Virtual Reality vs. Standard-of-Care for Comfort Before and After Sedation in the Emergency Department

• Emergence Phenomenon as measured by yes/no questions regarding participant experience.[ Time Frame: Immediately after the procedure and by phone the next day ]
  Patients will be asked whether they experienced nightmares, day-dreaming, or feeling unwell. Number of patients who experienced these negative emergence phenomenon will be tabulated and compared across groups.
• Satisfaction among Children by global rating scale[ Time Frame: Immediately after the procedure ]
  Children will be asked "On a scale of 0-10, how did the procedure go?" A score of 0 represents not very well and a score of 10 represents very well.
• Satisfaction among Guardians by global rating scale[ Time Frame: Immediately after the procedure ]
  Guardians will be asked "On a scale of 0-10, how did the procedure go?" A score of 0 represents not very well and a score of 10 represents very well.
• Satisfaction among Emergency Staff by global rating scale[ Time Frame: Immediately after the procedure ]
  Emergency Staff will be asked "How satisfied are you with how the procedure went?" A score of 0 represents not very well and a score of 10 represents very well.
• Type and dose of medication[ Time Frame: Intraoperative ]
  Amount of medication and what medications were used will be gathered from the nursing notes.
• Time difference of the procedure[ Time Frame: Intraoperative ]
  Time the procedure takes to complete with or without VR will be recorded to determine if there is any difference.
• Length of stay in the Emergency Department[ Time Frame: Intraoperative ]
  Length of stay in the Emergency Department will also be recorded. This will be determined by the intake time noted by triage and the discharge time as witnessed by research assistant or, if unseen, by the time noted on the discharge paperwork.

Children often need procedural sedation in the emergency department during painful procedures (such as reducing fractures). Virtual Reality (VR) is an immersive experience using sight, sound, and position sense. Using VR may enhance distraction during the painful procedure and may reduce attention to pain. VR may also reduce anxiety during sedation induction by reducing providing an alternative stimulus. This study will randomize children (6 - 16 years old) to receive Virtual Reality or standard of care while undergoing procedural sedation. Investigators will measure heart rate, blood pressure, satisfaction (child, parent, provider), amount of sedatives used and compare between the two groups.

• Device: Virtual Reality
  Participants wear a Virtual Reality headset that consists of a ASUS phone and a VOX+ Z3 3D Virtual Reality Headset. The phone runs the VR Roller Coaster app to produce the virtual environment.

• Experimental: Virtual Reality
  Participants are distracted by wearing the virtual reality headset and watching a roller coaster app while undergoing procedural sedation
• No Intervention: Standard-of-Care
  Participants are distracted with Standard-of-Care by doctors, nurses, nurse practitioners, child life specialists and/or parents.