PCP: Analgesia

• ⚠️ PCP: requires BCEHS-specific education (Flight Training Program; including IN ketAMINE endorsement)
• Intranasal
  • Initial dose: 0.75 mg/kg IN (max dose 100mg); usual dose: 50-100 mg
  • ☎️ Mandatory consult prior to administration with 1)CCP-A 2)EPOS 3) CliniCall
  • May repeat 0.5 mg/kg after 20 minutes
  • Consult as per above for additional dosing instructions. No maximum cumulative dose.
  • Safety Alert: Remember to account for the 0.1 mL dead space in the MAD to ensure accurate dose is administered and documented. 
  • See PR11: Intranasal Medication Administration procedure

ACP: Analgesia

• Intravenous/Intraosseous
  • 0.25mg/kg (max 35mg) IV/IO slow push q 20 minutes prn
• Intramuscular
  • 0.25 - 0.5 mg/kg IM q 45 minutes prn

ACP: Procedural Sedation

• Intravenous/Intraosseous
  • 0.1-0.5 mg/kg slow push every 60 seconds to effect
  • Consider starting at 0.5 mg/kg; use subsequent doses of 0.25 mg/kg or less as needed
  • Titrate to effect

ACP: Anesthesia Induction

• Shock index less than 1
  • 1-2 mg/kg IV/IO
• Shock index greater than 1
  • 0.5-1 mg/kg IV/IO (may repeat at 2-5 minutes to a maximum total of 2 mg/kg)

ACP: Maintenance of Anesthesia

• Infusion: 2 mg/kg/hour IV/IO (range 0.5-4 mg/kg/hour IV/IO)

      OR

• Direct: 0.5-1 mg/kg IV/IO q15 - 30 minutes

ACP: Excited Delirium

• Intramuscular
  • 4-5 mg/kg bolus
  • Maximum single/cumulative dose 500 mg
    • CliniCall consultation required if appropriate sedation is not achieved
  • Maximum volume of administration
    • Deltoid: 2 mL
    • Lateral thigh: 4-5 mL
    • Gluteal: 5 mL

PCP: Analgesia (Ages 5-11 years)

• ⚠️ PCP: requires BCEHS-specific education (Flight Training Program; including IN ketAMINE endorsement)
• Intranasal
  • 1 mg/kg IN (Maximum 100mg)
  • ☎️ Mandatory consult prior to administration with 1)CCP-A 2)EPOS 3) CliniCall
  • May repeat 1 mg/kg IN after 20 minutes prn
  • Consult as per above for additional dosing instructions. No maximum cumulative dose.
  • Safety Alert: Remember to account for the 0.1 mL dead space in the MAD to ensure accurate dose is administered and documented. 
  • See PR11: Intranasal Medication Administration procedure

ACP: Analgesia (Aged > 6 months)

• Intravenous/Intraosseous
  • 0.25 mg/kg (maximum 20mg) slow push q 20 minutes prn (Total max 0.6mg/kg)
• Intranasal
  • 1 - 1.5 mg/kg IN (Max 100mg) 
  • May repeat 1 mg/kg IN in 20 minutes prn
  • See PR11: Intranasal Medication Administration procedure

ACP: Procedural Sedation

• See adult dosing guidelines; follow weight-based dosing regimen

ACP: Anesthesia Induction

• Stable hemodynamics
  • 1-2 mg/kg IV/IO
• Unstable hemodynamics
  • 0.25-1 mg/kg IV/IO (may repeat at 2-5 minutes to a maximum total of 2 mg/kg)

ACP: Maintenance of Anesthesia

• Infusion: 5-20mcg/kg/min IV/IO

      OR

• Direct: 0.5-1 mg/kg IV/IO q15 - 30 minutes

ACP: Excited Delirium

• CliniCall consultation required prior to administration for any patient under 12 years of age
• See adult dosing guidelines for excited delirium above