Indications:

 

• Cardioversion
• 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.

 

Treatment:

 

• Remove patient from stressful environment
• Use verbal calming techniques (calm, reassure, establish rapport)
• GCS on all Patients
• Obtain a BGL
• Consider waveform Capnography monitoring
• Oxygen
• Apply Monitor
• Iniate IV

 

CPAP, Burns

 

• Consider Midazolam (Versed) 1-2 mg slow IV

 

Severe Anxiety

 

• Consider Midazolam (Versed) 1-2 mg slow IV; or Lorazepam (Ativan) 1 mg IV

 

Procedural Sedation

 

• OLMC: Consider Ketamine 1 mg/kg IV
• After 10 minutes; to prevent emergence reaction
• Consider Midazolam (Versed) 1-2 mg slow IV

 

PEARLS:

 

• 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.