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.
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 calculatorCommon 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.
Clinical review / use limits
Authored by: Airway of the Month education team. Last reviewed: July 2026. Audience: EM learners, faculty, EMS, RT, simulation educators, and airway teams.
This is an educational cognitive-aid scaffold, not a bedside order set. Verify medications, ventilator changes, pediatric dosing, and procedures against local ED, ICU, anesthesia, pharmacy, RT, EMS, and pediatric policies.
Resources · Editorial policy · ACEP intubation policy · ARDS ventilation reference