- Anxiety associated with CPAP
- Transcutaneous pacing
- Anxiety associated with Burns
- Severe anxiety
- Traumatic injury patient in which
- extrication and or movement will
- cause anticipated severe pain.
- Remove patient from stressful environment
- Use verbal calming techniques (calm, reassure, establish rapport)
- GCS on all Patients
- Obtain a BGL
- Consider waveform Capnography monitoring
- Apply Monitor
- Iniate IV
- Severe anxiety: Inhibits assessment, respiratory rate >30, inability to be reassured by non-pharmaceutical methods.
- CPAP: Dose should be titrated to provide comfort without causing unconsciousness or respiratory failure; just enough to reduce agitation.
- Procedural Sedation: Cardioversion, transcutaneous pacing, or traumatic injury patient in which extrication and or movement will cause anticipated severe pain.
- Always be prepared for airway management during sedation, Ketamine can cause laryngospasms.
- Ketamine is contraindicated in severe hypertension (>210 systolic or >110 diastolic).
- Be sure to monitor the patient’s breathing with continuous waveform capnography , blood pressure, heart rate, and O2 saturation after administration of Ketamine, Midazolam, or Lorazepam.
- Ketamine dose of 1 mg/kg will cause disassociation and unconsciousness even though patient will appear awake.
- Ketamine can cause a heightened sympathetic response that will increase heart rate and blood pressure. Use caution in severe hypertension.