Pacing - sedation or analgesia + sedation?

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NYMedic828

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So people are always posting that regardless of being sedated, procedures such as intubation are still painful to the patient to some degree.

Does the same concept apply to pacing and cardioversion?

For example if I am going to pace someone using 5mg versed should it really be 5mg of versed and 5mg of morphine/50-100mcg of fentanyl?

All of this is really just wishful thinking for NYC, but I could pull it off easy on my volunteer region. (NYC medics don't seem to share my beliefs on analgesia. Fentanyl has been used twice in the entire city and one was by accident)

For reference, here in NYC the "written" protocols are (non standing order)

Intubation
5-10mg IV Valium repeat of 5-10mg max 20mg
1-2mg IV versed repeats of 1mg max 5mg.
Etomidate 0.3mg/kg max 20mg IV w/ 5mg valium


Pacing allows for same benzo/etomidate dose as intubation.

Cardioversion allows for
0.15mg/kg etomidate max of 10mg.
Valium or versed same as intubation.
 
The only time I've ever cardioverted someone, they were unconscious, so I can't answer this question from personal experience. However, we're allowed to give up to 0.3 mg/kg of Versed for sedation prior to cardioversion or pacing.
 
we use analgesia only for pacing, 2-10mg morphine works great with no need for additional sedation.

as someone who has been paced I can tell you there really isnt a need for sedation. the procedure its self isn't terrifying, it just hurts like a SOB, take away the pain and the patient will by just fine.
 
NYMedic828 said:
So people are always posting that regardless of being sedated, procedures such as intubation are still painful to the patient to some degree.

Does the same concept apply to pacing and cardioversion?

For example if I am going to pace someone using 5mg versed should it really be 5mg of versed and 5mg of morphine/50-100mcg of fentanyl?

All of this is really just wishful thinking for NYC, but I could pull it off easy on my volunteer region. (NYC medics don't seem to share my beliefs on analgesia. Fentanyl has been used twice in the entire city and one was by accident)
Click to expand...

A decent slug of fentanyl has worked well for me (read: them) in the past. I haven't yet had to add versed, but that would be my next choice.

NYMedic828 said:
Pacing allows for same benzo/etomidate dose as intubation.
Click to expand...

Etomidate for pacing seems like a bit much!
 
Christopher said:
A decent slug of fentanyl has worked well for me (read: them) in the past. I haven't yet had to add versed, but that would be my next choice.



Etomidate for pacing seems like a bit much!
Click to expand...

oops sorry that was a typo. Etomidate is only for intubation/cardioversion.

Benzo only for pacing. But I feel like analgesia is what it should be...
 
fast65 said:
The only time I've ever cardioverted someone, they were unconscious, so I can't answer this question from personal experience. However, we're allowed to give up to 0.3 mg/kg of Versed for sedation prior to cardioversion or pacing.
Click to expand...

Man, 0.3/kg of midaz is a crap-ton. I've cardioverted numerous times over the years and I'd say rarely do you ever need more than 5 mg. No need for analgesia in cardioversion (and I'm a big pain med fan) but the pain is so short lived that the analgesia won't really do much.

As for pacing I've generally stuck with midaz as well. Take people to their happy place and they'll never remember a thing. I think if you end with with a breathing patient with an NPA in place and decent tidal volume while being effectively paced you're doing well..
 
fast65 said:
The only time I've ever cardioverted someone, they were unconscious, so I can't answer this question from personal experience. However, we're allowed to give up to 0.3 mg/kg of Versed for sedation prior to cardioversion or pacing.
Click to expand...

Hmmm, so on the average 70kg patient, you're going to give them 20mg of versed before you cardiovert them? Really?
 
I'm going to assume that's supposed to be 0.03mg/kg... :unsure:
 
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