Sedation and Analgesia Flashcards
Morphine
Dosage:
Adult: 2 – 10 mg IV, IO, IM, or subcutaneous administered slowly over a period of several minutes.
Pediatric: less than 110lbs: 0.025mg to 0.2 mg/kg IV, IO, IM, or subcutaneous.
Indications: Moderate to severe pain, including chest pain associated with ACS, CHF, and pulmonary edema.
Fentanyl
Dosage: Individualized.
Adult: 50 to 100 mcg/ dose (0.05 to 0.1 mg) IM, or slow IV, IO (admin over 1 to 2 minutes)
Pediatric: 1 to 2 mcg/kg IM or slow IV, IO (admin over 1 to 2 minutes).
Indications: Pain
AKA: Sublimaze
Dilaudid
Dosage:
0.015mg/kg IV, IO, IM, every 15:00
2 mg to 4 mg, orally, every 4 to 6 hours.
Indications: Pain
AKA: Hydromorphone
Toradol
Dosage:
Adult
IV: 30 mg single dose or 30 mg every 6 hours not to exceed a maximal total daily dose of 120 mg
IM: 60 mg as a single dose or 30 mg every 6 hours not to exceed a maximal total daily dose of 120 mg
Older Adult (age >65 age or weight < 110lbs
IV: 15 mg as a single dose or 15 mg every 6 hours not to exceed a maximal total daily dose of 60 mg
IM: 30 mg as a single dose or 15 mg every 6 hours not to exceed a maximal total daily dose of 60 mg
Indications: Moderate to severe pain.
AKA: Ketorolac
E.2omidat.6
Dosage:
Adult: 0.2 to 0.6 mg/kg slow IV, IO (over 30 to 60 seconds); 0.3 mg/kg is used in many protocols/ references. A typical adult intubating dose is 20 mg slow IV. Consider less in older adults or patients with cardiac conditions.
Pediatric: Older than 10 years – Same as adult dosing. Younger than 10 years: Safety has not been established.
Indications: Induction for rapid sequence intubation and pharmacologic-assisted intubation, induction of anesthesia.
AKA: Amidate
Valium
Dosage:
Anxiety
Adult:
Moderate: 2 to 5mg slow IV, IM
Severe: 5 to 10mg slow IV, IM (no faster than 5 mg/min)
Low: Low dosages are required for older adults or debilitated patients
Pediatric: 0.2 to 0.3 mg/kg per dose IV, IM every 4 hours to a maximum dose of 0.6mg/ kg
Delirium Tremens
Adult: 10 mg IV
Seizure
Adult: 5 to 10 mg slow IV, IO every 10 – 15 minutes; maximum total dose 30mg
Pediatric:
IV, IO
5 years or older: 1 mg over a 3:00 period every 2 to 5 minutes to a max dose of 10 mg
Older than 30 days to younger than 5 years: 0.2 to 0.5 mg over a 3-minute period. May repeat every 2-5 minutes to a max total dose of 5 mg.
Neonate: 0.1 – 0.3 mg/kg per dose given over a 3-5 minute period; may repeat every 15 – 30 minutes to a max total dose of 2mg
Rectal Administration
12 years and older: 0.2mg/kg
6 to 11 years: 0.3 mg/kg
2 to 5 years: 0.5 mg/kg
Younger than 2 years: Not recommended.
Indications: Anxiety, skeletal muscle relaxation, alcohol withdrawal, seizures.
AKA: Diazepam
Ver2.5d
Dosage:
Healthy and younger than 60 years: Some patients require as little as 1mg IV, IO.
No more than 2.5 mg should be given over a 2:00 interval. If additional sedation is required, continue to admin small increments over a 2:00 period (max dose: 5mg).
If the patient also has received a narcotic, he or she will typically require 30% less Versed than the same patient not given the narcotic.
60 years and older and debilitated or chronically ill patients: This group of patients has a higher risk of hypoventilation, airway obstruction, and apnea. The peak clinical effect can take longer in these patients; therefore, dose increments should be smaller, and rate of injection should be slower. If additional sedation is required, additional Versed should be given at a rate if no more than 1 mg over a 2:00 period. Max Dose: 3.5mg.
If the patient also has received a narcotic, he or she will typically require 50% less Versed than the patient not given the narcotic.
Continuous infusion: can be required for prolonged transport of intubated, critically ill, and injured patients, after an initial bolus dose, the adult pt will require a maintenance infusion dose of 0.02 to 0.1 mg/kg per hour.
Pediatric (weight based): Peds patents typically require higher doses of Versed than adults on the basis of weight (in mg/kg). Younger peds patients (younger than 6 years) require higher doses (in mg/kg) than older peds patients. Versed takes 3:00 to reach peak effect; therefore, wait at least 2:00 to determine the effectiveness of the drug and the need for additional dosing.
12 to 16 years: Same as adult dosing. Some patients in this age group require a higher dosage than that of an adult, but rarely more than 10mg
6 – 12 years: 0.025 to 0.05 mg/kg IV, IO up to a total dose of 0.4 mg/kg. Exceeding 10 mg is typically not necessary.
6 months to 5 years: 0.05 to 0.1 mg/kg IV, IO up to a total dose of 0.6 mg/kg. Exceeding 6 mg is typically not necessary.
Younger than 6 months: Dose recommendations for this age group is unclear. This age group is especially vulnerable to airway obstruction and hypoventilation, use small increments with frequent evaluation. Dose 0.05 to 0.1 mg/kg
Indications: Sedation, anxiety, skeletal muscle relaxation.
AKA: Midazolam
A2ivan
Dosage:
Analgesia and sedation:
Adult: 2mg or 0.44 mg/kg IV, IO, whichever is smaller. This dosage will provide adequate sedation in most patients and should not be exceeded in patients older than 50 years.
Pediatric: 0.05 mg/kg IV, IO. Each dose should not exceed 2 mg IV, IO.
Seizures
Adult: 2 to 4 mg IV, IO, given over 2 to 5 minutes; may repeat in 10 – 15 minutes (max total dose: 8mg in a 12-hour period).
Pediatric: 0.1 mg/kg slow IV, IO given over 2 to 5 minutes (max single dose: 4mg) May repeat at half the original dose in 10 – 15 minutes if seizure activity resumes
Indications: Preprocedural sedation induction, anxiety, status epilepticus
AKA: Lorazepam
Phenergan
Dosage:
Adult: 12 to 25 mg IV, IO
Pediatric: 2 years and older: 0.25 to 1mg/kg IV, IO. (maximum rate of IV, IO administration is 25 mg/min)
Indications: Nausea / Vomiting
AKA: Promethazine
Zo4r8n
Dosage:
Adult: 4 to 8 mg/kg IV, IO, PO
Pediatric: 2 to 16 years: 0.15 mg/kg IV, IO (max dose 16 mg)
Indications: Prevent or treat Nausea / vomiting.
AKA: Ondansetron
Narcan
Dosage:
Adult: 0.4 to 2mg IV, IO, endotracheal, IM, or subcutaneous. Alternatively, admin 2mg intranasally. Higher doses (10 to 20 mg) may be required for OD’s of synthetic narcotics. A repeat dose of 1/3rd to 2/3rds the original dose is often necessary.
Pediatric:
5 year or older or weight > 20 kg:
2 mg IV, IO, ET, IM, or subcutaneous.
Younger than 5 years or weight < 20kg: 0.1 mg IV, IO, ET, IM, or subcutaneous. May repeat every 2 to 3 minutes.
Indications:
Narcotic overdoses, reversal of narcotics used for procedure-related anesthesia.
AKA: Naloxone
R0ma2icon
Dosage:
Adult: 0.2mg IV, IO, over a 15-second period. If the desired effect is not observed after 45 seconds, admin a second dose 0.2 mg dose, again over a 15 second period. Doses can be repeated a total of 4x until a total dose of 1 mg has been admin.
Pediatric: Children older than 1 year, 0.01 mg/kg IV, IO given over a 15 second period. May repeat in 45 seconds and then every minute to a maximum cumulative dose of 0.05 mg/kg or 1mg, whichever is lower.
Indications: Benzodiazepine oversedation
AKA: Flumazenil
