Combative Patient

Question 1

Combative Patient Medical Directive
Indications

Answer 1

Combative
Or
Violent
Or
Agitated behaviour
THAT REQUIRES SEDATION FOR PATIENT SAFETY

Question 2

MIDAZOLAM
Conditions
Age?
SBP?
Other?

Answer 2

Age: ≥ 18 years
SBP: Normotension
Other: No reversible causes
e.g. hypoglycemia, hypoxia, hypotension

Question 3

KETAMINE
Conditions
Age?
SBP?
Other?

Answer 3

Age: ≥ 18 years
SBP: Normotension
Other: Suspected excited delirium, Severe violent psychosis, No reversible causes
e.g. hypoglycemia, hypoxia, hypotension

Question 4

Mandatory patch point?

Answer 4

BHP to proceed with Midazolam or Ketamine if unable to assess patient for normotension or other reversible causes

Question 5

MIDAZOLAM
Route - IV / IM
Dose?
Max. Single Dose?
Dosing Interval?
Max. Total Dose?
Max # of doses?

Answer 5

Dose: 2.5-5mg
Max. Single Dose: 5mg
Dosing Interval: 5min
Max. Total Dose: 10mg
Max # of doses: 2

patch if you can’t assess BP

Question 6

KETAMINE - ≥ 18 years to < 65 years
ROUTE - IM
Dose?
Max. Single Dose?
Dosing Interval?
Max # of Doses?

Answer 6

Dose: 5mg/kg
Max. Single Dose: 500mg
Dosing Interval: N/A
Max # of Doses: 1

Question 7

KETAMINE - ≥ 65 years
ROUTE - IM
Dose?
Max. Single Dose?
Dosing Interval?
Max # of Doses?

Answer 7

Dose: 3mg/kg
Max. Single Dose: 300mg
Dosing Interval: N/A
Max # of Doses: 1

Question 8

Vastus Lateralis can accomadate how much fluid per injection?

Answer 8

5ml

Ketamine may require over 5ml for full dose