Geriatric patients often require procedural sedation in the emergency department. These patients often have limited physiologic reserve, numerous chronic co-morbid conditions and may be on high-risk medications, thus presenting a challenge to emergency department physicians. Primum non nocere or “first, do no harm” should always be top of mind during patient care but is no more top of mind then when considering the sedation of an older adults. Through case-based learning, this session will review appropriate preparatory steps and sedation pearls to ensure smooth and successful sedation for older adults in the emergency department.