MDSO - Adult - Analgosedation & Paralysis - Memorize

Question 1

Treatment of Anxiety?

Answer 1

Ativan (Lorazepam) - 1 mg PO/SL - No Patch - MAP > 70

Question 2

Treatment for Agitated Combative: 3 options:

Answer 2

Midaz - IP - MAP > 70 —> 0.05 mg/kg IV/IO. OR. 0.1 mg/kg IM q 5 min PRN - - - Max is 0.2mg/kg IV/IM/IO

Ketamine - IP - no MAP —> 1-2 mg/kg IV/IO > 1-3 min. OR. 3-5 mg/kg IM. (Slow > 1 min, to reduce risk of apnea)

Other option : Haldol

Question 3

Moderate to Severe Pain: all options, doses for two main ones, and an optional one for soft pressures

Answer 3

IBUPROPHEN, TYLENOL, TORADOL

FENTANYL - NO PATCH - >70 ——> 25-50 mcg q 10 min (max 300mcg)

MORPHINE - NO PATCH >70 ——> 2-4 mg q 20 min PRN (max 10mg)

KETAMINE: IP >60 —-> 0.1 mg/kg q 5 min PRN - - - MAX 0.5 mg/kg

Question 4

Sedation and Pain - Intubated / Vented: (after intubation): Give Push and Infusion for the the main Analgesia and Sedation. - with Patch Status.

Answer 4

As CCP - no patch is needed if they are already intubated (need to patch for intubation)

Analgesia: FENTANYL - MAP>70 - Push 50-100 mcg (not weight based) IV/IM PRN q 5 min ; Infuse 1-3 mcg/kg/hr

Sedation:
KETAMINE (patch if MAP < 60) - Push 1-2 mg/kg > 1 min, then 0.5 mg/kg q 20 min PRN ; Infuse 0.3 to 2.0 mg/kg/hr

PROPOFOL (MAP>70) - Push 10-20 mg IV q 5 min (bolus = risk of hypotension); Infuse 1-5 mg/kg/hr (16.6 to 83.3 mcg/kg/min) - - titrate by 0.3

MIDAZOLAM: MAP>70; Push 1-2 mg IV q 5 min (Max 0.15 mg/kg/hr ); Infuse : 0.05 - 0.15 mg/kg/hr

Question 5

Hypotension Assoc with Sedation: Phenylephrine Dosing, Preparations and Patch Status

Answer 5

Most often found as 100 mcg/mL - 10 mL Push (1 mg/10 mL) - - or sometimes infusions at 10mg/100 mL (which is also 1 mg/10 mL - and 100mcg/mL)

We carry 50mcg/mL Push - - - in any case make sure to check concentrations

NO PATCH

Dose is 100mcg IV/IO x 3 q 3 min

Question 6

Post Intubation Paralysis - Dosing for main option, (Push and Infusion), name of secondary option.

Answer 6

ROC: PUSH 0.6 mg/kg IV/IO then 0.3 mg/kg IV/IO q 20 min PRN (Initiate then Patch)
INFUSION: 10-15 mcg/kg/min

Other Option Cisatracurium (aka NIMBEX) - - - more often used in ECMO type patients - - long term paralysis prefer NIMBEX