- 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
- Consider waveform Capnography monitoring
- Consider Midazolam (Versed) 1mg slow IV; may repeat once in 2 mins. If no IV, consider Midazolam (Versed) 5 mg IM.
1 mg slow IV; may repeat in 2 mins. If no IV, consider Midazolam (Versed) 5 mg IM.
- 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.