Special Considerations

Patient Monitoring During Sedation

Patients receiving analgesia and sedation require close monitoring for life-threatening side-effects of medications.

- Minimum: Blood pressure cuff, stethoscope, pulse oximeter; document vital signs trends.
- Better: Capnography in addition to minimum requirements
- Best: Portable monitor providing continuous vital signs display and capnography; document vital signs trends frequently.

Analgesia and Sedation for Expectant Care (i.e. End-of-Life Care)

An unfortunate reality of our profession, both military and medical, is that we encounter clinical scenarios that will inevitably end in a patient’s death. In these situations, it is a healthcare provider’s obligation to give palliative therapy to minimize the person’s suffering. In these circumstances, the use of opioid analgesics and sedative medications is therapeutic and indicated, even if these medications worsen a patient’s vital signs (i.e., cause respiratory depression and/or hypotension). If a patient is expectant:

- Teleconsultation
- Prepare to:
  - Give opioid until the patient’s pain is relieved. If the patient is unable to communicate their pain, give opioid medication until the respiratory rate is less than 20/min.
  - If the patient complains of feeling anxious (i.e., is worrying about the future but not complaining of pain) or he cannot express himself but is agitated despite having a respiratory rate less than 20/min, give a benzodiazepine until the anxiety is relieved or the patient is sedated (i.e., is not feeling anxious or is no longer agitated).
- Position the patient as comfortably as possible. Pad pressure points.
- Provide anything that gives the patient comfort (e.g., water, food, cigarette).
- Under no circumstances should paralytics be used without analgesia/sedation

*Link to Analgesia and Sedation Management in Prolonged Field Care, 11 May 2017 CPG 15

*Link to Pain, Anxiety and Delirium, 26 April 2021 CPG 16