- For use in trauma where the patient or other retrieval personnel’s safety are potentially at risk
- Time Critical Packaging/Transport of a patient is required
- Where a procedure is necessary and anticipated to cause extreme pain/distress to the patient
- Provide and maintain Analgesia/Sedation during the following trauma procedures:
- Extrication of significantly injured/trapped patient
- Splinting/realignment of fractures
- Finger Thoracostomy
- Patients requiring RSI
- Patients with current airway compromise
- Intended for very short duration, generally one off event
- High index of suspicion for potential airway compromise
- Current haemodynamic status
- Known comorbidities
- The potential for pulmonary aspiration and hypoventilation should be considered when determining the level of sedation
- Medications should be administered incrementally, titrate to effect. If both sedatives and analgesics are used, dose reduction should be considered
- Procedure only performed if able to ventilate/oxygenate patient should apnoea occur
- EtCO2 monitoring should be considered for all patients
- Administration of Ketamine should be given as a slow bolus to reduce chances of apnoea and laryngospasm
- Should laryngospasm occur management with IPPV via BVM
- Consider emergence syndrome problems with Ketamine where high stimuli situations may be present
Preparation:
- Establish vascular access
- Ondansetron as per guideline
- Pre-oxygenated prior to procedure with non-rebreather/nasal prongs
- Ensure monitoring during procedure, ECG, NiBP, SpO2
- Prepare equipment for resuscitation; BVM, OPA / NPA
- Suction available
- Analgesia as per guideline
- Consider patient positioning; head higher than stomach if possible
- Prepare all required equipment prior to sedation e.g. traction splints/dressings/thoracostomy and extrication equipment.
- Once sedation achieved perform relevant procedure/skill
- Regular reassessment of vital signs
- Continue management of patient as per relevant CPG.
- Hypoventilation
- Hypertension
- Tachycardia
- Reduced GCS
- In certain situations not all preparation may be possible e.g. vehicle extrication
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