Protocol Status: PUBLISHED
Protocol:
Version: 2026.01
Effective Date:
Last Reviewed:
Medical Director Approval:
Clinical Note: This content reflects current GCEMS clinical guidelines as of the dates listed above. If content appears inconsistent with current policy, use the most recent approved guideline and notify leadership for correction.

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 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

 

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, 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.