Sedation

Question 1

Diazepam (Valium)

Answer 1

For: Sedation, anticonvulsant

Adult dose: 5-10mg IV @ max rate of 5mg/min, repeated every 3-5min PRN for a max total dose of 30mg OR 10-20mg PR, then flushed with 2-3mL air after administration

Ped dose: 0.2mg/kg/dose slow IV up to a max of 10mg/dose; May repeat dose once in 5 minutes OR 0.5 mg/kg PR, then flushed with 2-3mL air after administration

Contraindications: Coma, shock, head injury, substance abuse, glaucoma, hypersensitivity

Note: Short duration of anticonvulsant effect. Reduce dose 50% in elderly patient

Question 2

Flumazenil (Romazicon)

Answer 2

For: Antidote for benzodiazepine overdose

Adult dose:
1st dose: 0.2mg IV over 15 sec
2nd dose: 0.3mg IV over 30 sec
3rd dose: 0.5mg IV over 30 sec at 1-min intervals until adequate
response or max total dose of 3 mg

Ped dose: Not recommended

Contraindications: TCA overdose, chronic benzodiazepine use, alcoholism, stimulant intoxication (eg. cocaine), hypersensitivity

Note: Patients should be monitored for possible re-sedation, respiratory depression, or other residual benzodiazepine effects

Question 3

Haloperidol (Haldol)

Answer 3

For: Acute psychotic episodes

Adult dose: 5mg IM

Ped dose: Not recommended

Contraindications: Parkinson’s, depressed mental status / agitation secondary to shock and hypoxia

Note: Treat hypotension secondary to haloperidol with fluids and norepinephrine, NOT Epinephrine.

Question 4

Ketamine (as sedative)

Answer 4

For: Excited delirium

Adult dose: 4mg/kg IM only

Ped dose: Not recommended

Contraindications: Hypersensitivity

Question 5

Lorazepam (Ativan)

Answer 5

For: Sedation, anticonvulsant

Adult dose, seizures: 2-4mg IM or slow IV. May repeat every 15-20min up to a max of 8mg

Adult dose, sedation: 0.05mg/kg IM to a max of 4mg

Ped dose, seizures: 0.05-0.20mg/kg IM or slow IV/IO. May repeat every 15-20min up to a max of 0.2mg/kg

Contraindications: Coma, shock, suspected drug abuse

Note: When given IV or IO, must dilute with equal volume of sterile water or sterile saline; When given IM, Lorazepam is not to be diluted.

Question 6

Versed (as sedative)

Answer 6

For: Sedation, anticonvulsant

Adult dose: 2.5-5mg; Repeat doses may be administered every 3-5 minutes (IV route) or every 5-10 minutes (IM route) until sedation is adequate and appropriate. Some patients may require a total dose of ~20 mg.

Ped dose: 0.2 mg/kg/dose IM/IN; repeat every 10 to 15 minutes; maximum dose: 6 mg/dose

Contraindications:

Note: Monitor respiratory status; may give alone or in combination with an antipsychotic