Sedation of Trauma Patients in the Emergency Department

Guidelines

Text:
1. Assess patient for reversible causes of agitation / restlessness:
Hypoxia
Na, K, Ca Abnormalities Drug / ETOH Withdrawal
Pain

Cerebral Hypoperfusion

Fear, depression, excess noise,

lack of sleep

2. Titrate Sedatives to Sedation Score ________________ (2-3)

Level
Response
1

Anxious, agitated, restless

Cooperative, oriented, tranquil

Sedated but responds to commands

Asleep but responds to loud auditory stimulus/gentle shaking

Asleep, responds only to loud auditory stimulus / painful

shaking

No response to painful stimulus

3. Monitor for adequacy of sedation with Sedation Scale every 10-15

minutes.
4. Medication:
Midazolam
Initial dose ________ mg (0.5-2.5mg) slow IV push x 1
Continuous infusion ________mg/hr (1-5mg/hr), may
increase infusion by 0.5-2.5 mg/hr every hour until
response, toxicity or maximum dose of 10mg/hr.
Propofol

Initial dose 5 mcg/kg by slow IV push (given by doctor)

Continuous infusion 5 mcg/kg/min, may increase infusion
by 5-10 mcg/kg/min every 5-10 min until response, toxicity
or maximum dose of 100 mcg/kg/min.
When the non-intubated patient leaves the department for
any reason on Propofol, he/she must be accompanied by a
physician.

**Severe respiratory depression may occur with these regimens.

Caution should be exercised when administering them to nonintubated patients or patients being weaned from mechanical

ventilation. Maximum doses are arbitrary and are intended to

prompt the clinician to investigate other potential problems (i.e.,
uncontrolled pain, paradoxial drug reaction, hypoxia)**