ANALGESIA AND SEDATION

Refer to the PCC guidelines and Analgesia and Sedation Management during Prolonged Field Care CPG for a thorough guide to pain and sedation management.

Pearls

- Utilization of a multimodal (i.e., local anesthetics, ketamine, dexmedetomidine, etc.) approach to analgesia in the polytrauma casualty is advised to avoid oversedation and the risk of apnea associated with ever increasing doses of opioids and benzodiazepines.18
- When possible, have on hand reversal agents for opioids (Naloxone) and benzodiazepines (Flumazenil), and be familiar with their dosing.19
- Consider duration of action and the effects of cumulative dosing during procedural sedation; anticipate the need for prolonged monitoring in the post-procedural period.19
- Consider decreasing standard dosing in the shock casualty, and always anticipate potential cardiovascular collapse with drugs that decrease sympathetic tone, particularly in the catecholamine depleted casualty (i.e., the under resuscitated casualty, or one with a prolonged extraction time, etc.).