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Rescue pathway

Sedation and analgesia medications

Prevent awake paralysis and treat dyssynchrony while protecting hemodynamics.

Sedation calculatorWeight-based bolus/rate amounts.If BP is fallingMedication/hypotension branch.If dyssynchronousWaveform/ventilator mismatch branch.

Use the focused sedation calculator

Includes fentanyl, propofol, ketamine, midazolam, dexmedetomidine, and emergency neuromuscular reversal reference. Verify with local protocol and medication concentration.

Open sedation calculatorOpen medication dose calculator

Principles

  • Analgesia and sedation should be ready before paralysis when feasible.
  • Choose drug by physiology: shock, bronchospasm, neuro, agitation, hemodynamics.
  • Verify local dosing, pump concentration, and contraindications.

Common buckets

  • Fentanyl: analgesia; watch hypotension/chest wall rigidity at high rapid doses.
  • Propofol: titratable hypnosis; hypotension caution.
  • Ketamine: analgesia/dissociation; useful in bronchospasm/shock contexts but still requires judgment.
  • Midazolam: anxiolysis/amnesia; prolonged sedation/hypotension/delirium concerns.
  • Dexmedetomidine: cooperative sedation/adjunct; bradycardia/hypotension and slower onset considerations.

Evidence and use limits

Last reviewed: 2026-07-23. Designed for: emergency medicine learners, clinicians, EMS, RT, and airway educators.

This is an educational cognitive aid, not a bedside order set. Confirm medications, ventilator changes, pediatric dosing, procedures, and escalation decisions against the patient’s physiology, the ventilator in use, and local ED/ICU/anesthesia/pharmacy/RT/EMS/pediatric policy.

Full references · Editorial policy · AARC 2024 ventilator assessment · ATS/ESICM/SCCM lung-protective ventilation · ATS 2024 ARDS update

About this resource
Created by: Andrew Pirotte, MD; Kyle Brown, MD; Reba Hodge, MD; Amanda Vanderwerf, PharmD, BCEMP; Morgan Kimball, PharmD, BCEMP; Joshua Mohess Clinical review: Clinical review pending: local ED, ICU, EMS, anesthesia, pharmacy, and pediatric protocol review recommended before bedside teaching rollout. Last reviewed: 2026-07-23 Next scheduled review: 2027-01-23 Designed for: EM residents, emergency physicians, EMS clinicians, airway educators, and simulation faculty Important: Educational resource and cognitive-aid guide only; not a bedside order set or substitute for local protocol, medical direction, or clinical judgment. Website contact: kybrown@kumc.edu