Conscious Sedation Procedures in Field Hospitals

[BadEnoughDudeRescueRonny]

I know that this may seem like a foolish question, but what is the standard conscious sedation procedure used in field settings. Is it the same as what one would find in a North American ED such as the combination of midazolam (Versed) and fentanyl or in some cases, infusions of smaller doses of Diprivan. Are "second-line" alternatives such as ketamine or nitrous oxide used?

I'm just wondering because of the monitoring and labor  needed to induce safe conscious sedation, given that ketamine does not induce respiratory depression and arguably does not increase intracranial pressure (this statement varies from source to source). However, as some sources indicate that ketamine increases ICP and is thus contraindicated for cranial trauma, what options are commonly used in field hospitals. Are fluranes used whatsoever?

 

[Armymedic]

There is no "standard" other than the current practices used by the clinicians in their every day jobs in civ ERs.

I have not seen fluranes used except by anesthesiologists. But then, that would not be considered a "conscious" sedation.

 

[BadEnoughDudeRescueRonny]

Yeah, I just realized that when I asked about fluranes, I left the realm of conscious sedation and entered into the world of general anaesthesia .

 

[Cantthinkofanything]

I haven't seen midazolam used in an ED in quite some time at least where I work, propofol or ketamine is what I have seen more often for resetting fractures etc.

 

[medicineman]

When I was still a staff geek in Victoria, we were working on a protocol for PA's that incorporated versed and fentanyl...however, most ER's I worked in used propofol +/- fentanyl or ketafol (ketamine/propofol) for kids.  As for CF standard, depends on the formula the person concerned is (a) cleared to use and (b) has available.

MM

 

[ModlrMike]

The last time I deployed, the protocol was Fentanyl and Versed, unless you were certified "Conscious Sedation" and then Ketamine could be added. Needless to say pharmacy got their nickers twisted and Ketamine was unavailable.


As for ED use, I use Midazolam every couple of days for sedation. It works great for reducing dislocations.

 

[Armymedic]

Ketamine is now in the PA Rx list.

Ketamine and midazolam make for a pretty tidy cocktail.

But the last time I checked, they don't have Versed in the PA list. Not sure why, as it is in the AEC protocols....?

 

[Hunter]

Versed and Midazolam are the same thing.

Versed = Midazolam
Valium = Diazepam

Versed and Valium are trade names for these medications.

 

[Nemo888]

Is epidural anesthesia catching on? We use that on all the total joint replacements with Fentanyl and Propofol. The anesthesiologists are not fond of fluranes. I remember how freaked out I was the first time I saw a patient wake up while we were sawing off the ball of his femur. A little squirt of propofol and right back to sleep.