CCMCP Sedation

Question 1

CCMCP Sedation - Anxious?

Answer 1

Ativan - 1 mg SL q 5 max 4 mg
or
Midazolam - 0.05 mg/kg single max of 5 mg q 5-10 min prn,

Question 2

CCMCP Sedation - Combative?

Answer 2

Haloperidol - 2.5 mg IV q 5 or 5 mg IM q 10, total max 10 mg
or
Midazolam - 0.05 mg/kg IV or 0.1 mg/kg, single max 5mg q 5-10 prn

Question 3

CCMCP Sedation - Procedural sedation?

Answer 3

Fentanyl - 0.5-1 mcg/kg IV prn
or 
Ketamine - 1 mg/kg IV or 3mg/kg IM 
with/without:
Midazolam - 0.05 mg/kg IV, single max 5mg q 5-10 prn

Question 4

CCMCP Sedation - Combative patient safety considerations

Answer 4

Ensure normoglycemia
Uncontrolled agitated and combative patients should not be transported by air
If control cannot be established, consider full sedation and intubation

Question 5

CCMCP Sedation - Sedation patient safety considerations

Answer 5

Prior to administration of sedation, access to basic and advanced airway equipment must be prepared and available for immediate use
Consider dose reduction in compensated shock states and patients over 75 years old

Question 6

CCMCP Sedation - Fentanyl indications

Answer 6

Procedural sedation

Question 7

CCMCP Sedation - Fentanyl dose

Answer 7

0.5 - 1 mcg/kg IV/IO prn

Question 8

CCMCP Sedation - Fentanyl EMS contraindications

Answer 8

Hypersensitivity

MAOI therapy within last 14 days

Question 9

CCMCP Sedation - Fentanyl precautions

Answer 9

myasthenia gravis

Question 10

CCMCP Sedation - Haloperidol indications

Answer 10

Combative behaviour

Question 11

CCMCP Sedation - Haloperidol dose

Answer 11

2.5 mg IV/IO (BP < 100 mmHg = 1.25 mg IV/IO)
q 5 minutes prn to a total maximum of 10 mg

5 mg IM
q 10 minutes prn to a total maximum of 10 mg

Question 12

CCMCP Sedation - Haloperidol EMS contraindications

Answer 12

Hypersensitivity
Recent or active seizures
Known or suspected prolonged QT (greater than 0.48 seconds)
Severe hypokalemia
Acute dystonic reaction
Undifferentiated hyperthermia syndrome (possible neuroleptic malignant syndrome)

Question 13

CCMCP Sedation - Haloperidol precautions

Answer 13

Excellent agent where respiratory depression or hypotension is concern
Decreases seizure threshold

Question 14

CCMCP Sedation - Haloperidol onset & duration

Answer 14

Onset of action: 5 – 10 min IV/IO, 10 – 30 min IM

Duration of action: 30 min – 3 hours

Question 15

CCMCP Sedation - Ketamine indication

Answer 15

Procedural sedation

Question 16

CCMCP Sedation - Ketamine dose

Answer 16

1 mg/kg IV/IO prn

3 mg/kg IM prn

Question 17

CCMCP Sedation - Ketamine EMS contraindications

Answer 17

Hypersensitivity

Conditions where a significant elevation of blood pressure is hazardous

Question 18

CCMCP Sedation - Ketamine precautions

Answer 18

Rapid administration can cause apnea
Analgesic properties throughout the dose range
Increased salivary secretions

Question 19

CCMCP Sedation - Ketamine onset and duration

Answer 19

Onset of action: 1 – 2 min IV/IO

Duration of action: 15 – 30 min

Question 20

CCMCP Sedation - Lorazepam indications

Answer 20

Acute Anxiety

Question 21

CCMCP Sedation - Lorazepam dose

Answer 21

1 mg SL q 5 minutes prn max of 4 mg

Question 22

CCMCP Sedation - Lorazepam EMS contraindications

Answer 22

Hypersensitivity to benzodiazepines
Acute narrow-angle glaucoma
Pediatric patient

Question 23

CCMCP Sedation - Midazolam indication

Answer 23

Sedation

Question 24

CCMCP Sedation - Midazolam dose

Answer 24

0.05 mg/kg IV/IO to a single max dose of 5 mg
0.1 mg/kg IM
q 5 – 10 minutes prn

Question 25

CCMCP Sedation - Midazolam EMS contraindications

Answer 25

Hypersensitivity to benzodiazepines
Myasthenia gravis
Hypotension
Compensated shock states

Question 26

CCMCP Sedation - Midazolam precautions

Answer 26

Can lead to vasodilation, cardiac suppression, and hypotension
Hemodynamic compromise is especially common in patients who are dependent on their sympathetic tone for their blood pressure
Sedative of choice for sympathomimetic toxidromes

Question 27

CCMCP Sedation - Midazolam onset and duration

Answer 27

Onset of action: 2 - 3 min IV/IO, 5 - 10 min IM

Duration of action: 30 - 60 min

Question 28

CCMCP Sedation - Procedural sedation indications

Answer 28

Extrication
Cardioversion / transcutaneous pacing
Reduction / realignment of limb dislocation / fracture

Question 29

CCMCP Sedation - Procedural sedation minimum monitoring equipment

Answer 29

SpO2 monitoring
EtCO2 value and waveform monitoring,
ECG monitoring
Blood pressure monitoring