In this post I excerpt “Post-intubation sedation and analgesia” from EM Quick Hits 26 LAST, Sodium Nitrite Poisoning, Post-intubation Care, Tetracaine for Corneal Abrasion, ST Segment in Occlusion MI, Coping with COVID. [Link is to the podcast and show notes.] Published February 2021. This segment of the podcast is from 17:29 to 25:57.
Here is the excerpt:
Post-intubation sedation and analgesia
- Under-treatment or over-treatment of pain and agitation of the post-intubation patient in the ED may increase the likelihood of the patient developing acute delirium, which has been associated with an increased mortality rate in ICU patients suffering from severe sepsis or septic shock and may prolong ICU stay
- For patients who are aggressively attempting to pull out their ETT and require immediate sedation and analgesia, consider Ketamine 0.7mg/kg IV (approx. 50mg IV), then 0.15-0.25mg/kg q5-10 mins prn titrated to effect.
- Benzodiazepines may increase the incidence of delirium and prolong the time on the ventilator, and so are not favored as a first line for sedation; if you choose to use benzodiazepines, be sure to control pain first with fentanyl before any benzodiazepine is administered, and use small doses (eg: 1-2mg Midazolam)