Post-Airway  Placement 

• Minimum (without IV access): Ketamine (sedation dose), 3-4mg/kg IM
• Better: IV/IO pushes of ketamine, opioid, and/or midazolam (alone or in combination as per the individual’s scope of practice, experience, and availability of medications)
• Best: Ketamine IV/IO Drip. Hydromorphone or alternate opioid IV/IO push for breakthrough pain and midazolam IV/IO push as needed for sedation

(Reference JTS Analgesia and Sedation Management During Prolonged Field Care CPG for details and drug doses).⁸

Neuromuscular blockade (succinylcholine, rocuronium, vecuronium, etc.) is only recommended for use by those trained and practiced in its use.  Though these are standard medications to use in rapid sequence intubation and ventilator management, their potential lethality in inexperienced hands does not justify routine use.  If trained and/or under direct supervision of telemedicine support, the use of neuromuscular blockade may be considered, subject to local medical direction and protocols.