Principles

- In an R1 or PFC setting, intravenous (IV) or interosseous (IO) medication delivery is preferred over intramuscular (IM) therapies. The IV/IO route is more predictable in terms of dose-response relationship.
- Remember, you can always give more, but it is very difficult to take away. Therefore, it is easier to prevent cardiorespiratory depression by being patient and methodical. Titrate to effect.
- Smaller, more frequent doses of medications are preferred to single large doses to achieve a constant level of pain control and sedation over a longer time.
- The lower the blood volume, the less drug and time will be needed to achieve similar effects as compared with a normovolemic patient. Start low, go slow.

Engage telemedicine support early and often if you are inexperienced in delivering analgesia and sedation beyond TCCC or if you are having difficulty.