Pain / Sedative / Induction / RSI Flashcards
Haloperidol
(mechansim of action)
The direct action of Haldol are unknown.
However Haldol produces calmness and reduces aggressiveness with the disappearance of hallucinations and delusions by depressing the cerebral cortex, hypothalamus and limbic system which controls activity and aggression.
Blocks postsynaptic dopamine (D1 and D2 receptors)
Haloperidol
(onset and duration)
Haloperidol
Onset: 20 - 30 min
Half Life: 21 - 24 hrs
Duration: 4 - 8 hrs
Haloperidol
(side effects)
Haloperidol
♦ Extrapyramidal symptoms
♦ Caution with elderly patients - may require smaller doses to achieve therapeutic effect.
♦ Haloperidol has been associated with cardiac arrest in patients with prolonged QT intervals.
♦ Closely monitor for cardiac arrhythmia, particularly when the medication is given IV.
May cause neuroleptic malignant syndrome.
Haloperidol
(indications)
Haloperidol
Altered Mental Status when patient is combative and potential for harm to patient and/or personnel is present.
Haloperidol
(contraindications)
♦ QT prolongation or hx of torsades de pointes.
♦ Tardive dyskinesia is a syndrome of potentially irreversible, involuntary, dyskinetic movements that may develop in pt’s treated w/ antipsychotics.
♦ Parkinson’s disease; have increased sensitivity to antipsychotics. May include severe extrapyramidal symptoms, confusion, sedation, and falls. Additionally, haloperidol may impair the antiparkinson effects of levodopa and other dopamine agonists.
Haloperidol
(adult dose)
Haloperidol (adult)
♦ 5 mg IM
♦ q 15 minutes PRN up to a total of 20mg.
Haloperidol
(pediatric dose)
Haloperidol (ped)
♦ 0.1 mg/kg IM
♦ Max dose of 5 mg
Haloperidol
(pregnancy safe)
Pregnancy Class C
Haloperidol should be used during human pregnancy only when the benefits to the mother outweigh the potential risks to the fetus.
breast-feeding should be avoided during treatment with haloperidol. Haloperidol is excreted into breast milk.
Etomidate (Amidate)
(mechanism of action)
♦ Etomidate is an ultra-short- acting nonbarbiturate that appears to act similar to GABA by depressing the activity of the brain stem reticular activating system, reducing subcortical inhibition and inducing sleep.
♦ Etomidate will induce apnea, cause a slight decrease in intracranial pressure and a moderate increase in intraocular pressure.
(will not cause significant hemodynamic changes)
Etomidate (Amidate)
(onset and duration)
Etomidate
Onset: 10 - 20 sec
Half Life: 75 min
Duration: 4 - 10 min
Etomidate (Amidate)
(side effects)
Etomidate Side Effects
♦ Respiratory depression,
♦ Venous pain,
♦ Skeletal muscle movement
Etomidate (Amidate)
(indications)
For use in RSI protocol – for anesthesia induction
Etomidate (Amidate)
(contraindications)
Etomidate Contraindications
♦ Adrenal Insufficiency
♦ Sepsis
Etomidate (Amidate)
(adult dose)
Etomidate(adult)
♦ 0.3 mg/kg IV push over 30 seconds
Maximum of 40 mg
(same as pediatric)
Etomidate (Amidate)
(pediatric dose)
Etomidate(pediatric)
♦ 0.3 mg/kg IV push over 30 seconds
Maximum of 40 mg
(same as adult)
Etomidate (Amidate)
(pregnancy safe)
Pregnancy Class C
No adequate human studies
Potential benifits may warrant use if benifits outweigh the risks
Rocuronium (Zemuron)
(mechanism of action)
Rocuronium _Non-_depolarizing NBA
♦ Causes total paralysis by blocking the binding of acetylcholine and the inotropic activity of Ach receptors
♦ Skeletal muscle relaxation proceeds in predictable order, muscles with fine movements, e.g., eyes, face, neck. → muscles of the limbs, chest, abdomen → diaphragm. Muscle tone returns in the reverse order.
Rocuronium (Zemuron)
(onset and duration)
Rocuronium
Onset: 1 min
Half Life: 1.4 - 2.4 hrs
Duration: ~ 30 min
Rocuronium (Zemuron)
(side effects)
Rocuronium Side Effects
♦ Hypotension,
♦ Hypertension,
♦ Increased pulmonary vascular resistance
Rocuronium (Zemuron)
(disease related concerns)
♦ Conditions that may antagonize neuromuscular blockade (decreased paralysis): Respiratory alkalosis, hypercalcemia, demyelinating lesions, peripheral neuropathies, denervation, and muscle trauma
♦ Conditions that may potentiate neuromuscular blockade (increased paralysis): Electrolyte abnormalities (eg, severe hypocalcemia, severe hypokalemia, hypermagnesemia), cachexia, neuromuscular diseases, metabolic acidosis, respiratory acidosis, Eaton-Lambert syndrome, and myasthenia gravis
♦ Hepatic impairment: clinical duration may be prolonged
♦ Pulmonary hypertension: may increase pulmonary vascular resistance worsening symptoms of right heart failure.
Rocuronium (Zemuron)
(indications)
♦ Facilitates endotracheal intubation by paralysis of skeletal muscle
♦ To increase pulmonary compliance during mechanical ventilation
Rocuronium (Zemuron)
(contraindications)
Rocuronium Contraindications
♦ Hypersensitivity
Rocuronium (Zemuron)
(adult dose)
Rocuronium(adult)
♦ 1 mg/kg IO/IV
Maximum dose of 100 mg
(same as pediatric)
Rocuronium (Zemuron)
(pediatric dose)
Rocuronium(pediatric)
♦ 1 mg/kg IO/IV
Maximum dose of 100 mg
(same as adult)
Rocuronium (Zemuron)
(pregnancy safe)
Pregnancy Class C
Rocuronium crosses the placenta
The manufacturer does not recommend use for rapid sequence induction during cesarean section.
Succinylcholine (Anectine)
(mechanism of action)
Succinycholine = Depolarizing NMBA
♦ causes rapid depolarization but remains bound to the receptor, preventing muscle fibers stimulation by Acetylcholine and being triggered again. (rapid onset, short duration 7-12 mins)
♦ Depolarization results in fasciculation of the skeletal muscles followed by muscle paralysis.
Initially, paralysis involves the levator muscles of the *face* and muscles of the *glottis_. → *_intercostals, _diaphragm_, and all other skeletal muscles. Recovery generally occurs in the reverse order.
Succinylcholine (Anectine)
(onset and duration)
Succinycholine
Onset: 1 min
Duration: 4 - 6 min
Succinylcholine (Anectine)
(warnings/precautions)
Succinylcholine Precautions
♦ Bradycardia: Risk of bradycardia may be increased with 2nd dose and may occur more in children. (may be reduced by pretreating with anticholinergic agents (eg, atropine)
♦ Increased intraocular pressure; avoid use in (eg, narrow-angle glaucoma, penetrating eye injuries).
♦ May cause a transient increase in ICP (adequate anesthetic induction prior to administration of succinylcholine will minimize this effect).
♦ Malignant hyperthermia: risk may be increased with concomitant administration of volatile anesthetics
♦ Hyperkalemia: Use with extreme caution in patients with pre-existing hyperkalemia. Severe hyperkalemia may develop in patients with chronic abdominal infections, burn injuries, multi-trauma/crush injuries, extensive denervation of skeletal muscle, upper motor neuron injury, subarachnoid hemorrhage, or conditions which cause degeneration of the central and peripheral nervous system.
Succinylcholine (Anectine)
(side effects)
SuccinycholineSide Effects
♦ Cardiac arrhythmias,
♦ Increased Intraocular Pressure,
♦ Muscle Fasciculation
Succinylcholine (Anectine)
(indications)
♦ Skeletal muscle relaxation
♦ Facilitate management of patients undergoing mechanical ventilation
Succinylcholine (Anectine)
(contraindications)
SuccinylcholineContraindications
♦ Penetrating eye injury
♦ Hypersensitivity to succinylcholine or any component of the formulation;
♦ Personal/family hx of malignant hyperthermia
♦ Use after the acute phase of injury following major burns, multiple trauma, extensive denervation of skeletal muscle, or upper motor neuron injury.
Succinylcholine (Anectine)
(adult dose)
Succinycholine(adult)
♦ 2 mg/kg IO/IV over 30 seconds
Maximum dose of 200 mg
(same as pediatric)
Succinylcholine (Anectine)
(pediatric dose)
Succinylcholine(pediatric)
♦ 2 mg/kg IO/IV over 30 seconds
Maximum dose of 200 mg
(same as adult)
Succinylcholine (Anectine)
(pregnancy safe)
Pregnancy Class C
Small amounts cross the placenta.
Use succinylcholine during pregnancy only if clearly needed.
Vecuronium Bromide (Norcuron)
(mechanism of action)
Vecuronium - Non**depolarizing NMBA
♦ Causes total paralysis by blocking the binding of acetylcholine and the inotropic activity of Ach receptors, (lasting 30 mins - 2 hours)
♦ Neuromuscular blockade begins with muscles associated with fine movements (e.g., eyes, face, and neck), → muscles of the limbs, chest, and abdomen and, finally, the diaphragm.
Muscle tone returns in the reverse order.
Vecuronium Bromide (Norcuron)
(onset and duration)
Vecuronium
Onset: 2.5 - 3 min
Half Life: 1.5 hrs
Duration: 45 - 46 min
Vecuronium Bromide (Norcuron)
(side effects)
VecuroniumSide Effects
Hypotension
Hypertension
Bronchospasm
Dysrythmias
Histamine Release
Malignant Hyperthermia
Vecuronium Bromide (Norcuron)
(reversal agent)
cholinesterase inhibitor
(e.g., neostigmine, pyridostigmine, edrophonium)
Vecuronium Bromide (Norcuron)
(adult dose)
Vecuronium(adult)
for long transports (if needed)
♦ 0.1 mg/kg IO/IV over 30 – 60 seconds
Maximum dose of 10 mg
(same as pediatric)
♦ Post Intubation long acting paralytic should only be used if appropriate nanlgesia/sedation are not effective
Vecuronium Bromide (Norcuron)
(pediatric dose)
Vecuronium(pediatric)
♦ 0.1 mg/kg IO/IV over 30 – 60 seconds
Maximum dose of 10 mg
(same as adult)
Vecuronium Bromide (Norcuron)
(pregnancy safe)
Pregnancy Class C
It is not known if vecuronium can cause fetal harm when administered to a pregnant woman.
It should be used during pregnancy only if clearly needed.
Malignant Hyperthermia
Following Succinycholine Administration
Facts
The risk of developing malignant hyperthermia following succinylcholine administration increases with the concomitant administration of volatile anesthetics.
♦ Malignant hyperthermia frequently presents as intractable spasm of the jaw muscles (masseter spasm) which may progress to generalized rigidity, increased oxygen demand, tachycardia, tachypnea and profound hyperpyrexia (temp)
♦ Recognition of the syndrome is a signal for discontinuance of anesthesia, attention to increased oxygen consumption, correction of acidosis, support of circulation, assurance of adequate urinary output and institution of measures to control rising temperature.
♦ Intravenous dantrolene sodium
Succinycholine Administration
Precautions / Warnings
(Pearls)
Hyperkalemia - should be administered with GREAT CAUTION to patients suffering from electrolyte abnormalities and those who may have massive digitalis toxicity, because in these circumstances succinylcholine may induce serious cardiac arrhythmias or cardiac arrest due to hyperkalemia.
In both adults and pediatric patients the incidence of bradycardia, which may progress to asystole, is higher following a second dose of succinylcholine. The incidence and severity of bradycardia is higher in pediatric patients than adults.
Succinylcholine causes an increase in intraocular pressure. (e.g., narrow angle glaucoma, penetrating eye injury)
Succinylcholine may cause a transient increase in intracranial pressure; however, adequate anesthetic induction prior to administration of succinylcholine will minimize this effect.
Succinylcholine may increase intragastric pressure, which could result in regurgitation and possible aspiration of stomach contents.
Fentanyl (Sublimaze)
(mechanism of action)
Fentanyl - Analgesic, Opioid
Binds with stereospecific receptors at many sites within the CNS, increases pain threshold, alters pain reception, inhibits ascending pain pathways producing CNS depression and analgesia.
The actions of fentanyl are similar to those of morphine, although fentanyl is much more lipophilic as compared to morphine (580:1) and has a more rapid onset of action.
Fentanyl (Sublimaze)
(onset and duration)
Fentanyl
Onset: 1 - 2 min
Half Life: 2 - 4 hr
Duration: 30 min - 1 hr
Fentanyl (Sublimaze)
(side effects)
Muscle rigidity, (tight chest) related to the dose and speed of injection, may be reduced by slow IV injection
Respiratory depression,
Bradycardia,
Myoclonic movements,
Tachycardia,
Vein irritation,
Dermatitis
Fentanyl (Sublimaze)
(indications)
Acute Coronary Syndrome
RSI / Ventilator
Pain control
Fentanyl (Sublimaze)
(contraindications)
♦ Bronchial asthma - Receipt of moderate doses in these patients may significantly decrease pulmonary ventilation
♦ Concomitant MAO inhibitors - it has been postulated that fentanyl may be a weak serotonin reuptake inhibitor. Symptoms of serotonin syndrome are possible.
♦ Myasthenia gravis - Fentanyl may cause muscle rigidity upon IV administration
RSI - Fentanyl (Sublimaze)
(adult dose)
Fentanyl(adult)
♦ Induction = 1 mcg/kg IM/IO/IV/IN Max 100 mcg
→ May repeat dose at 1 mcg/kg
♦ Post Intubation 1 mcg/kg IV/IO/IN max 100mcg → repeated in 0.05 mcg/kg doses PRN
Fentanyl (Sublimaze)
(pediatric dose)
Fentanyl(pediatric)
♦ 1 mcg/kg IM/IO/IV/IN
Maximum 100 mcg
May repeat dose at 1 mcg/kg
(same as adult)
Fentanyl (Sublimaze)
(pregnancy safe)
Pregnancy Class C
The drug readily crosses the placenta and should only be given to pregnant women if the potential benefit justifies the risk.
Midazolam (Versed)
(mechanism of action)
Anticonvulsant, Benzodiazepine
Potentiates GABA by binding to specific stereospecific benzodiazipine receptors on the postsynaptic GABA neuron at different sites within the CNS. Versed also exerts sedative, hypnotic, muscle relaxant, anxiolytic and anticonvulsant characteristics.
Midazolam (Versed)
(onset and duration)
Midazolam
Onset: 1 - 5 min
Half Life: 2 - 17 hrs
Duration: 2 - 6 hrs
Midazolam (Versed)
(side effects)
MidazolamSide Effects
♦ Apnea,
♦ Cardiac Arrhythmias,
♦ Hypotension
Midazolam (Versed)
(indications)
♦ Seizures and status epilepticus
♦ Conscious sedation
♦ Skeletal muscle relaxant
♦ Acute anxiety states
♦ Combative patients
Midazolam (Versed)
(contraindications)
♦ Glaucoma - can increase intraocular pressure
♦ Shock - can cause significant hypotension
♦ ETOH - effects are additive to those of other CNS depressants, including alcohol
♦ Pregnancy
♦ Renal Failure - half-life** **may be prolonged, can experience more rapid induction of and prolonged recovery from anesthesia
Coma
RSI Midazolam (Versed)
(adult dose)
Midazolam(adult)
♦ Post Intubation = 0.1mg/kg IV/IO/IN max of 10 mg
And
Fentanyl 1 mcg/kg max 100 mcg
→ 1 mcg/kg q PRN
RSI Midazolam (Versed)
(pediatric dose)
Midazolam (pediatric)
♦ Induction - 0.1 mg/kg IM/IO/IV max 5 mg
♦ Post Intubation - 0.1 mg/kg max 5 mg → May repeat in 0.05 mg/kg doses PRN
Ativan (Lorazepam)
(mechanism of action)
♦ Benzodiazepines act at the level of the limbic, thalamic, and hypothalamic regions of the CNS, and can produce any level of CNS depression required including sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activity, and coma.
♦ Benzodiazepines block the cortical and limbic arousal that occurs following stimulation of the reticular pathways.
Ativan (Lorazepam)
(onset and duration)
Ativan
Onset: 2-3 min
Half Life: 10 - 73 hrs
Duration: 9 - 12 hrs
Ativan (Lorazepam)
(side effects)
♦ Respiratory / cardiac arrest,
♦ Decreased LOC,
♦ Hypotension
Ativan (Lorazepam)
(indications)
♦ Seizures and status epilepticus
♦ Conscious sedation
♦ Skeletal muscle relaxant
♦ Acute anxiety states
♦ Combative patients
Ativan (Lorazepam)
(contraindications)
Respiratory depression
Ativan (Lorazepam)
(adult dose)
Ativan (adult)
♦ Post Intubation = 1 - 2 mg IV/IO/IN
up to *4 mg* *maximum*
♦ Behavioral Emergency
1 - 2 mg IM,IV,IO
Ativan (Lorazepam)
(pediatric dose)
Ativan(pediatric)
♦ 0.05 – 0.1 mg/kg IM/IO/IV
May repeat up to 4 mg maximum
Ativan (Lorazepam)
(pregnancy safe)
Pregnancy Class D
Ativan MAY CAUSE FETAL DAMAGE WHEN ADMINISTERED TO PREGNANT WOMEN.
Injection should not be used during pregnancy except in serious or life-threatening conditions where safer drugs cannot be used or are ineffective.
Ketamine (Ketalar)
(mechanism of action)
♦ Ketamine nonbarbiturate general anesthetic
♦ Ketamine induces sedation, immobility, amnesia, and marked analgesia.
Increasing doses of ketamine result in anesthesia.
Ketamine acts on receptors in the cortex and limbic system.
Ketamine has a sympathomimetic activity resulting in tachycardia, hypertension, increased myocardial and cerebral oxygen consumption, increased cerebral blood flow, and increased intracranial and intraocular pressure.
Ketamine is a potent bronchodilator and can be used to treat refractory bronchospasm.
Ketamine (Ketalar)
(onset and duration)
Onset IV: dissociation occurs in 60 seconds
♦ Anesthesia occurs within 30 to 60 seconds and
Duration: 5 to 10 minutes
♦ Analgesic effects of ketamine last from 20 to 45 minutes.
Onset IM: Anesthesia occurs within 3 to 5 minutes
Duration: 12 to 30 minutes
Ketamine (Ketalar)
(side effects / precautions)
Hallucinations, respiratory depression, elevated B/P
♦ Can cause psychosis and exacerbate symptoms of chronic schizophrenics, do not use.
♦ EMERGENCE REACTIONS HAVE OCCURRED IN APPROXIMATELY 12 PERCENT OF PATIENTS.
Ketamine (Ketalar)
(indications)
♦ Induction agent for RSI
♦ Pain Management (if opoids are not effective)
Ketamine (Ketalar)
(contraindications)
♦ < 3mos age
♦ Known schizophrenia
♦ Severe HTN
RSI Ketamine (Ketalar)
(adult dose)
Ketamine(adult)
♦ Induction = 2 mg/kg slow IO/IV push max 200mg
♦ Post Intubation = 1 mg/kg q 10 min PRN
♦ Sedation/Pain Management → 0.1 - 0.5 mg/kg → may repeat q 10 min PRN
RSI Ketamine (Ketalar)
(pediatric dose)
Ketamine(pediatric)
♦ Induction - 2 mg/kg slow IVP/IO max 200 mg
→ Post Intubation - 1 mg/kg q 10 minutes PRN
♦ Pain - 0.1 - 0.5 mg/kg IV/IO q 10 min PRN
Ketamine (Ketalar)
(pregnancy safe)
Pregnancy Class X
Since the safe use in pregnancy, including obstetrics (either vaginal or abdominal delivery), has not been established, such use is not recommended
Flumazenil (Romazicon)
(mechanism of action)
♦ Flumazenil antagonizes the actions of benzodiazepines on the central nervous system
♦ Flumazenil competes with benzodiazepines at this receptor for binding. Because binding is competitive and flumazenil has a much shorter duration of action than do most benzodiazepines, it is possible for the effects of flumazenil to dissipate sooner than the effects of the benzodiazepine
Flumazenil (Romazicon)
(onset and duration)
Onset: 1 to 2 minutes
80% response will be reached within 3 minutes,
with peak effect occurring at 6 to 10 minutes.
Flumazenil (Romazicon)
(side effects)
Dizziness, blurred vision, headache, seizures, dysrhythmia, GI distress, pain at injection site
Use of flumazenil can precipitate signs of benzodiazepine withdrawal, which may precipitate seizures.
Flumazenil (Romazicon)
(indications)
Reversal of sedative effects of Benzodiazepines
Flumazenil (Romazicon)
(contraindications)
♦ Hypersensitivity,
♦ Tricyclic overdose,
♦ benzodiazepine dependent patient,
♦ Status epilepticus patients who received benzodiazepines
Flumazenil (Romazicon)
(adult dose)
Romazicon(adult)
♦ 0.2 mg IO/IV
May be repeated at 1 min intervals to a
Max dose of 1 mg.
Flumazenil (Romazicon)
(pediatric dose)
Romazicon(pediatric)
♦ 0.01 mg/kg IO/IV, up to 0.2 mg.
May be repeated at 1 min intervals
to a max dose of 1 mg
Flumazenil (Romazicon)
(pregnancy safe)
Pregnancy Class C
there are no adequate and well-controlled studies in humans,
This drug should be used during pregnancy only if the benefit outweighs the risk to the fetus.
Morphine Sulfate
(mechanism of action)
Morphine sulfate is an opioid agonist indicated for the management of pain not responsive to non-narcotic analgesics.
Binds to opioid receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; produces generalized CNS depression
Morphine Sulfate
(onset and duration)
Morphine
Onset: Rapid
Half Life: 1 - 2 hrs
Duration: 4 - 6 hrs
Morphine Sulfate
(side effects)
♦ Respiratory Depression,
♦ Hypotension,
♦ Bradycardia,
♦ Nausea/Vomiting
Morphine Sulfate
(indications)
MorphineIndications
♦ Acute Coronary Syndrome
Pain Management
♦ AMI
♦ Acute pulmonary edema
♦ Severe pain
Morphine Sulfate
(contraindications)
MorphineContraindications
♦ Head injury,
♦ Hypotension,
♦ Asthma,
♦ COPD,
♦ Respiratory depression not caused by pulmonary edema
Morphine Sulfate
(adult dose)
⇒ Acute Coronary Syndrome
♦ 2 mg – 10 mg IM/IO/IV
⇒ Pain Management
♦ 0.1 mg/kg IM/IO/IV (max 5 mg)
► May repeat dose up to 5mg
Morphine Sulfate
(pediatric dose)
Morphine(pediatric)
⇒ Pain Management
♦ 0.1 mg/kg IM/IO/IV (max 5 mg)
► May repeat dose up to 5mg
RSI Induction Medications (adult)
♦ Fentanyl: (per pain protocol) - 1mcg/kg max 100
♦ Ketamine: 2mg slow IV/IO → 1mg/kg q 10 PRN
→ Push Dose Pressor if hypotensive
OR
♦ Etomidate: 0.3mg/kg IV,O,N max of 40mg
♦Succinylcholine 2mg/kg IV/IO
_ifcontraindicated_→Rocuronium 1mg/kgIV/IOMax 100 mg
RSI Post Intubation Medications (adult)
♦ Midazolam - 0.1 mg/kg IV,O,N up to 10 mg AND
♦ Fentanyl 1 mcg/kg IV,O,N (max 100 mcg) q 1mcg PRN OR
♦ Lorazepam 1-2 mg IV.O,N may repeat to a total dose of 4 mg OR
♦ Ketamine 1 mg/kg q 10 min PRN
♦ Long Txp’s consider Vecuronium 0.1 mg/kg max of 10 mg OR Rocuronium 1 mg/kg (max 100 mg) (only if analgesia/sedation not effective)
RSI Induction Medications (Pediatric)
♦ Consider Atropine: 0.02 mg/kg (min 0.1mg, max 1mg) (prevent bradycardia in 2 y/o or younger)
♦ Fentanyl: per pain protocol - 1mcg/kg max 100
→ Push Dose Pressor if hypotensive
♦ Ketamine: 2mg slow IV/IO → 1mg/kg q 10 PRN
♦ OREtomidate:0.3mg/kgIV,O,Nmax 40mgmay alsoconsiderVersed 0.1mg/kgIV,O,Nmax 5mg
♦Succinylcholine 2mg/kg IV/IO if contraindicated→ Rocuronium 1mg/kg IV/IO max 100 mg
RSI Post Intubation Medications (pediatric)
♦ Midazolam0.1 mg/kg IV,O.N max 5 mg may be repeated → 0.05 mg/kg doses PRN (watch for hypotension)
♦ Fentanyl 1 mcg/kg IV,O,N max 100 mcg → repeat at 0.5 mcg/kg PRN
♦ OR - Lorazepam 0.05 mg/kg up to 4 mg max
♦ Ketamine 1 mg/kg q 10 min PRN
♦ For long Txp’s (if needed) → Vecuronium 0.1 mg/kg max 10 mg OR Rocuronium 1 mg/kg max 100 mg (only if analgesia/sedation not effective)
Pain Management Options (Adult)
♦ Morphine - 0.1 mg/kg (max 5 mg) → may repeat once to a max of 10 mg
♦ Fentanyl - 1 mcg/kg max 100 mcg → repeat at 1 mcg/kg (max single dose 100 mcg)
♦ Ketamine - 0.1 - 0.5 mg/kg (if opioids not helping) q 10 min PRN
♦ Zofran - 4 mg PRN
Pain Management Options (pediatric)
If SBP is appropriate (see next)
⇒ Administer Zofran - 0.1 mg/kg max 4 mg PRN
♦ Morphine - 0.1 mg/kg (up to 5 mg) may repeat for total of 10 mg
♦ Fentanyl - 1 mcg/kg max 100 mcg: may repeat dose at 1 mcg/kg
♦ Ketamine - 0.1 mg/kg (if opioids not helping) → q 10 minutes PRN
Age Based Hypotension Guideline for Pediatrics
Age based hypotension:
♦ < 1 year: less than 70 SBP
♦ 1 - 10 years: less than 80 + (2 x age) SBP
♦ 11 - 12 years: less than 90 + (2 x age) SBP
Ketamine Adult
Pain Management
Ketamine Pain Management (adult)
0.1 - 0.5 mg/kg q 10 min PRN
(only if opoids are not managing pain)
