Sedation - Anxiety

 

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 techiniques (Calm, reassure, establish rapport)
  • GCS on all patients
  • Obtain BGL
  • Consider waveform Capnography monitoring
  • Oxygen
  • Apply monitor
  • Initiate 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

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

 

Notify receiving facility or contact Medical Control

 

PEARLS:

  • 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, trancutaneous 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.