CCMCP Post intubation analgesia and sedation Flashcards
CCMCP Post intubation analgesia and sedation - Hypotension risk medications
500ml bolus prn to maintain MAP of 65
Consider ephedrine or norepi
Ketamine with or without Fentanyl
CCMCP Post intubation analgesia and sedation - No risk of hypotension medications
Fentanyl with propofol or midazolam
CCMCP Post intubation analgesia and sedation - hypotension precautions
Hypotension should be anticipated in ever intubation
In head or spinal injuries a MAP of <85 is considered hypotensive
CCMCP Post intubation analgesia and sedation - pediatric fluid challenge dose
10ml/kg prn to maintain normotension for age
CCMCP Post intubation analgesia and sedation - Ephedrine dose
0.2 mg/kg to single max of 10mg q 5 prn
CCMCP Post intubation analgesia and sedation - Ephedrine indications
Temporizing measure during volume resuscitation or vasoactive agent initiated
Persistent post-intubation hypotension
CCMCP Post intubation analgesia and sedation - Ephedrine EMS contraindications
Hypersensitivity to sympathomimetics
CCMCP Post intubation analgesia and sedation - Epinephrine Infusion Indications
Symptomatic bradycardia
Shock with hypotension refractory to fluid resuscitation
Cardiogenic shock with refractory hypotension
CCMCP Post intubation analgesia and sedation - Epinephrine infusion Dose
Start at 0.1 mcg/kg/min IV/IO to a maximum of 1 mcg/kg/min
CCMCP Post intubation analgesia and sedation - Epinephrine infusion preparation and concentration
16mg epiNEPHrine into 250 mL D5W or normal saline = 64 mcg/mL
CCMCP Post intubation analgesia and sedation - Fentanyl indications
Post-intubation analgesia
*Administer fentaNYL to all intubated patients (unless contraindicated) and add appropriate sedative
CCMCP Post intubation analgesia and sedation - Fentanyl dose
0.5 - 1 mcg/kg IV/IO prn
CCMCP Post intubation analgesia and sedation - Fentanyl infusion dose
50 - 200 mcg/hr IV/IO
CCMCP Post intubation analgesia and sedation - Fentanyl EMS contraindications
Hypersensitivity
Monoamine oxidase inhibitor within 14 days
CCMCP Post intubation analgesia and sedation - Fentanyl infusion preparation and concentration
500 mcg in 100 mL D5W or normal saline = 5 mcg/mL
CCMCP Post intubation analgesia and sedation - Ketamine indications
Post intubation sedation
CCMCP Post intubation analgesia and sedation - Ketamine dose
1 mg/kg IV/IO
CCMCP Post intubation analgesia and sedation - Ketamine infusion dose
0.5 – 1.5 mg/kg/hr IV/IO
CCMCP Post intubation analgesia and sedation - Ketamine EMS contraindications
Hypersensitivity
Relative – conditions where a significant elevation of blood pressure is hazardous
CCMCP Post intubation analgesia and sedation - Ketamine infusion preparation and administration
200 mg in 100 mL of D5W or normal saline = 2 mg/mL
CCMCP Post intubation analgesia and sedation - Midazolam indications
Post intubation sedation
Consult TP
CCMCP Post intubation analgesia and sedation - Midazolam dose
0.05 mg/kg IV/IO to a single maximum dose of 5 mg q 5-10 min
CCMCP Post intubation analgesia and sedation - Midazolam infusion dose
1 – 10 mg/hr IV/IO
CCMCP Post intubation analgesia and sedation - Midazolam EMS contraindications
Hypersensitivity to benzodiazepines
Myasthenia gravis
Hypotension
CCMCP Post intubation analgesia and sedation - Midazolam infusion preparation and administration
50 mg in 100 mL of D5W or
normal saline = 0.5 mg/mL
CCMCP Post intubation analgesia and sedation - Norepinephrine indications
Symptomatic bradycardia
Shock with hypotension refractory to fluid resuscitation
Cardiogenic shock with refractory hypotension
CCMCP Post intubation analgesia and sedation - Norepinephrine infusion dose
0.1 mcg/kg/min IV/IO and titrate to a maximum of
1 mcg/kg/min
CCMCP Post intubation analgesia and sedation - Norepinephrine EMS contraindications
Mesenteric or peripheral vascular thrombosis
Pregnancy
Profound hypoxia
Hypovolemia
CCMCP Post intubation analgesia and sedation - Norepinephrine infusion preparation and administration
16 mg in 250 mL D5W or normal saline = 64 mcg/mL
CCMCP Post intubation analgesia and sedation - Norepinephrine precautions
MAOI or TCA – may precipitate hypertension
Check frequently for signs of extravasation;
CCMCP Post intubation analgesia and sedation - Propofol indications
Post-intubation sedation for hemodynamically stable patients
Consult TP
CCMCP Post intubation analgesia and sedation - Propofol infusion dose
1 – 3 mg/kg/hr IV/IO (15 - 50 mcg/kg/min)
CCMCP Post intubation analgesia and sedation - Propofol EMS contraindications
Hypersensitivity to propofol or its components (soybean oil, egg lecithin, or glycerol)
Settings where general anesthesia is contraindicated
CCMCP Post intubation analgesia and sedation - Propofol infusion preparation and administration
10 mg/mL = 10,000 mcg/mL
CCMCP Post intubation analgesia and sedation - Propofol precautions
Potent respiratory depressant, especially when used with either opioids or benzodiazepines
Shake well before using
CCMCP Post intubation analgesia and sedation - Rocuronium indications
Post-intubation paralysis if required after adequate sedation
CCMCP Post intubation analgesia and sedation - Rocuronium dose
0.5 mg/kg = 30 minutes of paralysis
1 mg/kg = 60 minutes of paralysis
CCMCP Post intubation analgesia and sedation - Rocuronium EMS contraindications
Hypersensitivity
CCMCP Post intubation analgesia and sedation - Rocuronium Precautions
Medications such as gentamicin, tobramycin, vancomycin, corticosteroids, and calcium-channel blockers, can potentiate the effects of rocuronium
