Post Intubation Pain, Agitation, & Delirium Treatment
Today, Candice and I discuss post-intubation sedation. We see a lot of problematic choices happening to patients after the tube is place.
The FoundStab Precepts from this post
Sedation
1. Use Propofol over Benzos for sedation
2. Standard Propofol Dosing is 20-50 mcg/kg/min
2.5 If you intubated with rocuronium, use higher doses of propofol and/or administer midazolam 2-4 mg
3. Use a sedation scale to allow quantification and titration of sedation
If your hospital doesn’t already have one, we recommend the RASS
Aim for sleepy, and arousable to voice (RASS -1 or -2) unless clinical circumstances dictate deeper sedation
Pain
4. Start with a bolus of opioid pain medication
e.g. 1 mg hydromorphone or 0.1 mg/kg of morphine
5. If transferring the patient, consider starting a fentanyl drip or administering a long-acting pain medication bolus just prior to transport
6. If keeping the patient, check for the need for additional intermittent boluses of pain medication q1 hour
7. Use a pain scale with hourly assessments for pain
If your hospital doesn’t have one, we recommend the CPOT score
8. Do not titrate pain or sedation medications for hypotension
Misc.
9. Call for norepi to be hanging at bedside on pump after every intubation with a standing order to begin if MAP < 65
10. Intubated patients in the ED should have soft, wrist restraints places without the need for arduous, high-risk documentation or sitters
Mitts before Wrists
cut the ties so you are Joint Commission safe
Intubation Checklist
EMCrit 176 – Updated EMCrit Rapid Sequence Intubation Checklist
Awareness during Paralysis
Sedation Posts on EMCrit
Richmond Agitation and Sedation Scale (RASS)
Critical Care Pain Observation Tool (CPOT) Scale
from Afenigus et al.
Front. Pain Res., 14 October 2024 Volume 5 – 2024 | https://doi.org/10.3389/fpain.2024.1481085
Additional New Information
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Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Nassau University Medical Center
No conflicts of interest (coi).
