Current medication exposures
›Medication reconciliation
›Home sedatives and hypnotics
›Home opioids
›Alcohol use pattern
›Stimulants
›Antipsychotics
›Antidepressants
›Antiepileptics
›Antihypertensives
›Anticoagulants and antiplatelets
Sedation agents and dosing
›Common ED agents
›Ketamine IV
›Adult 0.5 to 1 mg per kg IV for dissociation
›Pediatric 1 to 2 mg per kg IV for dissociation
›Redose 0.25 to 0.5 mg per kg IV as needed
›Ketamine IM
›Pediatric 4 to 5 mg per kg IM
›Redose 2 to 3 mg per kg IM if inadequate
›Propofol IV
›Adult 0.5 to 1 mg per kg IV initial
›Redose 0.25 to 0.5 mg per kg IV every 1 to 3 minutes
›Lower initial dose in older adults
›Etomidate IV
›Adult 0.1 to 0.2 mg per kg IV
›Avoid repeat dosing if possible
›Midazolam IV
›Adult 0.02 to 0.05 mg per kg IV
›Typical incremental dosing 0.5 to 1 mg IV every 2 to 3 minutes
›Fentanyl IV
›Adult 0.5 to 1 microgram per kg IV
›Redose 0.5 microgram per kg IV every 3 to 5 minutes
›Nitrous oxide inhaled
›Concentration local protocol dependent
›Avoid in pneumothorax risk
Reversal and rescue medications
›Reversal agents
›Naloxone IV
›0.04 mg IV titrate every 2 minutes to ventilation
›Typical total 0.4 to 2 mg IV
›Flumazenil IV
›0.2 mg IV over 15 seconds
›Repeat 0.2 mg IV every 1 minute
›Maximum 1 mg IV initially
Contraindications and interaction traps
›High risk medication interactions
›Benzodiazepine plus opioid synergy and apnea risk
›Propofol hypotension risk with antihypertensives
›Ketamine catecholamine depletion hypotension risk in shock
›Flumazenil seizure risk with chronic benzodiazepine use
›Flumazenil seizure risk with mixed overdose concern