MDSO - ADULT - Analgosedation & Paralysis

Question 1

Pre Transfer Anxiolysis: Indications/Conditions, Dosage, Patch

Answer 1

Indication - pt with anxiety , with GCS 15, MAP > 70, No concurrent sedation / analgesia

Lorazepam - 1 mg PO/SL (Max dose 1 mg)

Question 2

Analgesia - Moderate to Severe Pain: Meds / Dose and Patch ?

Answer 2

Can use Ibuprophen, Tylenol and Ketorolac…..but realistically:

FENTANYL: 25-50 mcg q 10 min PRN, Max 300 mcg (No Patch), MAP > 70 (>80 for ICP, ischemic stroke or SCI)

MORPHINE: 2- 4 mg q 20 PRN - MAX 10 mg (No Patch), MAP >70/>80

KETAMINE: - not first line, but option for multi system trauma / low hemodynamics - 0.1 mg/kg q 5 min, max 0.5 mg/kg….MAP> 60

Question 3

Sedation Score (RASS): What is the RASS Target when Intubated? And how do you assesss for it ?

Answer 3

RASS : aim for RASS -4 (Deep Sedation) - no response to voice, responds to painful stim

(-3 moves to voice, -5 no response to voice or pain)

Question 4

Sedation / Pain Management for Intubated and Vented Patients:

Analgesia Drug, Doses , Conditions, and Patch Status, Bolus and Infusion

Answer 4

FENTANYL: Bolus 50-100mcg q 5 min ; Infusion 1-3 mcg/kg/hr ; MAP > 70 (>80 ICP/Ischemic Stroke/ SCI) - NO PATCH

HYDROMOPHRONE: no bolus, infusion 1-60 mcg/kg/hr (usual dose 500-3000 mcg/hr)

Question 5

SEDATION / PAIN MANAGEMENT Intubated / Vented:

SEDATION OPTIONS: Drug, Push, Infusion, Conditions, Patch Status

Answer 5

MIDAZ , 1-2 mg PRN q 5 min ; Infusion 0.05 - 0.15 mg/kg/hr - MAP >70/80 - No Patch

PROPOFOL: 10 - 20 mg IV q 5 min (1-2 mL); Infusion 1-5 mg/kg/hr - titrate by 0.3 - MAP>70/80 ; - NO PATCH

KETAMINE: 1-2 mg/kg > 1 min x 1 then 0.5 mg/kg q 20 min PRN; infusion: 0.3-2.0 mg/kg/hr - PATCH only if MAP < 60

DexMEDEtomidine : no bolus , infuse 0.2 - 1 mcg/kg/hr, titrate by 0.2 mcg/kg/hr q 30 min

Question 6

Post Intubation Paralysis: Drug, dose push/infusion and patch status

Answer 6

2 Choices:

ROC 1st dose 0.6mg/kg, then 0.3 mg/kg q 20 min ; IP…..or ROC infusion 10-15 mcg/kg/min (No Patch for Infusion)- titrated to achieve no spontaneous vent trigger

Cisatracurium: 1-10 mcg/kg/min - (no patch) - again using it to treat vent trigger.

Question 7

What is the other name for Cisatracurium

Answer 7

NIMBEX