CCMCP Sedation Flashcards
CCMCP Sedation - Anxious?
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,
CCMCP Sedation - Combative?
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
CCMCP Sedation - Procedural sedation?
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
CCMCP Sedation - Combative patient safety considerations
Ensure normoglycemia
Uncontrolled agitated and combative patients should not be transported by air
If control cannot be established, consider full sedation and intubation
CCMCP Sedation - Sedation patient safety considerations
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
CCMCP Sedation - Fentanyl indications
Procedural sedation
CCMCP Sedation - Fentanyl dose
0.5 - 1 mcg/kg IV/IO prn
CCMCP Sedation - Fentanyl EMS contraindications
Hypersensitivity
MAOI therapy within last 14 days
CCMCP Sedation - Fentanyl precautions
myasthenia gravis
CCMCP Sedation - Haloperidol indications
Combative behaviour
CCMCP Sedation - Haloperidol dose
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
CCMCP Sedation - Haloperidol EMS contraindications
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)
CCMCP Sedation - Haloperidol precautions
Excellent agent where respiratory depression or hypotension is concern
Decreases seizure threshold
CCMCP Sedation - Haloperidol onset & duration
Onset of action: 5 – 10 min IV/IO, 10 – 30 min IM
Duration of action: 30 min – 3 hours
CCMCP Sedation - Ketamine indication
Procedural sedation
CCMCP Sedation - Ketamine dose
1 mg/kg IV/IO prn
3 mg/kg IM prn
CCMCP Sedation - Ketamine EMS contraindications
Hypersensitivity
Conditions where a significant elevation of blood pressure is hazardous
CCMCP Sedation - Ketamine precautions
Rapid administration can cause apnea
Analgesic properties throughout the dose range
Increased salivary secretions
CCMCP Sedation - Ketamine onset and duration
Onset of action: 1 – 2 min IV/IO
Duration of action: 15 – 30 min
CCMCP Sedation - Lorazepam indications
Acute Anxiety
CCMCP Sedation - Lorazepam dose
1 mg SL q 5 minutes prn max of 4 mg
CCMCP Sedation - Lorazepam EMS contraindications
Hypersensitivity to benzodiazepines
Acute narrow-angle glaucoma
Pediatric patient
CCMCP Sedation - Midazolam indication
Sedation
CCMCP Sedation - Midazolam dose
0.05 mg/kg IV/IO to a single max dose of 5 mg
0.1 mg/kg IM
q 5 – 10 minutes prn
CCMCP Sedation - Midazolam EMS contraindications
Hypersensitivity to benzodiazepines
Myasthenia gravis
Hypotension
Compensated shock states
CCMCP Sedation - Midazolam precautions
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
CCMCP Sedation - Midazolam onset and duration
Onset of action: 2 - 3 min IV/IO, 5 - 10 min IM
Duration of action: 30 - 60 min
CCMCP Sedation - Procedural sedation indications
Extrication
Cardioversion / transcutaneous pacing
Reduction / realignment of limb dislocation / fracture
CCMCP Sedation - Procedural sedation minimum monitoring equipment
SpO2 monitoring
EtCO2 value and waveform monitoring,
ECG monitoring
Blood pressure monitoring
