What
aspects of temperature-targeted management are most important to
EMS, and how should EMS guide sedation for the patient with a
return of spontaneous circulation? Check out this interview w/ Dr.
Leon Eydelman! The ROSC class referenced in this video can be found
in FOAMfrat Studio!
Trust
a high temperature and question a low one.
While
most EMS agencies likely do not carry propofol, it is the most
commonly used sedation medication in the ED because it washes out
quickly and allows for neuro eval. Benzodiazepines are associated
with higher rates of ICU delirium and complications. Running
levophed to counteract the vasodilation aspect of propofol. Don't
have propofol; hemodynamic-dosed ketamine is a good option as
well.
The
sedation dose should be reduced when the shock index is > 0.9.
When a patient is in shock, their volume of distribution changes,
and peripheral blood flow is reduced. This means more blood is
shunted to the brain,, and lower doses of sedation will give the
agent therapeutic brain levels.