Emergency Sedation
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Emergency Sedation
Indications:
Risk to self or others (inc impeding Rx or transfer)
Extreme distress
Contraindications:
Armed
Anaphylaxis
Explain to family
Offer PO
Olanzapine (unless on Risperidone or has Diabetes Mellitus)
Glass of water first
Can dissolve in any liquid except Coke/Grape juice
5mg <40kg, 10mg > 40kg (0.1-0.2mg/kg) on a gloved finger
Repeat at 60mins with Oral Diazepam if fails
Max 20mg/24hr <40kg or 30mg/24hr >40kg
Side effects: lower seizure threshold, hypotension, extrapyramidal symptoms, NMS
Risperidone if already taking, or diabetic
2mg (0.03-0.065mg/kg)
Repeat at 2 hours
Max/24hr: 4mg <40kg or 6mg >40mg
Side effects: Extrapyramidal (drooling), hypotension, Neuroleptic malignant syndrome,
Diazepam
5-20mg (0.2-0.4mg/kg)
Can repeat at 2 hours
Max/24hr 40mg <40kg or 120mg >40kg
Side effects: Respiratory depression, hiccoughs
Restraint -
7 people (TL, 5 point, administrator)
head restrainer only talking to pt in goggles
Face up in cub 7
IV Tranquilise (incremental) if possible
Alternate
IV Midazolam
0.1-0.2mg/kg (max 10mg/dose)
S.E.: Resp depression, laryngospasm, bronchospasm, hiccoughs
Antidote: Flumazenil 5microg/kg IV (max 200microg), repeat minutely, max 1mg
with
IV Haloperidol
0.01-0.1mg/kg (max 5mg/dose, 10mg total)
S.E. Tachycardia, reduced seizure threshold, hypotension, urine retention, laryngospasm, bronchospasm, NMS, extrapyramidal, prolonged QT.
IM Tranquilise then IVC ASAP
Haloperidol 5mg <40kg, 10mg >40kg AND Midazolam 5mg<40kg, 10mg>40kg
OR Olanzapine 5mg <40kg, 10mg >40kg
Neuroleptic Malignant Syndrome - hyperpyrexia, muscle rigidity, altered mental status, autonomic instability, raised CPK, myoglobinuria, renal failure
Rx Dantrolene
Extrapyramidal: PO risperidone, IV haloperidol
dystonia, opisthotonus, oculogyric crisis, hyperreflexia, restlessness, akasthisia
Rx PO/IV/IM Benztropine 0.1-0.2mg/kg, repeat 15minutely (max 4mg/24hr)
OBS
Alert: 30min obs
Drowsy: continuous sats, ECG, BP, and Neuro
Agitated: Nurse special
PRN sedation
Workup and refer to Psych
Schedule
Debrief
Emergency Sedation
Indications:
Risk to self or others (inc impeding Rx or transfer)
Extreme distress
Contraindications:
Armed
Anaphylaxis
Explain to family
Offer PO
Olanzapine (unless on Risperidone or has Diabetes Mellitus)
Glass of water first
Can dissolve in any liquid except Coke/Grape juice
5mg <40kg, 10mg > 40kg (0.1-0.2mg/kg) on a gloved finger
Repeat at 60mins with Oral Diazepam if fails
Max 20mg/24hr <40kg or 30mg/24hr >40kg
Side effects: lower seizure threshold, hypotension, extrapyramidal symptoms, NMS
Risperidone if already taking, or diabetic
2mg (0.03-0.065mg/kg)
Repeat at 2 hours
Max/24hr: 4mg <40kg or 6mg >40mg
Side effects: Extrapyramidal (drooling), hypotension, Neuroleptic malignant syndrome,
Diazepam
5-20mg (0.2-0.4mg/kg)
Can repeat at 2 hours
Max/24hr 40mg <40kg or 120mg >40kg
Side effects: Respiratory depression, hiccoughs
Restraint -
7 people (TL, 5 point, administrator)
head restrainer only talking to pt in goggles
Face up in cub 7
IV Tranquilise (incremental) if possible
Alternate
IV Midazolam
0.1-0.2mg/kg (max 10mg/dose)
S.E.: Resp depression, laryngospasm, bronchospasm, hiccoughs
Antidote: Flumazenil 5microg/kg IV (max 200microg), repeat minutely, max 1mg
with
IV Haloperidol
0.01-0.1mg/kg (max 5mg/dose, 10mg total)
S.E. Tachycardia, reduced seizure threshold, hypotension, urine retention, laryngospasm, bronchospasm, NMS, extrapyramidal, prolonged QT.
IM Tranquilise then IVC ASAP
Haloperidol 5mg <40kg, 10mg >40kg AND Midazolam 5mg<40kg, 10mg>40kg
OR Olanzapine 5mg <40kg, 10mg >40kg
Neuroleptic Malignant Syndrome - hyperpyrexia, muscle rigidity, altered mental status, autonomic instability, raised CPK, myoglobinuria, renal failure
Rx Dantrolene
Extrapyramidal: PO risperidone, IV haloperidol
dystonia, opisthotonus, oculogyric crisis, hyperreflexia, restlessness, akasthisia
Rx PO/IV/IM Benztropine 0.1-0.2mg/kg, repeat 15minutely (max 4mg/24hr)
OBS
Alert: 30min obs
Drowsy: continuous sats, ECG, BP, and Neuro
Agitated: Nurse special
PRN sedation
Workup and refer to Psych
Schedule
Debrief