• 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
Patient Factors & Considerations
  • 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



  • Ensure patient/bystanders are briefed
  • Ensure airway is protected
  • High flow oxygen in situ.
  • Ketamine as per guideline
  • Once sedation achieved perform relevant procedure/skill
  • Regular reassessment of vital signs
  • Continue management of patient as per relevant CPG.
Additional Information
  • Hypoventilation
  • Hypertension
  • Tachycardia
  • Reduced GCS
  • In certain situations not all preparation may be possible e.g. vehicle extrication


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