinspintervallesthinspreacuteguliersthinsp(pthinspexthinspthinsp5thinspminutes)thinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-thinsp

analgeacutesiethinsprsaquo agravethinspintervallesthinspplusthinsprapprocheacutesthinsplorsquethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsplrsquoexigethinsprsaquo durantthinsplathinsppeacuteriodethinspdethinspreacutecupeacuterationthinspetthinspjusqursquoauthinspretourthinspduthinspniveauthinspdethinspconsciencethinsp

initialethinspselonthinsplathinspconditionthinspcliniquethinspduthinsppatientthinsprsaquo authinspmomentthinspduthinspcongeacute

ILthinspFAUTthinspSAVOIRthinspQUE

LathinspSocieacuteteacutethinspcanadiennethinspdesthinspanestheacutesiologistesthinsp(SCA)thinspindiquethinspquethinsplesthinspthinspdirectivesthinspgeacuteneacuteralesthinspdethinspsoinsthinsp(ythinspcompristhinsplethinspmonitorage)thinsppourthinsplathinspseacutedationthinspconscientethinspsontthinsplesthinspmecircmesthinspquethinsppourthinsplesthinspautresthinspformesthinspdrsquoanestheacutesiethinsp[]thinsp(Merchantthinspetthinspcollabthinsp2014b)thinspDethinspplusthinspellethinspindiquethinspquethinsplethinspcapnographethinspthinspestthinsprequisthinsplorsthinspdethinspseacutedation-analgeacutesiethinspdethinspniveauthinspplusthinspeacuteleveacutethinsp(pthinspexthinspthinspRamsaythinspthinsp4-6)thinsp(Merchantthinspetthinspcollabthinsp2014athinspop cit)

CMQ - OIIQ - OPIQ 29

thinsp16thinspPOSTSEacuteDATION-ANALGEacuteSIEthinsp

Lethinsppatientthinspestthinspagravethinsprisquethinspdethinspdeacutevelopperthinspdesthinspcomplicationsthinspagravethinsplathinspsuitethinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinspsurtoutthinspsithinspcettethinspproceacutedurethinspestthinspdethinspcourtethinspdureacuteethinsp(pthinspexthinspthinspdeacutepressionthinsprespiratoirethinsphypotension)thinspEnthinspeffetthinspcertainsthinspmeacutedicamentsthinsptelsthinspquethinsplethinspmidazolamthinspetthinsplethinspfentanylthinspnethinspserontthinsppasthinspcomplegravetementthinspeacutelimineacutesthinspsithinsplathinspdureacuteethinspdethinsplrsquointerventionthinspestthinspmoinsthinspdethinsp30thinspminutesthinspDrsquoautresthinspfacteursthinsptelsthinspquethinsplethinspmanquethinspthinspdethinspstimulationthinspouthinsplrsquoabsorptionthinspretardeacuteethinspdrsquounthinspmeacutedicamentthinsppeuventthinspcontribuerthinspthinspagravethinspunethinspseacutedationthinspprolongeacuteethinspouthinsprebond

Unethinspdeacutepressionthinsprespiratoirethinsppeutthinspsurvenirthinspjusqursquoagravethinspeacuteliminationthinspcomplegravetethinspthinspduthinspmeacutedicamentthinsp

ParthinspconseacutequentthinspjusqursquoagravethinspsonthinspdeacutepartthinsplethinsppatientthinspdoitthinspecirctrethinspsousthinsplathinspsurveillancethinspdrsquounthinspprofessionnelthinsphabiliteacutethinspagravethinspreconnaicirctrethinsplesthinspcomplicationsthinspetthinspagravethinspintervenirthinsprapidementthinspplusthinspparticuliegraverementthinsppourthinspmaintenirthinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinspetthinspassurerthinsplrsquoassistancethinspventilatoirethinspLethinspmeacutedecinthinspayantthinspproceacutedeacutethinspagravethinsplrsquointerventionthinspsousthinspseacutedation-analgeacutesiethinspouthinspunthinspmeacutedecinthinspdeacutesigneacutethinspdoitthinspecirctrethinspdisponiblethinspenthinsptoutthinsptempsthinspafinthinspdethinsppouvoirthinspintervenirthinspsansthinspdeacutelaithinsplethinspcasthinspeacutecheacuteant

Rappelonsthinspquethinsplesthinspappareilsthinspdethinspmonitoragethinspdoiventthinspecirctrethinspenthinspfonctionthinspmaisthinspthinspenthinspaucunthinsptempsthinspilsthinspnethinspremplacentthinsplathinspsurveillancethinspdirectethinspduthinsppatientthinspparthinspthinsplethinspprofessionnel

Lethinsppatientthinspdoitthinspresterthinspagravethinsplathinspsallethinspdethinspreacutecupeacuterationthinspouthinspdrsquoobservationthinsppendantthinspthinsp30thinspminutesthinspauthinspminimumthinspapregravesthinspavoirthinspreccediluthinsplathinspderniegraverethinspdosethinspdethinspseacutedationthinspouthinspthinspdrsquoanalgeacutesiethinspintraveineusethinsp(Merchantthinspetthinspcollabthinsp2014bthinspop cit)

Sithinspunethinspmeacutedicationthinspantagonistethinspathinspeacuteteacutethinspadministreacuteethinsplethinsppatientthinspserathinspgardeacutethinspsousthinspthinspobservationthinsplethinsptempsthinspneacutecessairethinsp(lethinsptempsthinspserathinspaugmenteacutethinspdethinspgethinsp2thinspheuresthinspthinsp[Merchantthinspetthinspcollabthinsp2014bthinspop cit]thinspenthinspfonctionthinspdethinsplrsquoeacutetatthinspcliniquethinspduthinsppatient)thinsppourthinspsrsquoassurerthinspqursquoilthinspnrsquoythinspathinsppasthinspdethinspseacutedationthinsprebond

Parmithinsplesthinspcritegraveresthinspagravethinsprespecterthinspauthinspmomentthinspduthinspcongeacutethinsp

thinsprsaquo voiesthinspaeacuteriennesthinsppermeacuteablesthinspetthinspventilationthinspadeacutequatethinsprsaquo stabiliteacutethinspcardiovasculairethinspadeacutequatethinsprsaquo niveauthinspdethinspconsciencethinspduthinsppatientthinsprevenuthinspagravethinspsonthinspeacutetatthinspinitialthinsprsaquo douleurthinspreacutesiduellethinsptoleacuterablethinspabsentethinspouthinspcommethinspagravethinspsonthinspeacutetatthinspinitial

CMQ - OIIQ - OPIQ 30

thinsprsaquo mobiliteacutethinsprevenuethinspagravethinspsonthinspeacutetatthinspinitialthinsprsaquo peuthinspouthinsppasthinspdethinspvomissementsthinsprsaquo patientthinspouthinsppersonnethinspresponsablethinspduthinsppatientthinsppeutthinspcomprendrethinsplesthinspdirectivesthinsp

dethinspdeacutepart

thinsprsaquothinsprsaquo Cesthinspcritegraveresthinspdoiventthinspecirctrethinsprespecteacutesthinspdethinspfaccedilonthinspsysteacutematiquethinsp

Lesthinspprofessionnelsthinspdoiventthinspsrsquoassurerthinspquethinspquandthinsplethinsppatientthinspquittethinsplrsquoeacutetablis-sementthinspilthinspestthinspaccompagneacutethinspdrsquounthinspadultethinspresponsablethinspetthinspqursquounthinspdocumentthinsprelatifthinspauthinspcongeacutethinspcomprenantthinspdesthinspconsignesthinspclairesthinsppourthinsplathinspsurveillancethinspagravethinspdomicilethinsp(pthinspexthinspthinspquoithinspfairethinspenthinspcasthinspdrsquourgence)thinspleurthinspsoitthinspremisthinspetthinspexpliqueacutethinsp(annexethinspXII)thinsp

thinspthinsp17thinspDOCUMENTATIONthinspDESthinspSOINSthinspETthinspTENUEthinspthinspDEthinspDOSSIERSthinsp

Commethinsppourthinsptoutethinspautrethinspinterventionthinsplesthinspmecircmesthinspnormesthinspsrsquoappliquentthinsppourthinsplathinspreacutedactionthinspdesthinspnotesthinspenthinspseacutedation-analgeacutesiethinspthinsp

Enthinspplusthinspdesthinspeacuteleacutementsthinspgeacuteneacuteralementthinspverseacutesthinspauthinspdossierthinspcelui-cithinspdoitthinspcontenirthinsptoutesthinsplesthinspinformationsthinsprelativesthinspagravethinsplathinsppeacuteriodethinsppreacutethinspperthinspetthinsppostseacutedation-analgeacutesiethinspAinsithinsplesthinspeacuteleacutementsthinspsuivantsthinspdoiventthinspecirctrethinspdocumenteacutesthinspauthinspdossierthinspduthinsppatientthinsp

(listethinspnonthinsplimitative)thinsp

1 lrsquoidentificationthinspdesthinspfacteursthinspdethinsprisquethinsplieacutesthinspagravethinsplrsquointerventionthinspdiagnostiquethinspthinspouthinsptheacuterapeutiquethinspouthinspagravethinsplathinspseacutedation-analgeacutesie

2 lrsquoheurethinspduthinspdeacutebutthinspetthinspdethinsplathinspfinthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplrsquoheurethinspdrsquoarriveacuteethinspagravethinsplathinspsallethinspdethinspreacutecupeacuterationthinspouthinspdrsquoobservationthinsp(sithinspdiffeacuterente)thinspetthinsplrsquoheurethinspduthinspdeacutepart

3 lesthinspordonnancesthinspmeacutedicalesthinspcomplegravetes4 lathinspmeacutedicationthinspthinspdosagethinspquantiteacutethinspvoiethinspvitessethinspetthinspheurethinspdrsquoadministration5 lathinspconcentrationthinspouthinsplethinspdeacutebitthinspdethinsplrsquooxygegravenethinsp(outhinspduthinspmeacutelangethinspgazeux)thinspadministreacutethinspthinsp

lethinspcasthinspeacutecheacuteant

6 lathinspsurveillancethinspeffectueacuteethinspa lesthinspsignesthinspvitauxthinspavecthinsplrsquoheurethinspdesthinsplecturesb lethinsptauxthinspdethinspsaturationthinspcapillairethinspenthinspoxygegravenethinspavecthinsplrsquoheurethinspdesthinsplecturesc lethinspniveauthinspdethinspCO

2thinspthinsplethinspcasthinspeacutecheacuteantthinspavecthinsplrsquoheurethinspdesthinsplectures

d lathinspdescriptionthinsppeacuteriodiquethinspduthinspniveauthinspdethinspseacutedationagitationthinspetthinspdethinspthinspconsciencethinsplrsquoutilisationthinspdrsquounethinspeacutechellethinspestthinsprecommandeacuteethinsp(annexethinspIX)

e lathinspdescriptionthinsppeacuteriodiquethinspduthinspniveauthinspdethinspdouleurthinsplrsquoutilisationthinspdrsquounethinspeacutechellethinspestthinsprecommandeacuteethinsp(annexethinspX)

CMQ - OIIQ - OPIQ 31

f lathinspdescriptionthinspdethinsptoutethinspreacuteactionthinspdeacutefavorablethinsplethinspcasthinspeacutecheacuteantg lathinspdescriptionthinspdethinsplrsquoeacutetatthinspduthinsppatientthinspagravethinsplathinspfinthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-thinsp

analgeacutesieh lathinspdescriptionthinspdethinsplrsquoeacutetatthinspduthinsppatientthinspauthinspmomentthinspduthinspcongeacutethinspouthinsplathinspreacutefeacuterencethinspthinsp

agravethinspunthinspprotocolethinsp(critegraveresthinspdethinspcongeacute)7 lethinspmonitoragethinspthinspappareilthinspalarmethinspemplacementthinsplethinspcasthinspeacutecheacuteant8 lethinspconsentement9 unethinspcopiethinspdesthinsprecommandationsthinspeacutecritesthinspremisethinspauthinsppatientthinspauthinspmomentthinspduthinsp

congeacutethinsp(annexethinspXII)thinspouthinspagravethinspdeacutefautthinspunethinspnotethinspattestantthinsplathinspremisethinspdethinspcethinspdocumentthinspstandardiseacutethinspdontthinspunethinspcopiethinspestthinspconserveacutee

10 thinsplethinspprotocolethinspopeacuteratoire11 thinsplathinspnotethinspdethinspdeacutepart12 thinsptoutethinspautrethinspinformationthinspjugeacuteethinsppertinentethinsp(pthinspexthinspthinspreacutesultatthinspdrsquoauscultationthinspthinsp

complication)

Enfinthinsptousthinsplesthinspprofessionnelsthinspimpliqueacutesthinspdoiventthinspsrsquoassurerthinspduthinsprespectthinspdethinspleurthinspreacuteglementationthinspouthinspnormesthinsprespectivesthinspenthinspmatiegraverethinspdethinspdocumentationthinspdesthinspsoinsthinspetthinspdethinsptenuethinspdethinspdossiers

CMQ - OIIQ - OPIQ 32

Chapitre 2Patient peacutediatrique

thinspPREacuteAMBULEthinsp

Puisquethinsplrsquoenfantthinsppossegravedethinspdesthinspcaracteacuteristiquesthinspquithinspluithinspsontthinsppropresthinspetthinspquithinspeacutevoluentthinspenthinspfonctionthinspdethinspsonthinspstadethinspdethinspdeacuteveloppementthinspilthinspestthinspdoncthinspopportunthinspdrsquoeacutetablirthinspdesthinsplignesthinspdirectricesthinspparticuliegraveresthinspagravethinspcettethinspclientegravelethinsp

Cesthinsplignesthinspdirectricesthinspvisentthinsplesthinspenfantsthinspacircgeacutesthinspdethinspplusthinspdethinsp3thinspansthinsp

Unethinspseacutedation-analgeacutesiethinspreacuteussiethinspameacuteliorethinsplathinspqualiteacutethinspdesthinspexamensthinspdemandeacutesthinspdiminuethinsplathinspneacutecessiteacutethinspdethinsprecourirthinspagravethinspdesthinspcontentionsthinspphysiquesthinspameacuteliorethinsplathinspcollaborationthinspetthinsplathinspconfiancethinspdethinsplrsquoenfantthinspetthinspdesthinspparentsthinspquantthinspauxthinspsoinsthinspprodigueacutesthinspetthinspauxthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspreacutealiseacuteesthinsp

Lathinspseacutedation-analgeacutesiethinsp(tousthinspniveaux)thinspenthinsppeacutediatriethinspdoitthinspecirctrethinspreacuteserveacuteethinspauthinspmilieuthinsphospitalierthinspouthinspauxthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacuteces-sairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspetthinspcethinspenthinspraisonthinspduthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquithinspestthinspgeacuteneacuteralementthinspneacutecessairethinspEllethinspcomportethinspdesthinsprisquesthinspseacuterieuxthinsppeuthinspimportethinsplrsquoeacutetatthinspdethinspsanteacutethinspdethinsplrsquoenfantthinspLesthinspcomplicationsthinsplesthinspplusthinspfreacutequentesthinspsontthinsplrsquoobstructionthinspdesthinspvoiesthinspaeacuteriennesthinsplrsquoapneacuteethinsplrsquoaspirationthinspdethinspseacutecreacutetionsthinspthinspetthinsplesthinspvomissements

thinsp21thinspOBJECTIFSthinspETthinspCLIENTEgraveLEthinspCIBLEthinsp

OBJECTIFS

Outrethinsplesthinspobjectifsthinspdethinspseacutedation-analgeacutesiethinspdeacutefinisthinsppourthinsplathinspclientegravelethinspadultethinsp(pthinsp8)thinspthinsp

lathinspseacutedation-analgeacutesiethinsppourthinsplathinspclientegravelethinsppeacutediatriquethinspvisethinspeacutegalementthinspagravethinspthinsp

thinsprsaquo eacuteviterthinspunthinsptraumatismethinsppsychologiquethinsprsaquo diminuerthinsplrsquoanxieacuteteacutethinspetthinsplathinsppeurthinspdethinsplrsquoenfantthinspetthinspdesthinspparentsthinsprsaquo obtenirthinsplathinspcollaborationthinspdethinsplrsquoenfant

CMQ - OIIQ - OPIQ 33

CLIENTEgraveLEthinspCIBLE

EnthinsppeacutediatriethinsplethinspniveauthinspdethinspseacutedationthinsprequisthinspestthinsptributairethinspdethinsplrsquoacircgethinspduthinspstadethinspdethinspdeacuteveloppementthinspdethinsplathinspcapaciteacutethinspcognitivethinspetthinspdethinsplathinspcollaborationthinspdethinsplrsquoenfantthinspAinsithinspchezthinsplrsquoenfantthinspdethinsp

thinsprsaquo 3thinspagravethinsp6thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspmodeacutereacutethinspsrsquoavegraverethinsprarementthinspsuffisantethinspLathinspplupartthinspdesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspneacutecessitentthinspunthinspniveauthinspprofondthinsp(voirethinspunethinspanestheacutesiethinspgeacuteneacuterale)thinsp

thinsprsaquo 7thinspagravethinsp13thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspmodeacutereacutethinspsrsquoavegraverethinspgeacuteneacuteralementthinspsuffisantethinspToutefoisthinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinsppeuventthinspneacutecessiterthinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspprofondthinsp

thinsprsaquo gethinsp14thinspansthinspthinspunethinspseacutedation-analgeacutesiethinspdethinspniveauthinspleacutegerthinspouthinspmodeacutereacutethinspsrsquoavegraverethinspsuffisantethinspToutefoisthinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinsppeuventthinspneacutecessiterthinspunthinspniveauthinspdethinspseacutedation-analgeacutesiethinspprofond

Chezthinsplrsquoenfantthinspdethinspmoinsthinspdethinsp3thinspansthinspouthinspdansthinsplethinspcasthinspdrsquounethinspseacutedationthinspprofondethinspviseacuteethinsplethinspmeacutedecinthinspdoitthinspsrsquoassurerthinspdethinsplathinspcollaborationthinspdrsquounthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespira-toirethinsppeacutediatriquethinspavanceacutee

Dethinspplusthinspilthinspestthinsprecommandeacutethinspdrsquoutiliserthinsplathinspclassificationthinspdethinsplrsquoeacutetatthinspphysiquethinspduthinspthinsppatientthinspquethinsplrsquoonthinsptrouvethinspdansthinsplethinsptableauthinspdethinsplathinsppagethinspsuivante

CMQ - OIIQ - OPIQ 34

Tableau 4 Classification de lrsquoeacutetat physique du patient selon lrsquoAmerican Society of Anesthesiologists (ASA) (ASA Physical Status Classification System [En ligne]) (Notre traduction)

Classification Eacutetatthinspdethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp1 Patientthinspenthinspbonnethinspsanteacute

ASAthinspPhysicalthinspStatusthinsp2Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspleacutegegravere

ASAthinspPhysicalthinspStatusthinsp3Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgrave

ASAthinspPhysicalthinspStatusthinsp4Patientthinspatteintthinspdrsquounethinspaffectionthinspthinspsysteacutemiquethinspgravethinspquithinsprepreacutesentethinspunethinspmenacethinspconstantethinsppourthinspsathinspvie

ASAthinspPhysicalthinspStatusthinsp5Patientthinspmoribondthinspquithinspnethinspsurvivrathinsppasthinspthinspagravethinspmoinsthinspdrsquounethinspinterventionthinsp

ASAthinspPhysicalthinspStatusthinsp6Patientthinspdeacuteclareacutethinspenthinspeacutetatthinspdethinspmortthinspceacutereacutebralethinspdontthinsplesthinsporganesthinspontthinspeacuteteacutethinsppreacuteleveacutesthinspagravethinspdesthinspfinsthinspdethinspdon

CMQ - OIIQ - OPIQ 35

Volet organisationnelthinsp22thinspCOMPEacuteTENCESthinspPROFESSIONNELLESthinsp

Outrethinsplesthinspcompeacutetencesthinspprofessionnellesthinspmentionneacuteesthinsppourthinsplethinsppatientthinspadultethinspthinsp(pthinsp11)thinsptousthinsplesthinspprofessionnelsthinspdethinsplathinspsanteacutethinsp(meacutedecinthinspinfirmiegraverethinspetthinspinhalotheacutera-peute)thinspquithinspprocegravedentthinspagravethinspunethinspseacutedation-analgeacutesiethinspaupregravesthinspdethinsppatientsthinsppeacutediatriquesthinspdoiventthinspposseacutederthinsp

athinsp lesthinspconnaissancesthinspetthinsplesthinspcompeacutetences73neacutecessairesthinspagravethinsplathinspreacuteanimationthinspthinspcardiorespiratoirethinsppeacutediatrique84(dethinsppreacutefeacuterencethinspenthinspsoinsthinspavanceacutes)thinspcrsquoest-agrave-direthinspmaicirctriserthinspenthinspprioriteacutethinsplesthinsptechniquesthinspdethinsplathinspprisethinspenthinspchargethinspdethinsplathinspventilationthinspduthinspmassagethinspcardiaquethinspetthinspdethinsplathinspmeacutedicationthinspassocieacutee

bthinspunethinspexpertisethinspcliniquethinspspeacutecifiquethinspagravethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeu-tiquethinspagravethinspreacutealiserthinspthinsp

thinspthinsp23thinspRESSOURCESthinspMATEacuteRIELLESthinsp

Sithinsplesthinspressourcesthinspmateacuteriellesthinspdethinspbasethinspetthinsplrsquoemplacementthinspsontthinspessentiellementthinsplesthinspmecircmesthinspquethinspchezthinsplrsquoadultethinsp(pthinsp11)thinspcelles-cithinspdoiventthinsptoutefoisthinspecirctrethinspadapteacuteesthinspauthinsp

patientthinsppeacutediatriquethinsp(crsquoest-agrave-direthinsptaillethinsppoidsthinspetthinspparticulariteacutes)thinsp

Agravethinsptitrethinspdrsquoexemplethinsp(listethinspnonthinsplimitative)thinsp

thinsprsaquo capteurthinspduthinspsaturomegravetrethinspdethinspmodegravelethinsppeacutediatriquethinsprsaquo reacuteanimateurthinspautogonflantthinsp(Ambuthinspbag)thinspetthinspmasquesthinspdethinspdiffeacuterentesthinsptaillesthinspthinsprsaquo lamesthinspdethinsplaryngoscopethinspsondesthinspendotracheacutealesthinsp(avecthinspouthinspsansthinspballonnet)thinspdethinsp

taillesthinspdiffeacuterentesthinsprsaquo canulesthinsporonasopharyngeacuteesthinspdethinspdiffeacuterentesthinsptaillesthinsprsaquo tubulurethinspagravethinspsoluteacutethinspdethinsptypethinspmicrogouttesthinspavecthinspouthinspsansthinspburettethinsprsaquo outilsthinspsupraglottiquesthinsp(pthinspexthinspthinspmasquethinsplaryngeacute)thinspdethinspdiffeacuterentesthinsptaillesthinsprsaquo deacutefibrillateurthinspavecthinspeacutelectrodesthinsppeacutediatriquesthinsprsaquo steacutethoscopethinspdethinsptaillethinsppeacutediatriquethinsp(preacutecordialthinspouthinsppreacutetracheacutealthinsppourthinspeacutecoutethinspenthinsp

continuethinspsrsquoilthinspythinspathinsplieu)thinsprsaquo appareilthinspagravethinspaspirationthinsppouvantthinspgeacuteneacutererthinspunethinsppressionthinspneacutegativethinspdethinsp40thinspagravethinsp60thinspmmthinsp

Hgthinspouthinspunethinspcapaciteacutethinspdethinspflotthinspdethinsp100thinsplitresthinspparthinspminutethinspetthinsplethinspmateacuterielthinspneacutecessairethinspdethinsptaillethinspadapteacutee

7thinsp Onthinspentendthinspparthinspconnaissancesthinspetthinspcompeacutetencesthinspqursquoellesthinspsoientthinspmisesthinspagravethinspjourthinspselonthinsplesthinsprecommandationsthinspenthinspvigueur

8thinsp Onthinspentendthinspparthinspcertificationthinspenthinspreacuteanimationthinspcardiorespiratoirethinsplesthinspformationsthinspsuivantesthinspthinsp rsaquothinspReacuteanimationthinspcardiorespiratoirethinspdethinspbasethinspthinspSoinsthinspimmeacutediatsthinspenthinspreacuteanimationthinsp(SIR)thinsppourthinspprofessionnelsthinspdethinsplathinspthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspsanteacutethinspouthinsplrsquoeacutequivalentthinsp rsaquothinspReacuteanimationthinspcardiorespiratoirethinspavanceacuteethinspthinspSoinsthinspavanceacutesthinspenthinspreacuteanimationthinsppeacutediatriquethinsp(SARP)thinspouthinsplrsquoeacutequivalent

CMQ - OIIQ - OPIQ 36

Volet professionnelthinsp24thinspPREacuteSEacuteDATION-ANALGEacuteSIEthinsp

SEacuteLECTIONthinspDESthinspPATIENTS

Sithinspunethinspseacutelectionthinsprigoureusethinspdesthinsppatientsthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinspattentionthinspquethinspchezthinsplrsquoadultethinsp(pthinsp15)thinspcertainesthinspparticulariteacutesthinsppropresthinspagravethinsplrsquoenfantthinspdoiventthinsp

toutefoisthinspecirctrethinspprisesthinspenthinspcomptethinsp

LorsthinspdethinspsituationsthinspparticuliegraveresthinspouthinspcomplexesthinspapregravesthinsplrsquoeacutevaluationthinspduthinsppatientthinsplethinspmeacutedecinthinspdevraitthinspconsulterthinspunthinspmeacutedecinthinspayantthinspunethinspformationthinspreconnuethinspenthinspanestheacutesiologiethinspouthinspenthinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspCitonsthinspagravethinsptitrethinspdrsquoexemplethinspmaisthinspsansthinspsrsquoythinsplimiterthinsp

thinsprsaquo preacutesencethinspdethinspcertainsthinspsyndromesthinspdontthinsplathinsptrisomiethinsp21thinsprsaquo anomaliethinspdesthinspvoiesthinspaeacuteriennesthinsprsaquo anomaliethinspcranio-facialethinsprsaquo infectionthinsprespiratoirethinspasthmethinsprsaquo maladiethinspneuromusculairethinsprsaquo maladiethinspcardiaquethinsprsaquo troublethinsprespiratoirethinspduthinspsommeilthinspetthinsplathinsptheacuterapiethinspassocieacuteethinsprsaquo obeacutesiteacutethinspimportantethinsprsaquo refluxthinspgastro-œsophagienthinsprsaquo eacutetatthinspdethinspconsciencethinspalteacutereacutethinsprsaquo troublethinspenvahissantthinspduthinspdeacuteveloppementthinsp(pthinspexthinspthinspautisme)

Dethinspmecircmethinsptoutthinspcommethinspchezthinsplrsquoadultethinsplesthinspinterventionsthinspeffectueacuteesthinspsousthinspseacutedation-analgeacutesiethinspdoiventthinspecirctrethinspreacuteserveacuteesthinspprincipalementthinspauxthinsppatientsthinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp1thinspouthinspauxthinsppatientsthinspatteintsthinspdrsquounethinspaffectionthinsp

systeacutemiquethinspleacutegegraverethinspclasseacuteethinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp2thinsp

Notonsthinspquethinsplorsquethinspcestthinspjustifieacutethinspauthinspdossierthinspmeacutedicalthinsplathinspseacutedation-analgeacutesiethinsppeutthinspecirctrethinspeffectueacuteethinspchezthinsplesthinsppatientsthinspstablesthinspclasseacutesthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp3thinspetthinspexceptionnellementthinspdansthinsplathinspcateacutegoriethinspASAthinspPhysicalthinspStatusthinsp4thinspToutefoisthinspellethinspdoitthinsplrsquoecirctrethinspdansthinspdesthinspeacutetablissementsthinspayantthinsplesthinspinstallationsthinsprequisesthinspEllethinspdevraitthinspecirctrethinspeffectueacuteethinspparthinspunethinspeacutequipethinspayantthinsplesthinspcompeacutetencesthinspneacutecessairesthinsppourthinspassurerthinspunethinspsurveillancethinspcliniquethinspoptimalethinspunethinspprisethinspenthinspchargethinspventilatoirethinspetthinspunethinspreacuteanimationthinspcardiorespiratoirethinsppeacutediatriquethinspavanceacuteethinspetthinsprapidementthinspdisponiblethinspDethinspplusthinspcesthinsppatientsthinspdoiventthinsp

fairethinsplrsquoobjetthinspdrsquounethinspeacutevaluationthinspindividualiseacuteethinspetthinspplusthinspapprofondiethinspEacuteVALUATIONthinspDESthinspPATIENTSthinsp

CMQ - OIIQ - OPIQ 37

EacuteVALUATIONthinspDESthinspPATIENTS

Sithinspunethinspeacutevaluationthinsprigoureusethinspdesthinsppatientsthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinspatten-tionthinspquethinspchezthinspladultethinsp(pthinsp15)thinspcettethinspeacutevaluationthinspdoitthinspaussithinspinclurethinspsansthinspsrsquoythinsplimiterthinsplrsquoacircgethinsplathinsptaillethinsplethinsppoidsthinsplethinspstadethinspdethinspdeacuteveloppementthinsplathinspcapaciteacutethinspcognitivethinsplesthinspallergiesthinsplesthinspproblegravemesthinspmeacutedicauxthinspouthinspfamiliauxthinsppertinentsthinsplesthinspmeacutedicamentsthinsp(outhinspautrethinspsubstancethinspnonthinspprescrite)thinsppristhinspreacuteguliegraverementthinspouthinspreacutecemmentthinspetthinsplrsquoheurethinspduthinspdernierthinspingestathinspainsithinspquethinsplethinsptypethinspetthinsplathinspquantiteacutethinspconsommeacutee

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinsppeutthinspecirctrethinsputiliseacutethinspafinthinspdethinspstructurerthinsplrsquoeacutevaluationthinsp(anamnegravesethinspetthinspexamenthinspphysique)thinspetthinspdethinspsrsquoassurerthinspquethinspcelle-cithinspsoitthinspcomplegravetethinspthinsp

CONSENTEMENTthinsp(REacuteSUMEacute)

LethinsplecteurthinspdoitthinspsethinspreacutefeacutererthinspagravethinsplrsquoannexethinspVIIIthinsppourthinsplethinsptextethinspcomplet

ToutthinspcommethinspchezthinsplrsquoadultethinspilthinspestthinspobligatoirethinspauthinspQueacutebecthinspdrsquoobtenirthinsplethinspconsente-mentthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspinterventionthinspCelathinspditthinsppourthinsplathinspclientegravelethinsppeacutediatriquethinspilthinspfautthinspajouterthinspunethinsppreacutecisionthinspextraitethinspduthinsp

Code civil du QueacutebecthinspthinspSithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsp(traitementsthinspdethinspmeacutedecinethinspetthinspdethinspchirurgiethinspestheacutetiquethinspexpeacuterimentationthinspetthinspdonsthinspdrsquoorganes)thinsplethinsppatientthinspdoitthinspecirctrethinspinformeacutethinspdethinsptousthinsplesthinsprisquesthinsppossiblesthinspmecircmethinspsrsquoilsthinspsontthinspraresthinspthinspetthinsplethinspconsentementthinspdoitthinspecirctrethinspdonneacutethinspparthinspeacutecrit

thinsprsaquo Unethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsp(gethinsp14thinspans)thinsppeutthinspconsentirthinspseulethinspthinspagravethinspmoinsthinspqursquoilthinspsrsquoagissethinspdethinspsoinsthinspnonthinsprequisthinspetthinspcomportantthinspdesthinsprisques

thinsprsaquo Pourthinspunethinsppersonnethinspmineurethinspdethinspmoinsthinspdethinsp14thinspansthinsp(ltthinsp14thinspans)thinsplethinspconsentementthinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentale

Srsquoilthinspsrsquoagitthinspdethinspsoins requisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsplrsquoobligationthinspdrsquoinformerthinsp

croicirctthinspenthinspfonctionthinspdethinsplathinsppreacutevalencethinspetthinspdethinsplathinspgraviteacutethinspdesthinspcomplications

thinsprsaquo Lethinspconsentementthinspdrsquounethinsppersonnethinspmineurethinsp(ltthinsp18thinspans)thinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinsp

thinsprsaquo Unethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsp(gethinsp14thinspans)thinsppeutthinspconsentirthinspmaisthinspnethinsppeutthinsppasthinsprefuserthinspseulethinspdesthinspsoinsthinspquithinspseraientthinspjugeacutesthinsprequisthinsp

DIRECTIVESthinspETthinspCONSEILSthinsp

Toutthinspcommethinsppourthinsplrsquoadultethinsp(pthinsp19)thinsplrsquoenfantthinspetthinspsonthinspparentthinsp(outhinspremplaccedilant)thinspdoiventthinsprecevoirthinsplesthinspdirectivesthinspneacutecessairesthinspCelathinspditthinspauxthinspdirectivesthinsprelativesthinspauthinspjeucircnethinsp

CMQ - OIIQ - OPIQ 38

preacute-interventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspnonthinspurgentethinsp(eacutelective)thinspilthinspfautthinspajouterthinspcecithinsp(Merchantthinspetthinspcollabthinsp2014a op cit)thinsp

thinsprsaquo liquidethinspclairthinsp(pthinspexthinspthinspeauthinspjusthinspdethinspfruitthinsp[sansthinsppulpe])thinspthinspjeucircnethinspdethinsp2thinspheuresthinsprsaquo laitthinspmaternelthinspthinspjeucircnethinspdethinsp4thinspheuresthinsprsaquo formulesthinsplacteacuteesthinspnonthinsphumaniseacuteesthinspouthinsppreacuteparationsthinspcommercialesthinsppourthinsp

nourrissonsthinspthinspjeucircnethinspdethinsp6thinspheuresthinspthinspAucunthinspajoutthinspnrsquoestthinsppermisthinspauthinsplaitthinspmaternelthinsptireacutethinsp

thinsp25thinspPERSEacuteDATION-ANALGEacuteSIEthinsp

APPROCHEthinspPHARMACOLOGIQUEthinsp

Sithinsplathinspmeacutedicationthinspgeacuteneacuteralementthinsputiliseacuteethinspestthinsplathinspmecircmethinspquethinspchezthinsplrsquoadultethinsp(pthinsp20)thinsplathinspdosethinspdoitthinspecirctrethinspadapteacuteethinspnotammentthinspenthinspfonctionthinspduthinsppoidsthinspetthinspdethinsplathinspcondi-tionthinspcliniquethinspdethinsplrsquoenfantthinspParthinspailleursthinspilthinspfautthinspretenirthinspquethinsplathinsppharmacocineacutetiquethinspetthinsplathinsppharmacodynamiquethinspdesthinspagentsthinspdethinspseacutedation-analgeacutesiethinspsontthinspinfluenceacuteesthinspparthinsplrsquoacircgethinspduthinsppatientthinspAgravethinsptitrethinspdrsquoexemplethinsppourthinspunthinspenfantthinspacircgeacutethinspdethinspunthinspagravethinspsixthinspansthinsplathinspclairancethinspdesthinspagentsthinspdethinspseacutedation-analgeacutesiethinspestthinspsupeacuterieurethinspagravethinspcellethinspdethinsplrsquoadultethinspIlthinspfaudrathinspdoncthinspajusterthinsplesthinspdosesthinspchezthinspunthinspenfantthinspdrsquoacircgethinsppreacutescolairethinsp(Saunderthinspetthinsp

collabthinsp2008)thinsp

Lrsquoutilisationthinspdrsquounethinsppommadethinspanalgeacutesiquethinsp(pthinspexthinspthinsplathinspcregravemethinspEMLAreg)thinsppeutthinspecirctrethinspavantageusethinsppourthinspcontrerthinsplathinspdouleurthinspassocieacuteethinspagravethinsplathinspposethinspdrsquounthinspcatheacuteterthinspintra-veineuxthinspparthinspexemplethinsp(lethinsptempsthinspdrsquoattentethinspdethinsp60thinspagravethinsp90thinspminutesthinspdoitthinspecirctrethinsppristhinspenthinspconsideacuteration)thinsp

APPROCHEthinspNONthinspPHARMACOLOGIQUE

Pourthinsplrsquoenfantthinspquithinspnethinspbeacuteneacuteficiethinspquethinspdrsquounethinspanalgeacutesiethinsp(aucunethinspseacutedation)thinspilthinspfautthinspretenirthinspquethinsplathinspdistractionthinsp(attirerthinsplrsquoattentionthinspversthinspquelquethinspchosethinspdethinsppositif)thinsppen-dantthinspunthinspsointhinspdouloureuxthinsp(outhinspquithinspinquiegravete)thinsppeutthinspsrsquoaveacutererthinspunthinspmoyenthinspefficacethinsppourthinspdiminuerthinspsonthinspanxieacuteteacutethinspetthinsplathinspperceptionthinspdethinspsathinspdouleurthinsp(AssociationthinspSparadrapthinspthinsp[Enthinspligne])

Agravethinsptitrethinspdrsquoexemplethinspetthinspsansthinspsrsquoythinsplimiterthinsp

thinsprsaquo discuterthinspavecthinsplrsquoenfantthinspouthinsplrsquoadolescentthinspdethinspsesthinsppreacutefeacuterencesthinsprsaquo utiliserthinspunthinspjouetthinspchanterthinspunethinspchansonthinspouthinspraconterthinspunethinsphistoirethinspagravethinsplrsquoenfantthinspthinsp

plusthinspjeunethinsprsaquo lathinsppreacutesencethinspetthinsplathinspcollaborationthinspdrsquounthinspparentthinsppeuventthinspecirctrethinsppertinentes

CMQ - OIIQ - OPIQ 39

SURVEILLANCEthinspCLINIQUE

Lathinspsurveillancethinspcliniquethinspcomprendthinspplusieursthinspeacuteleacutementsthinspquithinspconcernentthinspnotam-mentthinsplesthinspsystegravemesthinsprespiratoirethinspcardiaquethinspetthinspneurologiquethinspetthinspellethinspdoitthinsptenirthinspcomptethinspentrethinspautresthinsp

thinsprsaquo dethinsplathinspconditionthinspduthinsppatientthinspavantthinspetthinsppendantthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutique

thinsprsaquo dethinsplathinspcomplexiteacutethinspdethinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspreacutealiseacuteethinsprsaquo dethinsplathinspmeacutedicationthinsputiliseacuteethinsp(dosethinspdureacuteethinspetthinsppicthinspdrsquoactionthinspvoiethinspetthinspvitessethinsp

drsquoadministrationthinspcombinaisonthinspetthinspantagonistes)thinsprsaquo dethinsplrsquoassistancethinspagravethinspapporterthinspauthinspmeacutedecin

Lethinspmeacutedecinthinspquithinsppratiquethinspunethinspinterventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspchezthinspunthinspenfantthinspsousthinspseacutedation-analgeacutesiethinspdoitthinspcompterthinspsurthinsplathinsppreacutesencethinspdrsquoauthinspmoinsthinspunthinspautrethinspprofessionnelthinsphabiliteacutethinspduthinspmilieuthinspdethinsplathinspsanteacutethinsp(infirmiegraverethinspinhalotheacuterapeutethinspouthinspautrethinspmeacutedecin)thinsp(annexethinspII)thinspEnthinspeacutetroitethinspcollaborationthinspavecthinsplethinspmeacutedecinthinspreacuteali-santthinsplrsquointerventionthinspceux-cithinspassurentthinsplathinspgestionthinspdethinsplathinspseacutedationthinspetthinspdethinsplrsquoanalgeacutesiethinsp

qui comprend entre autres la surveillance clinique de lrsquoenfantthinspresponsabiliteacutethinspthinspagravethinsplaquellethinspilsthinspdoiventthinspenthinsptoutthinsptempsthinspsethinspconsacrerthinspen prioriteacutethinsp

Dansthinspcertainsthinspcasthinsplethinspprofessionnelthinspquithinspassurethinspen prioriteacutethinsplathinspsurveillancethinspthinspcliniquethinspdethinsplrsquoenfantthinsppeutthinspecirctrethinspappeleacutethinspagravethinspassisterthinsplethinspmeacutedecinthinspdansthinsplathinspreacutealisationthinspthinspdethinspsonthinspinterventionthinspCettethinspassistancethinspquithinspdoitthinspsrsquoeffectuerthinspdansthinsplathinspmecircmethinsppiegravecethinspdoitthinspecirctrethinspdethinsptregravesthinspcourtethinspdureacuteethinspDethinspplusthinspellethinspdoitthinsppouvoirthinspecirctrethinspinterrompuethinspagravethinsptoutthinspmomentthinsppourthinspintervenirthinspimmeacutediatementthinspaupregravesthinspdethinsplrsquoenfantthinspenthinspcasthinspdethinspcomplicationsthinspouthinspdethinspbesoin

Parthinspailleursthinsplorsquethinspcertainesthinspinterventionsthinspdiagnostiquesthinspouthinsptheacuterapeutiquesthinspneacutecessitentthinspunethinspassistancethinsptechniquethinspcontinuellethinspauthinspmeacutedecinthinsplrsquoajoutthinspdrsquounthinsptroisiegravemethinspprofessionnelthinspdethinsplathinspsanteacutethinsphabiliteacutethinsp(meacutedecinthinspinfirmiegraverethinspouthinspinhalotheacutera-peute)thinspattitreacute exclusivementthinspagravethinsplathinspsurveillancethinspcliniquethinspdethinsplrsquoenfantthinspestthinsprequisthinsp

CMQ - OIIQ - OPIQ 40

Tableau 5 Tableau reacutecapitulatif du nombre de professionnels habiliteacutes requis en seacutedation-analgeacutesie - Clientegravele peacutediatrique

Toutthinspauthinsplongthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinspdoitthinspecirctrethinspcontinuethinspetthinsplathinspcommunicationthinspavecthinspcelui-cithinspmaintenuethinsp

Proceacutederthinspagravethinsplathinspsurveillancethinspcliniquethinspcrsquoestthinspeacutevaluerthinspqualitativementthinspetthinspquanti-tativementthinspdethinspfaccedilonthinspsoutenuethinspetthinspenthinspcontinuthinsplrsquoensemblethinspdesthinspparamegravetresthinspsui-vantsthinsp(listethinspnonthinsplimitative)thinsp(tableauthinsp6)thinsp

thinsprsaquo mesurethinspdethinsplathinsppressionthinsparteacuteriellethinspduthinsppouls95etthinspdethinsplathinsprespiration106

thinsprsaquo lecturethinspdethinsplathinspsaturationthinspcapillairethinspenthinspoxygegraveneLathinsptonaliteacutethinspdethinsppoulsthinspdoitthinspecirctrethinspactiveacuteethinspenthinsptoutthinsptempsthinspetthinspsonthinspniveauthinspdoitthinspecirctrethinspajusteacutethinspdethinspfaccedilonthinspagravethinspecirctrethinspentenduthinspclairement

thinsprsaquo eacutevaluationthinspdethinsplrsquoeacutetatthinspdethinsplathinspcolorationthinspetthinspdethinsplathinsptempeacuteraturethinspdethinsplathinsppeauthinsprsaquo niveauthinspdrsquoO

2thinspdethinspCO

2thinspetthinspmonitoragethinspcardiaquethinspselonthinsplethinspcasthinsp

Enthinspplusthinspdesthinspparamegravetresthinspdethinspmonitoragethinspcliniquethinsp(mentionneacutesthinsppreacuteceacutedemment)thinsplathinspsurveillancethinspcliniquethinspduthinsppatientthinsppeacutediatriquethinspdoitthinspcomprendrethinspthinsp

thinsprsaquo lrsquoeacutevaluationthinspdethinsplathinsppermeacuteabiliteacutethinspdesthinspvoiesthinspaeacuteriennesthinsp(pthinspexthinspthinspbradycardiethinsphypoxiquethinsppreacutecocethinspsithinspobstruction)

thinsprsaquo lrsquoapportthinspliquidienthinsprsaquo lathinsppertethinspdethinspchaleurthinsp(selonthinsplathinspdureacuteethinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesie)

9thinspthinspthinspthinspthinspLethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp10thinspthinspthinspthinspLathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinspetthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

Nombrethinspdethinspprofessionnelsthinsphabiliteacutesthinsprequis

2 Nombrethinspmimimalthinsprequis

3 Sithinsputilisationthinspdethinsppropofolthinspkeacutetaminethinspouthinspdethinspdexmeacutedeacutetomidine

3 SithinsputilisationthinspconcomitantethinspdethinspN2Othinspetthinspdrsquounthinspagentthinspseacutedatifthinspouthinspthinsp

dunthinspopioiumldethinspouthinspsithinspconcentrationthinspdethinspN2Othinspmodifiable

3 Sithinsplassistancethinsptechniquethinspauthinspmeacutedecinthinspestthinspcontinuelle

CMQ - OIIQ - OPIQ 41

thinsprsaquo lrsquoeacutevaluationthinspdethinsplrsquoefficaciteacutethinspdethinsplrsquoanalgeacutesiethinspetthinspdethinsplathinspseacutedationthinspagravethinsplrsquoaidethinspdrsquooutilsthinspadapteacutesthinspagravethinsplathinspconditionthinspetthinspagravethinsplrsquoacircgethinspdethinsplrsquoenfantthinsp(annexesthinspIXthinspetthinspX)

thinsprsaquo lathinsppositionthinspduthinsppatientthinspetthinsplesthinsppointsthinspdrsquoappuithinsp(compression)

Tableau 6 Surveillance des paramegravetres cliniques en seacutedation-analgeacutesie - Clientegravele peacutediatrique

Paramegravetrethinspdethinspthinspsurveillancethinspclinique

PatientNiveauthinspdethinspthinspseacutedation

MeacutedicationInterventionthinspdiagnostiquethinspouthinsptheacuterapeutique

TAthinspRC11thinspthinspRR12thinspthinspetthinspsaturationthinspdrsquoO

2thinspthinsp

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

Niveauthinspdethinspthinsp-thinspseacutedationagitationthinspthinspthinspthinspconscience-thinspdouleur

rsaquothinspObligatoire

Chezthinsptousthinsplesthinsppatients

NiveauthinspdethinspCO2

SelonthinsplesthinspcaracteacuteristiquesthinspAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)thinsp

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspmeacutedication Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire rsaquothinspAccegravesthinspindirectthinspouthinspthinspthinspthinspthinsprestreintthinspauthinsppatientthinspthinspthinsp(pthinspexthinspthinspIRM)

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetaminethinsp

rsaquothinspRecommandeacute rsaquothinspASAthinspgethinsp3thinsprsaquothinspApneacuteethinspobstructivethinspthinspthinspduthinspsommeilthinsprsaquothinspMaladiethinspthinspthinsprespiratoirethinsprsaquothinspObeacutesiteacutethinspmorbide

Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

Monitoragethinspcardiaque

SelonthinsplesthinspcaracteacuteristiquesAgravethinsptitrethinspdrsquoexemplethinspthinsp(etthinspsansthinspsrsquoythinsplimiter)

Selonthinsplethinspniveauthinspthinspdethinspseacutedation

Selonthinsplathinspmeacutedication Selonthinsplathinspdureacuteethinspthinspdethinsplrsquointervention

rsaquothinspObligatoire rsaquothinspASAthinspgethinsp3thinsprsaquothinspMaladiethinspcardiaque

rsaquothinspPropofolthinsprsaquothinspDexmeacutedeacutetomidinethinsprsaquothinspKeacutetamine

Interventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspprolongeacuteethinsp(effetthinspcumulatifthinspdethinsplathinspmeacutedication)

rsaquothinspRecommandeacute Selonthinsplethinspniveauthinspthinspdethinspseacutedationthinspthinsp(pthinspexthinspthinspvaleurthinspgethinsp4thinspsurthinsplrsquoeacutechellethinspdethinspRamsaythinspmodifieacuteethinspouthinspeacutequivalent)

thinspthinsp IlthinspnethinspsrsquoagitthinsppasthinspdrsquounethinsplistethinsplimiteacuteethinspdesthinspsituationsthinspcliniquesthinspDrsquoautresthinspsituationsthinspcliniquesthinsppeuventthinspneacutecessiterthinspthinsplethinspmonitoragethinspcardiaquethinspouthinspduthinspCO

2thinspIlthinsprevientthinspauxthinspprofessionnelsthinspdethinspjugerthinspdethinsplathinspsituationthinspenthinspfonctionthinspdethinspthinsp

chaquethinsppatient

11thinspthinsp Lethinsppoulsthinspdoitthinspecirctrethinspeacutevalueacutethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspetthinspdethinspsonthinsprythmethinsp12thinspthinsp Lathinsprespirationthinspdoitthinspecirctrethinspeacutevalueacuteethinspenthinspfonctionthinspdethinspsathinspfreacutequencethinspdethinspsonthinsprythmethinspetthinspdethinspsonthinspamplitudethinspthoraciquethinsp

etthinspdansthinspcertainsthinspcasthinspselonthinsplethinspreacutesultatthinspdethinsplrsquoauscultationthinsppulmonaire

CMQ - OIIQ - OPIQ 42

ILthinspFAUTthinspSAVOIRthinspQUE

LathinspSocieacuteteacutethinspcanadiennethinspdesthinspanestheacutesiologistesthinsp(SCA)thinspindiquethinspquethinsplesthinspthinspdirectivesthinspgeacuteneacuteralesthinspdethinspsoinsthinsp(ythinspcompristhinsplethinspmonitorage)thinsppourthinsplathinspseacutedationthinspthinspconscientethinspsontthinsplesthinspmecircmesthinspquethinsppourthinsplesthinspautresthinspformesthinspdrsquoanestheacutesiethinsp[]thinspthinsp(Merchantthinspetthinspcollabthinsp2014bthinspopthinspcit)thinspDethinspplusthinspellethinspindiquethinspquethinsplethinspthinspcapnographethinspestthinsprequisthinsplorsthinspdethinspseacutedation-analgeacutesiethinspdethinspniveauthinspplusthinspeacuteleveacutethinspthinsp(pthinspexthinspthinspRamsaythinsp4-6)thinsp(Merchantthinspetthinspcollabthinsp2014athinspop cit)

LethinspjugementthinspcliniquethinspdesthinspprofessionnelsthinspimpliqueacutesthinspestthinspprimordialthinspetthinspcethinspmecircmethinspsithinsplrsquoappareillagethinspenthinspplacethinspestthinspcompletthinspetthinspfonctionnelthinspUnethinspbonnethinspcommunica-tionthinspentrethinspcesthinspderniersthinspestthinspdoncthinspessentiellethinspafinthinspdethinspbienthinspcoordonnerthinsplathinspseacutedationthinspetthinsplrsquoanalgeacutesiethinspavecthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinspLes alarmes (audibles et visuelles) de chaque appareil doivent ecirctre en fonction et les paramegravetres ajusteacutes agrave lrsquoacircge et agrave la condition clinique de chaque enfant

IlthinspfautthinspsrsquoassurerthinspdethinsplathinsptraccedilabiliteacutethinspdethinsplrsquoeacutevaluationthinspetthinspdethinsplathinspsurveillancethinspcliniquethinspthinspeffectueacuteesthinspparthinspunethinsptenuethinspdethinspdossiersthinspconformethinspauxthinspnormesthinspenthinspvigueurthinspthinspLesthinspoutilsthinspdrsquoeacutevaluationthinsputiliseacutesthinspdoiventthinspecirctrethinspsimplesthinspstandardiseacutesthinspvalideacutesthinspdethinsppreacutefeacuterencethinspetthinspadapteacutesthinspauthinspcontextethinspetthinspauxthinspcaracteacuteristiquesthinspduthinsppatientthinspnotam-mentthinsppourthinsplrsquoeacutevaluationthinspduthinspniveauthinspdethinspseacutedationagitationthinspdethinspconsciencethinspetthinspdethinspdouleurthinsp(annexesthinspIXthinspetthinspX)

Lathinspfreacutequencethinspdethinsplathinspmesurethinspdethinspcesthinspparamegravetresthinspetthinspleurthinspenregistrementthinspdoiventthinspecirctrethinspdeacutetermineacutesthinspentrethinspautresthinspenthinspfonctionthinspdethinsplathinspmeacutedicationthinspetthinspdethinsplathinspconditionthinsp

cliniquethinspduthinsppatientthinsp

Ideacutealementthinsplethinspprofessionnelthinspdoitthinsplesthinspdocumenterthinsp

thinsprsaquo avantthinsplethinspdeacutebutthinspdethinsplathinspproceacutedurethinspdethinspseacutedation-analgeacutesiethinsprsaquo apregravesthinsplrsquoadministrationthinspdrsquounthinspagentthinspdethinspseacutedation-analgeacutesiethinspouthinspdrsquounthinspantagonistethinsprsaquo authinsppicthinspdrsquoactionthinspdethinspchacunthinspdesthinspagentsthinspadministreacutesthinspthinsprsaquo agravethinspintervallesthinspreacuteguliersthinsp(pthinspexthinspthinsp5thinspminutes)thinspdurantthinsplathinspproceacutedurethinspdethinspseacutedation-

analgeacutesiethinsprsaquo agravethinspintervallesthinspplusthinsprapprocheacutesthinsplorsquethinsplathinspconditionthinspcliniquethinspduthinsppatientthinsplrsquoexigethinsprsaquo durantthinsplathinsppeacuteriodethinspdethinspreacutecupeacuterationthinspetthinspjusqursquoauthinspretourthinspduthinspniveauthinspdethinspconsciencethinsp

initialthinspselonthinsplathinspconditionthinspcliniquethinspduthinsppatientthinsprsaquo authinspmomentthinspduthinspcongeacutethinsp

CMQ - OIIQ - OPIQ 43

thinsp26thinspPOSTSEacuteDATION-ANALGEacuteSIEthinsp

Commethinsppourthinsplethinsppatientthinspadultethinsp(pthinsp29)thinsplathinspsurveillancethinspcliniquethinspdoitthinspecirctrethinspcons-tantethinspetthinsprigoureusethinsptoutthinspauthinsplongthinspdethinsplathinsppeacuteriodethinsppostseacutedation-analgeacutesiethinspetthinspcethinspjusqursquoauthinspretourthinspdethinsplrsquoeacutetatthinspinitialthinspdethinsplrsquoenfantthinspenthinspfonctionthinspdethinspsonthinspstadethinspdethinspdeacutevelop-pement

Rappelonsthinspquethinsplesthinspappareilsthinspdethinspmonitoragethinspdoiventthinspecirctrethinspenthinspfonctionthinspthinspmaisthinspenthinspaucunthinsptempsthinspilsthinspnethinspremplacentthinsplathinspsurveillancethinspdirectethinspduthinsppatientthinspthinspparthinsplethinspprofessionnelthinsp

LathinsppeacuteriodethinspdrsquoobservationthinspenthinspeacutetablissementthinspdoitthinspecirctrethinspsuffisammentthinspprolongeacuteethinsppourthinsppreacutevenirthinsplesthinspproblegravemesthinsppendantthinspetthinspauthinspretourthinspagravethinsplathinspmaisonthinspComptethinsptenuthinspdethinspsonthinspacircgethinspetthinspdethinspsathinspconditionthinsplrsquoenfantthinspdoitthinspecirctrethinspcapablethinspdethinspsrsquoasseoirthinspdethinspboirethinspdethinspparlerthinspetthinspdethinspmarcherthinspavecthinspunethinspaidethinspminimalethinsp

Selonthinsplathinspdistancethinspagravethinspparcourirthinspauthinspretourthinspilthinsppeutthinspecirctrethinspjudicieuxthinspdethinspprolongerthinsplathinsppeacuteriodethinspdrsquoobservation

Unthinspdocumentthinsprelatifthinspauthinspcongeacutethinspcomprenantthinspdesthinspconsignesthinspclairesthinsppourthinsplathinspthinsp

surveillancethinspagravethinspdomicilethinspdoitthinspecirctrethinspremisthinspetthinspexpliqueacutethinspauxthinspparentsthinsp(annexethinspXII)

thinsp27thinspDOCUMENTATIONthinspDESthinspSOINSthinspETthinspTENUEthinspDEthinspDOSSIERSthinsp

Lathinsptenuethinspdethinspdossiersthinspdoitthinspecirctrethinspfaitethinspavecthinsplathinspmecircmethinsprigueurthinspetthinsplathinspmecircmethinsppreacutecisionthinspquethinspchezthinsplrsquoadultethinsp(pthinsp30)thinspCertainesthinspinformationsthinsppropresthinspagravethinsplrsquoenfantthinspdoiventthinspecirctrethinspajouteacuteesthinspnotammentthinsp

thinsprsaquo sithinsppreacutesencethinspdrsquounthinspparentthinsprsaquo lethinsppoidsthinspetthinsplrsquoacircgethinspdethinsplrsquoenfantthinsprsaquo lathinsptaillethinspouthinsplrsquoIMCthinspsrsquoilthinspythinspathinsplieu

CMQ - OIIQ - OPIQ 44

CONCLUSION

Lathinspseacutedation-analgeacutesiethinspvisethinspagravethinspalteacutererthinsplethinspniveauthinspdethinspconsciencethinspainsithinspqursquoagravethinspsoulagerthinsplrsquoanxieacuteteacutethinspetthinsplathinspdouleurthinspdrsquounthinsppatientthinspauthinspcoursthinspdrsquounethinspinterventionthinsptheacuterapeutiquethinspouthinspdiagnostiquethinspCettethinspproceacutedurethinspbienthinspquethinspfreacutequemmentthinsputiliseacuteethinspcomportethinspcependantthinspcertainsthinsprisques

On doit y recourir de faccedilon seacutecuritaire pour le patient et en tout temps preacutevenir et reconnaicirctre les complica-tions lieacutees agrave la seacutedation-analgeacutesie afin drsquoeffectuer rapidement et efficace-ment les manœuvres neacutecessaires

LethinsprespectthinspdesthinsplignesthinspdirectricesthinspeacutenonceacuteesthinspdansthinspcethinspdocumentthinspaiderathinsplesthinspprofessionnelsthinspagravethinspmenerthinspadeacutequatementthinspcettethinspproceacutedurethinspCeux-cithinspdemeurentthinsptoutefoisthinspresponsablesthinspdethinsplathinspmisethinspagravethinspjourthinspdethinspleursthinspconnaissancesthinspetthinspduthinspdeacuteveloppementthinspdethinspleursthinspcompeacutetencesthinsprespectivesthinsp

Parthinspailleursthinsplesthinspeacutetablissementsthinspdethinspsanteacutethinspetthinsplesthinspcliniquesthinspouthinspcabinetsthinsppriveacutesthinspdevraientthinspsrsquoinspirerthinspdethinspcesthinsplignesthinspdirectricesthinsppourthinspeacutelaborerthinspthinspdesthinspproceacuteduresthinsprelativesthinspagravethinsplathinspthinspseacutedation-analgeacutesiethinspetthinspenthinspassurerthinsplrsquoeacutevaluationthinsppeacuteriodiquethinspdethinsplathinspqualiteacutethinsp

CMQ - OIIQ - OPIQ 45

mdash Annexe

thinspANNEXEthinspIthinspndashthinspDEacuteFINITIONthinspDEthinspLrsquoANESTHEacuteSIEthinspGEacuteNEacuteRALEthinspETthinspthinsp

DESthinspNIVEAUXthinspDEthinspSEacuteDATION-ANALGEacuteSIEthinspSELONthinspLrsquoAMERICANthinspSOCIETYthinspOFthinsp

ANESTHESIOLOGISTSthinsp(ASA)thinsp(AMERICANthinspSOCIETYthinspOFthinspANESTHESIOLOGISTSthinsp

ASAthinspHOUSEthinspOFthinspDELEGATEthinsp2014AthinspOP CIT)thinsp(NOTREthinspTRADUCTION)

Seacutedationthinspminimalethinspthinspanxiolyse

Seacutedation-thinspthinspanalgeacutesiethinspthinspmodeacutereacutee(consciente)

Seacutedation-thinspanalgeacutesiethinspthinspprofonde

Anestheacutesiethinspthinspgeacuteneacuterale

Reacuteponse Reacuteponsethinspnormalethinspagravethinsplathinspstimulationthinspverbale

Reacuteponsethinspvolontairethinspagravethinsplathinspstimulationthinspverbalethinspouthinsptactile

Reacuteponsethinspvolontairethinspsuivantthinspunethinspstimulationthinspreacutepeacuteteacuteethinspouthinspdouloureuse

Nonthinspeacuteveillablethinspmecircmethinspavecthinspstimulusthinspdouloureux

Voiesthinspthinspaeacuteriennes

Nonthinspaffecteacutees Pasthinspdrsquointerventionthinsprequise

Interventionthinsppeutthinspecirctrethinsprequise

Interventionthinspthinspsouventthinsprequise

Ventilationspontaneacutee

Nonthinspaffecteacuteethinsp Adeacutequate Peutthinspecirctrethinspinadeacutequate

Freacutequemmentthinspinadeacutequate

Fonctionthinspcardio-thinspvasculaire

Nonthinspaffecteacutee Geacuteneacuteralementthinspthinspmaintenue

Geacuteneacuteralementthinspthinspmaintenue

Peutthinspecirctrethinspthinspcompromise

thinspthinspLethinspreacuteflexethinspdethinspretraitthinspagravethinsplathinspsuitethinspdrsquounethinspstimulationthinspdouloureusethinspnrsquoestthinsppasthinspconsideacutereacutethinspcommethinspunethinspreacuteponsethinspvolontaire

Rappelonsthinspquethinsplathinspseacutedation-analgeacutesiethinspprofondethinspchezthinsplrsquoadultethinspetthinsplrsquoanestheacutesiethinspgeacuteneacuteralethinsp(adultethinspetthinsppeacutediatrique)thinspthinspnethinspfontthinsppasthinsplrsquoobjetthinspdethinspcettethinsppublication

CMQ - OIIQ - OPIQ 46

mdash Annexe

thinspANNEXEthinspIIthinspndashthinspINFORMATIONthinspCOMPLEacuteMENTAIREthinsp-thinspLECTURESthinspDrsquoINTEacuteREcircT

COLLEgraveGEthinspDESthinspMEacuteDECINSthinspDUthinspQUEacuteBECthinsp(CMQ)

thinsprsaquo Proceacutedures et interventions en milieu extrahospitalier (2011)thinsprsaquo Code de deacuteontologie des meacutedecinsthinsp(2015)

ORDREthinspDESthinspINFIRMIEgraveRESthinspETthinspINFIRMIERSthinspDUthinspQUEacuteBECthinsp(OIIQ)thinsp

thinsprsaquo EacutediteurthinspofficielthinspduthinspQueacutebec Code de deacuteontologie des infirmiegraveres et infirmiers (2014)

thinsprsaquo Le champ drsquoexercice et les activiteacutes reacuteserveacutees des infirmiegraveresthinsp(2013)thinsp2ethinspeacutedthinspthinsprsaquo Mosaiumlque des compeacutetences cliniques de lrsquoinfirmiegravere Compeacutetences initiales

(2009)thinsp2ethinspeacutedthinspthinsprsaquo Les obligations deacuteontologiques de lrsquoinfirmiegravere et le consentement aux soins

(2005)

ORDREthinspPROFESSIONNELthinspDESthinspINHALOTHEacuteRAPEUTESthinspDUthinspQUEacuteBECthinsp(OPIQ)

thinsprsaquo Profil national des compeacutetencesthinspLrsquoalliancethinspdesthinsporganismesthinspdethinspregraveglementationthinspenthinsptheacuterapiethinsprespiratoirethinsp(2011)

thinsprsaquo Les notes au dossier dans le secteur de lrsquoassistance anestheacutesique et de la seacutedation analgeacutesiethinsp-thinspGuidethinspdethinsppratiquethinsp(2008)

thinsprsaquo Compeacutetences relatives agrave lrsquoentreacutee dans la pratique (2003)thinsprsaquo Regraveglement sur les dossiers les autres effets les cabinets et la cessation

drsquoexercice des membres de lrsquoOrdre professionnel des inhalotheacuterapeutes du Queacutebecthinsp(2002)thinsp

thinsprsaquo Code de deacuteontologie des inhalotheacuterapeutes du Queacutebec

CMQ - OIIQ - OPIQ 47

thinspANNEXEthinspIIIthinspndashthinspPROCEacuteDURESthinspPROTOCOLESthinspOUthinspALGORITHMESthinsp

Dansthinsptousthinsplesthinsplieuxthinspougravethinspsethinsppratiquethinsplathinspseacutedation-analgeacutesiethinspagravethinspdesthinspfinsthinspdiagnos-tiquesthinspouthinsptheacuterapeutiquesthinsplethinspmeacutedecinthinspresponsablethinspdoitthinspeacutelaborerthinspenthinspcollabora-tionthinspavecthinsplesthinspmembresthinspdethinspsonthinspeacutequipethinspsoignantethinsplesthinspproceacuteduresthinspprotocolesthinspouthinsp

algorithmesthinspconcernantthinspnotammentthinsplesthinspsujetsthinspsuivantsthinsp

PARMIthinspLESthinspPROCEacuteDURESthinspOUthinspPROTOCOLESthinsp(ADULTEthinspETthinspPEacuteDIATRIQUE)thinsp

thinsprsaquo allergiethinspauthinsplatexchocthinspanaphylactiquethinsprsaquo antagonistethinsprsaquo bradycardiethinsprsaquo critegraveresthinspcliniquesthinspdethinspcongeacutethinsprsaquo hypertensionthinspmalignethinsprsaquo seacutedation-analgeacutesiethinsprsaquo transfertthinspdrsquourgence

PARMIthinspLESthinspALGORITHMESthinsp(ADULTEthinspETthinspPEacuteDIATRIQUE)thinsp

thinsprsaquo gestionthinspdesthinspvoiesthinspaeacuteriennesthinspdifficilesthinsp(ventilationintubation)thinsprsaquo reacuteanimationthinspcardiorespiratoirethinsp

thinspthinspthinspILthinspFAUTthinspPENSERthinspAgravethinsp

thinsprsaquo Lrsquoaffichagethinspdesthinspproceacuteduresthinspprotocolesthinspouthinspalgorithmesthinspdrsquourgencethinspquithinsppermettrathinspdrsquoythinspavoirthinspaccegravesthinsprapidementthinspenthinspcasthinspdrsquourgencethinspetthinspdethinsplesthinspconsulterthinspreacuteguliegraverementthinspparthinsplathinspmecircmethinspoccasionthinsp

thinsprsaquo Lrsquoeacutelaborationthinspdrsquounthinspprogrammethinsppeacuteriodiquethinspdrsquoexercicethinsp(pthinspexthinspthinspsimulation)thinspquithinsppermettrathinspdethinsprevoirthinsplesthinspdiffeacuterentesthinspproceacuteduresthinspenthinspplacethinspavecthinsptousthinsplesthinspmembresthinspdethinsplrsquoeacutequipethinspsoignantethinspetthinspdrsquoinitierthinsplethinspnouveauthinsppersonnelthinspassurantthinspainsithinspunethinspmeilleurethinsprelegravevethinspDethinspmecircmethinspmettrethinsplethinspplanthinspenthinsppratiquethinsppermetthinspdrsquooptimiserthinsplathinsprapiditeacutethinspetthinsplathinsppreacutecisionthinspdesthinspgestesthinspposeacuteesthinspetthinspdrsquoidentifierthinspdesthinspproblegravemesthinsppotentielsthinsp(avecthinspdethinsplrsquoeacutequipementthinspparthinspexemple)thinspetthinspcethinspavantthinspqursquoilthinspythinspaitthinspurgencethinspdrsquoagirthinsp

mdash Annexe

CMQ - OIIQ - OPIQ 48

thinspANNEXEthinspIVthinspndashthinspEacuteVALUATIONthinspDESthinspVOIESthinspAEacuteRIENNESthinspSUPEacuteRIEURESthinspAUthinsp

thinspMOYENthinspDUthinspSCOREthinspDEthinspMALLAMPATIthinsp(DIEMUNSCHthinspETthinspCOLLABthinsp2008)thinsp

(Agravethinsptitrethinspinformatifthinspseulement)

Objectifthinspthinspthinsp Eacutevaluerthinsplathinspvisibiliteacutethinspdesthinspstructuresthinsporopharyngeacuteesthinspetthinsplathinsptaillethinspthinsp

dethinsplathinsplangue

Lesthinsp4thinspclassesthinspdethinspMallampatithinspmodifieacuteesthinsp(SamsoonthinspandthinspYoung)thinspsontthinsp

thinsprsaquo ClassethinspIthinspthinspluettethinsppiliersthinspduthinspvoilethinspduthinsppalaisthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIIthinspthinsppiliersthinspduthinspvoilethinspduthinsppalaisthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIIIthinspthinsppalaisthinspmouthinsppalaisthinspdurthinsprsaquo ClassethinspIVthinspthinsppalaisthinspdurthinspseulthinsp

LesthinspclassesthinspIthinspetthinspIIthinsppreacutesagentthinspdrsquounethinspintubationthinspathinsppriorithinspfacilethinsplesthinspclassesthinspIIIthinspetthinspIVthinspdrsquounethinspintubationthinspdifficile

ClassesthinspdethinspMallampatithinspmodifieacuteesthinsp(Jmarchnthinsp[Enthinspligne])

LrsquoinsuffisancethinspdethinsplathinspclassificationthinspdethinspMallampatithinspathinspeacuteteacutethinspspeacutecifiquementthinspmon-treacuteethinspchezthinsplrsquoobegravesethinspEllethinspnethinsppeutthinspecirctrethinspconsideacutereacuteethinspcommethinspunthinsppreacutedicteurthinspisoleacute-mentthinspsuffisantthinspdethinsplathinspdifficulteacutethinspdethinsplathinsplaryngoscopiethinspouthinspathinspfortiorithinspdethinsplrsquointuba-tionthinspdifficilethinsp

mdash Annexe

CMQ - OIIQ - OPIQ 49

ANNEXEthinspVthinspndashthinspOUTILthinspDrsquoEacuteVALUATIONthinspDEthinspLrsquoAPNEacuteEthinspOBSTRUCTIVEthinspDUthinspSOMMEILthinsp

(AOS)thinspADAPTEacutethinspAgravethinspLAthinspCONSULTATIONthinspPREacuteANESTHESIQUESEacuteDATION-thinsp

ANALGEacuteSIEthinspthinsp(ADAPTEacutethinspDEthinspCHUNGthinspETthinspSEETthinsp2010)thinsp(NOTREthinspTRADUCTION)

(Agravethinsptitrethinspinformatifthinspseulement)

mdash Annexe

Exemplethinspdethinspquestionnairethinspstop-bang

Question Reacuteponse

Sthinspnore PreacutesencethinspdethinspronflementVosthinspronflementsthinspsont-ilsthinspbruyants(suffisammentthinsppourthinspecirctrethinspentendusthinspagravethinsptraversthinspunethinspportethinspfermeacutee)

OuithinspouthinspNon

Tthinspiredthinspfatiguethinsporthinspsleepy PreacutesencethinspdethinspsomnolencethinspouthinspfatigueVousthinspsentez-vousthinspsouventthinspfatigueacutethinspeacutepuiseacutethinspouthinspsomnolentthinsppendantthinsplathinspjourneacutee

OuithinspouthinspNon

Othinspbservedthinspapnea ApneacuteethinspobserveacuteethinspQuelqursquounthinspa-t-ilthinspdeacutejagravethinspobserveacutethinspquethinspvousthinspthinsparrecirctiezthinspdethinsprespirerthinspenthinspdormant

OuithinspouthinspNon

Pthinspressure PreacutesencethinspdrsquoHTAAvez-vousthinspouthinspecirctes-vousthinsptraiteacutepourthinspunethinsptensionthinsparteacuteriellethinspeacuteleveacutee

OuithinspouthinspNon

BthinspMI IMCthinspgtthinsp35thinspkgm2 OuithinspouthinspNon

Athinspge Acircgethinspgtthinsp50thinspans OuithinspouthinspNon

Nthinspeck Circonfeacuterencethinspduthinspcouthinspgtthinsp40thinspcm OuithinspouthinspNon

Gthinspender Sexethinspmasculin OuithinspouthinspNon

INTERPREacuteTATIONthinspCLINIQUE

ltthinsp3thinspreacuteponsesthinsppositivesthinsp=thinspfaiblethinsprisquethinspdrsquoAOS

ge 3 reacuteponses positives = risque eacuteleveacute drsquoAOS

CMQ - OIIQ - OPIQ 50

thinspANNEXEthinspVIthinspndashthinspANAMNEgraveSEthinspthinspAIDEthinspMNEacuteMOTECHNIQUEthinsp

(Agravethinsptitrethinspinformatifthinspseulement)

ObjectifthinspthinspthinspthinspCetthinspoutilthinspdrsquoaidethinspmneacutemotechniquethinspsertthinspagravethinspstructurerthinsplathinspfaccedilonthinspdontthinspthinsponthinspprocegravedethinspagravethinsplathinspcollectethinspsommairethinspdesthinspdonneacuteesthinspdansthinsplethinspcadrethinspdethinsplrsquoeacutevaluationthinspcliniquethinsp

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinspfacilitethinsplathinspcompreacutehensionthinspetthinsplathinspreacutealisationthinspdethinsplrsquoanamnegravesethinspchezthinsplrsquoadultethinspetthinsplrsquoenfant

SAMPLEthinsp(AdapteacutethinspdethinspAltonthinspetthinspcollabthinsp2007thinsp[Notrethinsptraduction])thinsp(outhinspvariante)

SthinspthinspSignesthinspetthinspsymptocircmes

AthinspthinspAllergiesthinspetthinspreacuteactionthinsp

MthinspthinspMeacutedicamentsthinspetthinspautresthinspsubstancesthinsp(prescritsthinspouthinspnon)thinspetthinsptraitement

PthinspthinspPasseacutethinspmeacutedicalfamilialthinsp

LthinspthinspLastthinspmeallunchthinsp(dernierthinsprepas)

EthinspthinspEnvironnementeacuteveacutenement

thinsp

mdash Annexe

CMQ - OIIQ - OPIQ 51

thinspANNEXEthinspVIIthinsp-thinspEXAMENthinspPHYSIQUEthinspthinspAIDEthinspMNEacuteMOTECHNIQUE

(Agravethinsptitrethinspinformatifthinspseulement)

Objectifthinspthinspthinsp Lrsquoexamenthinspphysiquethinspdesthinspvoiesthinspaeacuteriennesthinspsupeacuterieuresthinspcherchethinspagravethinspmettrethinspenthinspeacutevidencethinspcertainsthinspcritegraveresthinspreconnusthinsppourthinspecirctrethinspassocieacutesthinspagravethinspunethinspassis-tancethinspventilatoirethinspdifficilethinspquithinsppeutthinspsurvenirthinspdansthinsplethinspcasthinspdrsquounthinspniveauthinspdethinspseacutedationthinspplusthinspeacuteleveacutethinspquethinspceluithinspviseacutethinspparthinspexemple

Lethinsprecoursthinspagravethinspunethinspaidethinspmneacutemotechniquethinspfacilitethinsplathinspcompreacutehensionthinspetthinsplathinspreacutealisationthinspdethinsplrsquoexamenthinspphysiquethinsprelativementthinspauxthinspvoiesthinspaeacuteriennesthinspdethinsplrsquoadulte

1thinspIndicateursthinspdrsquounethinsppossiblethinspventilationthinspdifficilethinsp(MOANSthinsp[AdapteacutethinspdethinspWallsthinspetthinspthinspthinspthinspthinspMurphythinsp2012]thinsp[Notrethinsptraduction]thinspouthinspvariante)

Mthinspthinspmask sealthinsp(eacutetancheacuteiteacutethinspduthinspmasque)thinspthinspeacutetancheacuteiteacutethinspcompromisethinspenthinspraisonthinspthinspthinspthinspthinspthinspthinspthinspthinspthinspdrsquounethinspbarriegraverethinspmeacutecaniquethinsp(barbethinspfourniethinsptraumatismethinspfacialthinspetc)

OthinspthinspobeacutesiteacuteobstructionthinspthinsppatientthinspdontthinsplrsquoIMCthinspestthinspgtthinsp25thinsp(kgm2)thinspfemmethinspenceintethinspthinspthinspthinspthinspthinspthinspthinspgtthinsp6thinspmoisthinsp(2ethinsptrimestre)thinspangio-œdegravemethinspabcegravesthinspetc

Athinspthinspacircgethinspthinsppatientthinspgethinsp55thinspansthinsp(variablethinspselonthinsplesthinspauteurs)thinspenthinspraisonthinspnotammentthinspthinspthinspthinspthinspthinspthinspdethinsplathinsppertethinspdrsquoeacutelasticiteacutethinspdesthinsptissus

Nthinspthinspno teeththinsp(eacutedenteacute)thinspthinspdifficulteacutethinsplorsthinspdethinsplrsquoassistancethinspventilatoire

Sthinspthinspstiffthinsp(rigiditeacute)thinspthinsppathologiesthinspagravethinspconseacutequencesthinspsurthinsplathinspcompliancethinspetthinsplathinspthinspthinspthinspthinspthinspreacutesistancethinsppulmonairethinsp(asthmethinspMPOCthinsppneumoniethinspdethinspstadethinspavanceacutethinspetc)

thinspthinspVentilationthinspdifficilethinsp(masquethinspouthinspoutilthinspextraglottiquethinsptelthinspquethinspmasquethinspthinspthinspthinspthinspthinsplaryngeacute)thinsp(AdapteacutethinspdethinsplrsquoAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinsp[Notrethinspthinspthinspthinspthinspthinsptraduction])thinspImpossiblethinspdrsquoeffectuerthinspunethinspventilationthinspdethinspfaccedilonthinspadeacutequatethinspthinspthinspthinspthinspthinspenthinspraisonthinspdethinsplrsquounethinspetouthinspdethinsplrsquoautrethinspdesthinspsituationsthinspsuivantesthinsp

athinspMauvaisethinspeacutetancheacuteiteacutethinspduthinspmasquethinspouthinspdethinsplrsquooutilthinspextraglottiquebthinspFuitethinspdethinspgazthinspexcessivecthinspReacutesistancethinspexcessivethinspagravethinsplrsquoinspirationthinspouthinspagravethinsplrsquoexpiration

thinsp

mdash Annexe

CMQ - OIIQ - OPIQ 52

2thinspIndicateursthinspdrsquounethinsppossiblethinsplaryngoscopiethinspouthinspintubationthinspdifficilethinsp(thinspLEMONthinspthinspthinspthinspthinspthinsp[WallsthinspetthinspMurphythinsp2012thinspopthinspcit]thinsp[Notrethinsptraduction]thinspouthinspvariante)

Lthinspthinspthinsplook externallythinsp(apparencethinspphysique)thinspthinspmicrognathiethinspmacroglossiethinspdenti-tionthinspirreacuteguliegraverethinspcirconfeacuterencethinspduthinspcouthinspgethinspgrossessethinspetc

thinspEthinspthinspthinspeacutevaluationthinspthinspregraveglethinspduthinsp3-3-2thinsp(variantethinsppossiblethinspselonthinsplesthinspauteurs)thinsp-thinspthinsp

consideacuterationsthinspgeacuteomeacutetriquesthinsp(agravethinsplrsquoaidethinspdesthinspdoigtsthinspduthinsppatient)3thinspthinsp ouverturethinspdethinspbouchethinspthinspinsertionthinspdethinsp3thinspdethinspsesthinspdoigts3thinspthinsp taillethinspduthinsplarynxthinsp(longueurthinspmandibulaire)thinspthinsp3thinspdoigtsthinspsousthinsplethinspmentonthinsp

(boutthinspdethinspsonthinspmentonthinspjusqursquoagravethinsplathinspjonctionthinspduthinspcouthinspauthinspniveauthinspdethinspthinsplrsquoosthinsphyoiumlde)

2thinspthinsp positionthinspduthinsplarynxthinspthinsp2thinspdethinspsesthinspdoigtsthinspentrethinsplathinspjonctionthinspcou-mentonthinsp(osthinspthinsphyoiumlde)thinspetthinsplethinspcartilagethinspthyroiumlde

thinspMthinspthinspthinspMallampatithinsp(annexethinspIV)thinspOthinspthinspthinspobeacutesiteacuteobstructionthinspthinspIMCthinspthinspœdegravemethinspduthinsplarynxthinspneacuteoplasiethinspdethinsplathinspsphegraverethinsp

ORLthinspcompressionthinspextrinsegravequethinspparthinspheacutematomethinspcervicalthinspdifficulteacutethinspagravethinspavalerthinspdyspneacutee

thinspNthinspthinspthinspneck mobilitythinsp(mobiliteacutethinspcervicale)thinspthinspimmobilisationthinspauthinspmoyenthinspdrsquounthinspcol-

lierthinspcervicalthinsppreacutesencethinspdrsquounethinsppathologiethinspouthinspdrsquounethinspsituationthinspcliniquethinspagravethinspconseacutequencethinspsurthinsplrsquoassistancethinspventilatoirethinspouthinspdethinsplrsquointubationthinsp(pthinspexthinspthinspthinsparthrosethinspouthinsparthritethinspimportantethinsptrisomiethinsp21thinspetc)

thinspthinsp Lanryngoscopiethinspdifficilethinspthinspimpossibiliteacutethinspdethinspvisualiserthinspnrsquoimportethinspquellethinsppartiethinspdesthinspcordesthinspvocalesthinspapregravesthinspdethinspmultiplesthinsptentativesthinspavecthinspunthinsplaryngoscopethinspconventionnelthinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinspop citthinsp[Notrethinsptraduction])thinsp

thinspthinspIntubationthinspendotracheacutealethinspdifficilethinspthinspintubationthinspquithinsprequiertthinspdethinspmultiplesthinspthinsptentativesthinspenthinsppreacutesencethinspouthinspenthinsplrsquoabsencethinspdrsquounethinsppathologiethinsptracheacutealethinsp(AdapteacutethinspdethinsplAmericanthinspSocietythinspofthinspAnesthesiologiststhinsp2013thinspop citthinspthinsp[Notrethinsptraduction])

IlthinspfautthinspnoterthinspquethinsplrsquoinsuffisancethinspdethinsplathinspclassificationthinspdethinspMallampatithinspathinspeacuteteacutethinspspeacutecifiquementthinspmontreacuteethinspchezthinsplrsquoobegravesethinspellethinspnethinsppeutthinspecirctrethinspconsideacutereacuteethinspcommethinspunthinsppreacutedicteurthinspisoleacutementthinspsuffisantthinspdethinsplathinspdifficulteacutethinspdethinsplathinsplaryngoscopiethinspouthinspathinspfortiorithinspdethinsplrsquointubationthinspdifficile

mdash Annexe

ge

ge

CMQ - OIIQ - OPIQ 53

thinspANNEXEthinspVIIIthinsp-thinspLEthinspCONSENTEMENT

SelonthinsplethinspdroitthinspenthinspvigueurthinspilthinspestthinspobligatoirethinspauthinspQueacutebecthinspdrsquoobtenirthinsplethinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspduthinsppatientthinspouthinspdrsquounthinsptiersthinsphabiliteacutethinspavantthinsptoutethinspintervention

LethinspCode civil du Queacutebec eacutetablitthinspdesthinspregraveglesthinspgeacuteneacuteralesthinspconcernantthinsplethinspconsente-mentthinspauxthinspsoinsthinspquithinspsrsquoappliquentthinspquelsthinspquethinspsoientthinsplethinsplieuthinspetthinsplathinspnaturethinspdesthinspsoinsthinspOnthinspythinspfaitthinspcependantthinspcertainesthinspdistinctionsthinspselonthinspquethinsplesthinspsoinsthinspsontthinsprequisthinspouthinspnonthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspetthinspselonthinspquethinsplethinsppatientthinspestthinspaptethinspagravethinspconsentirthinspouthinspnon

Sithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsp(traitementsthinspdethinspmeacutedecinethinspetthinspdethinspchirurgiethinspestheacutetiquethinspexpeacuterimentationthinspetthinspdonsthinspdrsquoorganes)thinsplethinsppatientthinspdoitthinspecirctrethinspinformeacutethinspdethinsptousthinsplesthinsprisquesthinsppossiblesthinspmecircmethinspsrsquoilsthinspsontthinspraresthinspetthinsplethinspconsentementthinspdoitthinspecirctrethinspdonneacutethinspparthinspeacutecritthinspHabituellementthinspilthinspnethinsppeutthinspecirctrethinspdonneacutethinspquethinspparthinspunthinsppatientthinspaptethinspetthinspacircgeacutethinspdethinsp14thinspansthinspetthinspplusthinspparthinsplethinspmandatairethinsplethinsptuteurthinspouthinsplethinspcurateurthinspdrsquounethinsppersonnethinspinaptethinspouthinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinspdrsquounethinsppersonnethinspdethinspmoinsthinspdethinsp14thinspansthinspLrsquoautorisationthinspdethinsplathinspcourthinspestthinspenthinspoutrethinspneacutecessairethinspsithinsplesthinspsoinsthinsppreacutesententthinspunthinsprisquethinspseacuterieuxthinsppourthinsplathinspsanteacutethinspdethinspcesthinsppersonnesthinspouthinspsrsquoilsthinsppeuventthinspcauserthinspdesthinspeffetsthinspgravesthinspetthinsppermanentsthinspUnethinsppersonnethinspmineurethinspdethinspthinsp14thinspansthinspetthinspplusthinsppeutthinspconsentirthinspseulethinspagravethinspmoinsthinspqursquoilthinspsrsquoagissethinspdethinspsoinsthinspnonthinsprequisthinspetthinspthinspcomportantthinspdesthinsprisques

SrsquoilthinspsrsquoagitthinspdethinspsoinsthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinsplrsquoobligationthinspdrsquoinformerthinspcroicirctthinspenthinspfonctionthinspdethinsplathinsppreacutevalencethinspetthinspdethinsplathinspgraviteacutethinspdesthinspcomplicationsthinspSithinsplethinsppatientthinspestthinspinaptethinspetthinspqursquoilthinspnrsquoestthinsppasthinsprepreacutesenteacutethinspparthinspunthinspmandatairethinspunthinsptuteurthinspouthinspunthinspcura-teurthinsplethinspconsentementthinsppeutthinspecirctrethinspdonneacutethinspparthinspunthinspconjointthinspouthinspagravethinspdeacutefautthinspduthinspconjointthinspparthinspunthinspprochethinspouthinspunethinsppersonnethinspquithinspdeacutemontrethinspunthinspinteacuterecirctthinspparticulierthinsppourthinsplathinspper-sonnethinspinaptethinspIlthinspnrsquoythinspathinsppasthinspdrsquoobligationthinspagravethinspcethinspquethinspcethinspconsentementthinspsoitthinspdonneacutethinspparthinspeacutecritthinspLethinspconsentementthinspauxthinspsoinsthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspdrsquounethinsppersonnethinspmi-neurethinspestthinspdonneacutethinspparthinsplethinsptitulairethinspdethinsplrsquoautoriteacutethinspparentalethinspouthinsplethinsptuteurthinspUnethinsppersonnethinspmineurethinspdethinsp14thinspansthinspetthinspplusthinsppeutthinspconsentirthinspmaisthinspnethinsppeutthinsppasthinsprefuserthinspseulethinspdesthinspsoinsthinspquithinspseraientthinspjugeacutesthinsprequisthinspEnthinspcasthinspdrsquourgencethinsplethinspconsentementthinspauxthinspsoinsthinspmeacutedicauxthinspnrsquoestthinsppasthinspneacutecessairethinsplorsquethinsplathinsppersonnethinspouthinspsonthinspinteacutegriteacutethinspestthinspmenaceacuteethinspetthinspquethinsplethinspconsentementthinspnethinsppeutthinspecirctrethinspobtenuthinspagravethinsptemps

LathinspLoi sur les servicesthinspdethinspsanteacutethinspetthinsplesthinspservicesthinspsociauxthinsp(LSSS)thinspeacutetablitthinspquantthinspagravethinspellethinspcertainesthinspregraveglesthinspenthinspmatiegraverethinspdethinspconsentementthinspauxthinspinterventionsthinspchirurgicalesthinspetthinspagravethinsplrsquoanestheacutesiethinsp

mdash Annexe

CMQ - OIIQ - OPIQ 54

Selonthinspcettethinsploithinsplethinspconsentementthinspagravethinspunethinspanestheacutesiethinspouthinspagravethinspunethinspinterventionthinspchirurgi-calethinspdoitthinspecirctrethinspattesteacutethinspparthinspunthinspdocumentthinspeacutecritthinspsigneacutethinspparthinsplethinsppatientthinspouthinspsonthinsprepreacutesen-tantthinspetthinspcethinspdocumentthinspdoitthinspfairethinspeacutetatthinspdesthinspinformationsthinspapproprieacuteesthinspconcernantthinspnotammentthinsplesthinsprisquesthinspouthinsplesthinspeffetsthinsppossiblesthinspCetthinspeacutecritthinspdoitthinspecirctrethinspcontresigneacutethinspparthinsplethinspmeacutedecinthinspouthinsplethinspdentistethinsptraitantthinspetthinspconserveacutethinspdansthinsplethinspdossierthinspduthinsppatientthinspLethinspdossierthinspdoitthinspcontenirthinspunthinspdocumentthinspattestantthinsplethinspconsentementthinsppourthinsplesthinspsoinsthinspetthinsplesthinspservicesthinspdispenseacutesthinspdansthinspunthinspcentrethinsphospitalierthinsp(CH)thinspunthinspcentrethinspdrsquoheacutebergementthinspetthinspdethinspsoinsthinspdethinsplonguethinspdureacuteethinsp(CHSLD)thinspetthinspunthinspcentrethinsplocalthinspdethinspservicesthinspcommunau-tairesthinsp(CLSC)

CesthinspdispositionsthinspnethinspsrsquoappliquentthinspqursquoauxthinspsoinsthinspdispenseacutesthinspenthinspeacutetablissementthinspthinspMaintenantthinspquethinspplusieursthinspinterventionsthinspautrefoisthinspreacuteserveacuteesthinspauxthinspeacutetablissementsthinsppeuventthinspecirctrethinspeffectueacuteesthinspenthinspdehorsthinspdethinspceux-cithinsplathinspquestionthinspsethinspposethinsptoutefoisthinspdethinspsavoirthinspsithinsplesthinspmecircmesthinspexigencesthinspdevraientthinspsrsquoappliquerthinsppartoutthinsp

Qursquoenthinspest-ilthinspparthinspexemplethinspdethinsplathinspsignaturethinspdrsquounthinspformulairethinspdethinspconsentementthinspEnthinsppratiquethinspetthinspagravethinsplrsquousagethinspilthinspsrsquoestthinspaveacutereacutethinspqursquounthinspformulairethinspdethinspconsentementthinspducircmentthinspsigneacutethinspnethinsppeutthinspagravethinspluithinspseulthinspprouverthinspquethinsplethinspconsentementthinspathinspeacuteteacutethinsplibrethinspetthinspeacuteclaireacutethinspUnethinspcourtethinspnotethinspverseacuteethinspauthinspdossierthinspreacutesumantthinsplesthinspinformationsthinsptransmisesthinspetthinsplesthinspeacutechangesthinspauxquelsthinspellesthinspontthinspdonneacutethinsplieuthinspestthinsppreacutesentementthinspjugeacuteethinspbeaucoupthinspplusthinsppertinentethinspagravethinspcetthinspeacutegardthinspLethinspformulairethinspdethinspconsentementthinspcomplegravetethinsplesthinsprenseigne-mentsthinspfournisthinspverbalementthinspIlthinspsrsquoagitthinspdrsquounthinspajoutthinspagravethinsplrsquoinformationthinspverbalethinsptransmisethinspthinsp

etthinspnonthinspdrsquounethinspmesurethinspvisantthinspagravethinsplathinspremplacer

LethinspCode de deacuteontologiethinspdes meacutedecinsthinsppreacutecisethinsplesthinspobligationsthinspdesthinspmeacutedecinsthinsp

quantthinspauthinspconsentementthinsp

Article 28Le meacutedecin doit sauf urgence avant drsquoentreprendre un examen une investiga-tion un traitement ou une recherche obtenir du patient ou de son repreacutesentant leacutegal un consentement libre et eacuteclaireacute

Article 29Le meacutedecin doit srsquoassurer que le patient ou son repreacutesentant leacutegal a reccedilu les explications pertinentes agrave leur compreacutehension de la nature du but et des conseacutequences possibles de lrsquoexamen de lrsquoinvestigation du traitement ou de la recherche qursquoil srsquoapprecircte agrave effectuer Il doit faciliter la prise de deacutecision du patient et la respecter

mdash Annexe

CMQ - OIIQ - OPIQ 55

DansthinspsesthinspguidesthinspdrsquoexercicethinspportantthinspsurthinsplathinsptenuethinspdesthinspdossiersthinsplethinspCollegravegethinspestimethinspdrsquoailleursthinspquethinsplethinspdossierthinspdrsquounthinsppatientthinspdoitthinspcontenirthinspunethinspnotethinspattestantthinspquethinsplesthinspin-formationsthinspneacutecessairesthinspagravethinspunethinspprisethinspdethinspdeacutecisionthinspeacuteclaireacuteethinspontthinspeacuteteacutethinsptransmisesthinspparthinsplethinspmeacutedecinthinspetthinspcomprisesthinspparthinsplethinsppatientthinspouthinspsonthinsprepreacutesentantthinsplorsquethinsplathinspchosethinspestthinspjugeacuteethinsppertinentethinspathinspfortiorithinsplorsqursquoilthinspsrsquoagitthinspdrsquounethinspinterventionthinspchirurgicalethinspdrsquounethinspinterventionthinspchirurgicalethinspsousthinspseacutedation-analgeacutesiethinspdrsquoanestheacutesiethinspreacutegionalethinspouthinspgeacuteneacuteralethinsp

DansthinsplethinspCode de deacuteontologie des infirmiegraveres et infirmiersthinsponthinsppreacutevoitthinspquethinsp

thinspArticle 40 Lrsquoinfirmiegravere ou lrsquoinfirmier doit fournir agrave son client toutes les explications neacuteces-saires agrave la compreacutehension des soins et des services qursquoil lui prodigue

Article 41Lorsque lrsquoobligation drsquoobtenir un consentement libre et eacuteclaireacute incombe agrave lrsquoin-firmiegravere ou agrave lrsquoinfirmier ce dernier doit fournir au client toutes les informations

requises

LethinspCode de deacuteontologie des inhalotheacuterapeutes du Queacutebecthinspnethinspcontientthinsppasthinspdethinsp

dispositionthinsptouchantthinsppreacuteciseacutementthinsplethinspconsentementthinspOnthinsppreacutecisethinspcependantthinspquethinsp

Article 13En plus des avis et des conseils lrsquoinhalotheacuterapeute doit fournir agrave son client les explications neacutecessaires agrave la compreacutehension et agrave lrsquoappreacuteciation des services qursquoil

lui rend

EnthinspcompleacutementthinspdansthinspsesthinspnormesthinspdethinsppratiquethinspportantthinspsurthinsplathinsptenuethinspdesthinspdossiersthinsplrsquoOrdrethinspprofessionnelthinspdesthinspinhalotheacuterapeutesthinspduthinspQueacutebecthinspdemandethinspquethinsplethinspdos-sierthinspdrsquounthinsppatientthinspcomportethinspunethinspmentionthinspdesthinspsoinsthinspetthinspdesthinspservicesthinspprodigueacutesthinspagravethinspsonthinspeacutegardthinspAgravethinspcetthinspeffetthinsptoutethinspactiviteacutethinspexerceacuteethinspparthinsplrsquoinhalotheacuterapeutethinsptellethinspquethinsplrsquoinformationthinsptransmisethinspauthinsppatientthinspeuthinspeacutegardthinspagravethinsplathinspseacutedation-analgeacutesiethinspdoitthinspecirctrethinspinscritethinspauthinspdossierthinspduthinsppatientthinspetthinspcethinspauthinspfurthinspetthinspagravethinspmesurethinspquethinsplesthinspactiviteacutesthinspsontthinspexerceacutees

EnthinspsommethinsplathinsploithinspexigethinspunthinspconsentementthinspeacutecritthinspsithinsplesthinspsoinsthinspnethinspsontthinsppasthinsprequisthinspparthinsplrsquoeacutetatthinspdethinspsanteacutethinspduthinsppatientthinspainsithinspquethinsppourthinsplesthinspanestheacutesiesthinsplesthinspinterventionsthinspchirurgicalesthinspetthinsplesthinspsoinsthinspdispenseacutesthinspenthinspeacutetablissementthinspDansthinspsesthinspguidesthinspportantthinspsurthinsplesthinspproceacuteduresthinspetthinspinterventionsthinspenthinspmilieuthinspextrahospitalierthinspnotammentthinsplethinspCollegravegethinsprecommandethinsptoutefoisthinspquethinsplethinspmeacutedecinthinspversethinspunethinspnotethinspexplicativethinspauthinspdossierthinspetthinspobtiennethinspunthinspconsentementthinspeacutecritthinsppourthinsptoutethinspinterventionthinspmeacutedicalethinspouthinsp

mdash Annexe

CMQ - OIIQ - OPIQ 56

chirurgicalethinspeffractivethinspqursquoellethinspsoitthinspeffectueacuteethinspdansthinspunthinspbutthinspdiagnosticthinsptheacuterapeu-tiquethinspouthinspestheacutetiquethinspLorsquethinsplethinspconsentementthinspportethinspagravethinsplathinspfoisthinspsurthinsplathinspseacutedation-thinspthinspanalgeacutesiethinspetthinspsurthinsplrsquointerventionthinspdiagnostiquethinspouthinsptheacuterapeutiquethinsplrsquoinformationthinsptrans-misethinspdoitthinspinclurethinsplesthinsprisquesthinspdethinsplrsquointerventionthinspetthinspceuxthinspdethinsplathinspseacutedation-analgeacutesiethinspcelle-cithinsppouvantthinspcomporterthinspdesthinsprisquesthinspimportantsthinspmecircmethinspsithinsplrsquointerventionthinspestthinspmineure

Lrsquoobtentionthinspdrsquounthinspconsentementthinsplibrethinspetthinspeacuteclaireacutethinspdemeurethinspunethinspobligationthinspthinspinheacuterentethinspagravethinsplrsquointerventionthinspmeacutedicalethinspelle-mecircmethinspIlthinsprelegravevethinspdoncthinspdethinsplathinspresponsabiliteacutethinspduthinspmeacutedecinthinspdethinspsrsquoassurerthinspdethinsplathinsptransmissionthinspdethinsplrsquoinformationthinsppertinentethinspauthinsppatientthinspetthinspdethinspsathinspcompreacutehensionthinspdethinsplathinspnaturethinspduthinspbutthinspetthinspdesthinsprisquesthinsprelatifsthinspagravethinsplrsquointerventionthinspToutefoisthinsplathinsptacircchethinspdethinsptransmettrethinspdethinsplrsquoinfor-mationthinspcompleacutementairethinspouthinspdethinspfairethinsplrsquoenseignementthinspauxthinsppatientsthinsppeutthinspecirctrethinspconfieacuteethinspagravethinspdrsquoautresthinspprofessionnelsthinspetthinspcellethinspdethinsprecueillirthinsplathinspsignaturethinspdrsquounthinspthinspformulairethinspdethinspconsentementthinspagravethinspdrsquoautresthinspmembresthinspdethinsplrsquoeacutequipethinspdethinspsoins

mdash Annexe

CMQ - OIIQ - OPIQ 57

mdash Annexe

thinspANNEXEthinspIXthinsp-thinspEacuteVALUATIONthinspDEthinspLrsquoEFFICACITEacutethinspDEthinspLAthinspSEacuteDATIONthinsp(EXEMPLES)thinsp

(Listethinspnonthinsplimitative)thinsp

1 Eacutechelle de seacutedation de Ramsay modifieacuteethinsp(Adapteacute de Merchant et collab 2014b op cit)

Instruction Descriptiondeacutefinition Valeur

thinspObserverthinsplethinsppatientEacuteveilleacutethinspthinsplethinsppatientthinspestthinspanxieuxthinspetthinspagiteacutethinspouthinspnerveuxthinspouthinsplesthinspdeux 1

ObserverthinsplethinsppatientLethinsppatientthinspeacutetablit-ilthinspunthinspcontactthinspvisuelthinspetthinspreacutepond-ilthinspauxthinspordres

Eacuteveilleacutethinspthinsplethinsppatientthinspestthinspcoopeacuteratifthinspthinsporienteacutethinspetthinspcalme 2

ParlerthinspauthinsppatientthinspLethinsppatientthinspeacutetablit-ilthinspunthinspcontactthinspvisuelthinspetthinspreacutepond-t-ilthinspauxthinspordres

Eacuteveilleacutethinspthinsplethinsppatientthinspreacutepondthinspseulementthinspauxthinspordres 3

StimulerthinspphysiquementthinsplethinsppatientthinspenthinspagitantthinspsonthinspeacutepaulethinsptoutthinspenthinspparlantthinspfortthinspLethinsppatientthinspreacuteagit-ilthinspdansthinsplesthinsp10thinspsecon-des

Endormithinspthinsplethinsppatientthinspreacuteagitthinspparthinspunethinspreacuteponsethinspvivethinspagravethinsplathinspstimulationthinspdethinsplathinspgla-bellethinspouthinspagravethinspunthinspstimulusthinspauditifthinspintense 4

StimulerthinspphysiquementthinsplethinsppatientthinspenthinspagitantthinspsonthinspeacutepaulethinsptoutthinspenthinspparlantthinspfortthinspLethinsppatientthinspreacuteagit-ilthinspapregravesthinsp10thinspsecondes

Endormithinspthinsplethinsppatientthinspreacuteagitthinspparthinspunethinspreacuteponsethinspfaiblethinspagravethinsplathinspstimulationthinspdethinsplathinspglabellethinspouthinspagravethinspunthinspstimulusthinspauditifthinspintense

5

UtiliserthinspdesthinspstimulithinspdouloureuxAucunethinspreacuteaction

Endormithinspthinsplethinsppatientthinspnethinspreacuteagitthinsppasthinspagravethinsplathinspdouleur 6

thinsp Peuthinspimportethinsplrsquoeacutechellethinsputiliseacuteethinspcelle-cithinspdoitthinspecirctrethinspchoisiethinspselonthinsplathinspclientegravelethinspetthinsplethinspcontextethinspdonneacutethinspDethinspmecircmethinspsonthinsputilisationthinspdoitthinspecirctrethinspuniformethinspetthinspstandardiseacuteethinspauthinspseinthinspdrsquounethinspmecircmethinspeacutequipethinsp

CettethinspeacutechellethinsppeutthinspecirctrethinsputiliseacuteethinspchezthinsplrsquoenfantthinspToutefoisthinspellethinspserathinspdavantagethinsputilethinspdansthinsplethinspcadrethinspdrsquounethinspeacutevaluationthinsppostseacutedationthinsp(soinsthinsppostproceacutedures)thinspcarthinspilthinsppeutthinspecirctrethinspcliniquementthinspinapproprieacutethinspdethinspstimulerthinspphysiquementthinspunthinspenfantthinspsousthinspseacutedationthinspprofondethinsp

CMQ - OIIQ - OPIQ 58

2 Eacutechelle de vigilance-agitation de Richmond (Richmond Agitation Sedation Scale - RASS) (Tireacute et adapteacute de Chanques et collab 2006)

Lathinsptraductionthinspfranccedilaisethinspdethinspcettethinspeacutechellethinspathinspfaitthinsplrsquoobjetthinspdrsquounethinspvalidationthinspdethinspsathinspthinspreproductibiliteacutethinspinterobservateurthinsp

mdash Annexe

Instruction DescriptionDeacutefinition Niveau

Observerthinsplethinsppatientthinspsansthinspfairethinspdethinspbruit

Srsquoilthinspmanifestethinspunethinspactiviteacutethinspmotricethinspspon-taneacuteethinspquantifierthinsplethinspniveauthinspdrsquoagitationthinsp

Combatifthinspthinspdangerthinspimmeacutediatthinspenversthinsplrsquoeacutequipe + 4Tregraves agiteacutethinspthinsptirethinsparrachethinsptuyauxthinspouthinspcatheacutetersthinspetouthinspagressifthinspenversthinsplrsquoeacutequipe + 3Agiteacutethinspthinspmouvementsthinspfreacutequentsthinspsansthinspbutthinsppreacutecisthinspetouthinspdeacutesadaptationthinspauthinsprespirateur + 2Ne tient pas en placethinspthinspanxieuxthinspouthinspcraintifthinspmaisthinspmouvementsthinsporienteacutesthinsppeuthinspfreacutequentsthinspnonthinspvigoureuxthinspnonthinspagressifs

+ 1

Srsquoilthinspestthinspcalmethinspetthinspreacutepondthinspouthinspnonthinspauxthinspordresthinspsimplesthinsp

Eacuteveilleacute et calmethinspthinspcalmethinspetthinsplesthinspyeuxthinspouvertsConscientthinspthinspRASSthinsp0thinsp+thinspreacutepondthinspauxthinspordresthinspsimples

0

Srsquoilthinspestthinspcalmethinsplesthinspyeuxthinspfermeacutesthinspthinspquan-tifierthinsplethinspniveauthinspdrsquohypovigilancethinsp(outhinspdrsquoendormissement)thinspenthinspsrsquoadressantthinspauthinsppatientthinspparthinspsonthinspnomthinspsansthinsplethinsptoucherthinspenthinsputilisantthinspunethinspvoixthinspdethinspplusthinspenthinspplusthinspfortethinspetthinspdrsquoautantthinspplusthinspfortethinspquethinsplethinsppatientthinspestthinspsusceptiblethinspdrsquoecirctrethinspsourdthinsp(sujetthinspacircgeacutethinspseacutejourthinspprolongeacutethinspenthinspreacuteanimationthinspthinspbouchonthinspdethinspceacuterumenthinsptoxiciteacutethinspdesthinspantibiotiquesthinspetthinspduthinspfuroseacutemide)thinsp

Somnolentthinspthinsppasthinspcomplegravetementthinspeacuteveilleacutethinspmaisthinsprestethinspeacuteveilleacutethinspauthinspcontactthinspvisuelthinspagravethinsplrsquoappelthinspthinsp(gtthinsp10thinsps)

- 1

Diminution leacutegegravere de la vigilancethinspthinsprestethinspeacuteveilleacutethinspbriegravevementthinspavecthinspcontactthinspvisuelthinspagravethinsplrsquoappelthinsp(ltthinsp10thinsps)

- 2

Diminution modeacutereacutee de la vigilancethinspthinspnrsquoimportethinspquelthinspmouvementthinspagravethinsplrsquoappelthinsp(ouverturethinspdesthinspyeux)thinspmaisthinsppasthinspdethinspcon-tactthinspvisuel

- 3

Sithinsplethinsppatientthinspnethinspfaitthinspaucunthinspmouvementthinspythinspcompristhinspenthinsplrsquoappelantthinspdrsquounethinspvoixthinspfortethinspthinspfrictionnerthinspdrsquoabordthinsplrsquoeacutepaulethinsppuisthinsplethinspster-numthinspsansthinspecirctrethinspnociceptifthinsp

Diminution profonde de la vigilancethinspthinspau-cunthinspmouvementthinspagravethinsplrsquoappelthinspnrsquoimportethinspquelthinspmouvementthinspagravethinsplathinspstimulationthinspphysiquethinsp(frictionthinspnonthinspnociceptivethinspdethinsplrsquoeacutepaulethinspouthinspduthinspsternum)

- 4

Non reacuteveillablethinspthinspaucunethinspmouvementthinspnithinspagravethinsplrsquoappelthinspnithinspagravethinsplathinspstimulationthinspphysiquethinsp(frictionthinspnonthinspnociceptivethinspdethinsplrsquoeacutepaulethinspouthinspduthinspsternum)

- 5

CMQ - OIIQ - OPIQ 59

thinspANNEXEthinspXthinsp-thinspEacuteVALUATIONthinspDEthinspLrsquoEFFICACITEacutethinspDEthinspLrsquoANALGEacuteSIEthinsp(EXEMPLES)

(Listethinspnonthinsplimitative)thinsp

Selonthinsplrsquoacircgethinspduthinsppatientthinspsathinspconditionthinspetthinsplethinspcontextethinspcliniquethinspdeuxthinspstrateacutegiesthinspdrsquoeacuteva-luationthinsppeuventthinspecirctrethinsputiliseacuteesthinspsoitthinsplrsquoauto-eacutevaluationthinsp(parthinspdesthinspmotsthinspdesthinspchiffresthinspthinspouthinspdesthinspdessins)thinspouthinsplrsquoheacuteteacutero-eacutevaluationthinspcomportementalethinspCelathinspditthinspsithinsplrsquoauto-thinspeacutevaluationthinspestthinspagravethinspprivileacutegierthinspcrsquoestthinsptoutefoisthinsplrsquoacircgethinspduthinsppatientthinsp(patientthinsppeacutediatrique)thinspetthinspsathinspcapaciteacutethinspcognitivethinspquithinspguiderontthinsplethinspchoixthinspduthinspclinicienthinspdansthinsplathinspseacutelectionthinspduthinspmeilleurthinspoutilthinsp

Pourthinsplethinsppatientthinspnrsquoayantthinsppasthinsplathinspcapaciteacutethinsp(pthinspexthinspthinsphabiliteacutethinspverbalethinspouthinspcognitivethinsplimiteacutee)thinspdrsquoeacutevaluerthinsplui-mecircmethinsplrsquointensiteacutethinspdethinsplathinspdouleurthinspunethinspreacuteponsethinspverbalethinsp(ouinon)thinspouthinspgestuellethinspsignifiantthinsplathinsppreacutesencethinspouthinsplrsquoabsencethinspdethinspdouleurthinspconstituethinspunethinspformethinspdrsquoauto-eacutevaluationthinspacceptablethinspenthinsppratiquethinspcliniquethinspaupregravesthinspdethinspcertainesthinsppopulationsthinsptellesthinspquethinsplethinspjeunethinspenfantthinsplethinsppatientthinspdeacutementthinspouthinspceluithinspvivantthinspavecthinspunethinspdeacuteficiencethinspintellectuellethinsp(McCafferythinspciteacutethinspdansthinspHerrthinspetthinspcollabthinsp2011thinsp[Notrethinsptraduc-

tion])

thinspthinsp Peuthinspimportethinsplrsquoeacutechellethinsputiliseacuteethinspcelle-cithinspdoitthinspecirctrethinspchoisiethinspselonthinsplathinspclientegravelethinspetthinsplethinspcontextethinspdonneacutethinspDethinspmecircmethinspsonthinsputilisationthinspdoitthinspecirctrethinspuniformethinspetthinspstandardiseacuteethinspauthinspseinthinspdrsquounethinspmecircmethinspeacutequipethinspsoignantethinsp

ADULTE-AIcircNEacutethinsp

AUTO-EacuteVALUATIONthinsp(DOULEURthinspAIGUEuml)

thinsprsaquo Eacutechellethinspnumeacuteriquethinsp(0thinspagravethinsp10)thinsp(EN)thinsprsaquo Eacutechellethinspverbalethinspsimplethinsp(EVS)thinsprsaquo Eacutechellethinspvisuellethinspanalogiquethinsp(EVA)

HEacuteTEacuteRO-EacuteVALUATIONthinspCOMPORTEMENTALEthinsp(DOULEURthinspAIGUEuml)

thinsprsaquo ALGOPLUSthinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspdesthinsptroublesthinspdethinsplathinspcommunicationthinspverbale)

thinsprsaquo PACSLACthinspouthinspPACSLAC-Fthinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspunethinspcapaciteacutethinsplimiteacuteethinspagravethinspcommuniquer

thinsprsaquo PAINADthinsp(anglais)thinspthinsppersonnethinspacircgeacuteethinsppreacutesentantthinspunethinspdeacutemencethinspouthinspautrethinsptroublethinspcognitifthinspetthinspquithinspnethinsppeutthinspcommuniquerthinspdethinspmaniegraverethinspfiable

Les hyperliens concernant ces eacutechelles sont fournis agrave titre informatif seulement

mdash Annexe