Sedation - Anxiety



  • 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.



  • Remove patient from stressful environment
  • Use verbal calming techniques (Calm, reassure, establish rapport)
  • GCS on all patients
  • Obtain BGL
  • Consider waveform Capnography monitoring
  • Oxygen
  • Apply monitor
  • Initiate IV


CPAP, Burns

  • Consider Midazolam (Versed) 1mg slow IV; may repeat once in 2 mins. If no IV, consider Midazolam (Versed) 5 mg IM.
          • OR


Severe anxiety

  • Consider Midazolam (Versed ) 1 mg slow IV; may repeat once in 2 mins. If no IV,consider Midazolam (Versed) 5 mg IM.
          • OR
  • Lorazepam (Ativan) 1 mg IV/IO; may repeat once in 2 mins.


Procedural Sedation

  • Consider Midazolam (Versed) 1 mg slow IV; may repeat in 2 mins. If no IV, consider Midazolam (Versed) 5 mg IM.
          • OR
          • OR
  • Consider Ketamine 1 mg/kg slow IV, max dose 100 mg


Notify receiving facility or contact Medical Control



  • Sever 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 e respiratory failure; just enough to reduce agitation.
  • Procedural Sedation: Cardioversion, transcutaneous pacing.
  • 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. After 10 minutes consider 1-2 mg IV/IO Versed to prevent emergence reaction.
  • Ketamine can cause a heightened sympathetic response that will increase heart rate and blood pressure. Use caution in severe hypertension.