Download INDICATIONS Intubated Patients THE FOLLOWING CRITERIA

Patient Stamp
330 Mount Auburn Street, Cambridge, MA 02138
ICU SEDATION
PHYSICIAN ORDERS Page 1 of 2
IMPORTANT: PLEASE WRITE LEGIBLY. Orders with a Box  Require a Check Mark to Activate
INDICATIONS

Intubated Patients
EXCLUSIONS

THE FOLLOWING CRITERIA
INDICATE PATIENT IS A
CANDIDATE FOR CONTINUOUS
INFUSION OF
ANALGESIA/SEDATION:

High peep greater than 10

PIP greater than 45 cm

Continuous de-saturations with
agitation

Pressure controlled ventilation

Inverse I:E ratios

Bolus sedation inadequate to achieve
ventilation goals
Use Bolus Dosing if patient does
not fit criteria for continuous
infusion
Physician Signature:_____________________________ Date: ____ Time: ______ Beeper: ________
Printed Name: _____________________________________
RN Signature: ______________________________________ Date: ____ Time: ______ Fax Time:
_____
1310 Vrsion 6/1/06 MEDICAL RECORD COPY
Patient Stamp
330 Mount Auburn Street, Cambridge, MA 02138
ICU SEDATION
PHYSICIAN ORDERS Page 2 of 2
IMPORTANT: PLEASE WRITE LEGIBLY. Orders with a Box  Require a Check Mark to Activate
Drug Sensitivities:_______________________________
Height: _________
Actual body weight: _________Kg Ideal Body Weight (if applicable): _________Kg
RASS Score
Doses/Drips are given per RASS score of: _________________ (Suggested goal of 0 to –1)
Richmond-Agitation Scale (RASS)
Score
+4
+3
+2
+1
0
-1
-2
-3
-4
-5
Descriptor
Combative
Very agitated
Agitated
Restless
Alert and calm
Drowsy
Light sedation
Moderate
sedation
Deep sedation
Not arousable
Characteristics
Combative, violent, immediate danger to self/staff
Pulls or removes tubes, aggressive
Frequent, non-purposeful movements, fights ventilator
Anxious, but movements not aggressive or vigorous
Eyes open and contact to voice >10 seconds
Briefly awakens with eye contact to voice < 10 sections
Movement or eye open (no eye contact) to voice
No response to voice, but movement or eye opening to physical stimulus
No response to physical stimulation
Sedation Protocol Bolus Dosing and Continuous Drip
Versed: Caution use in Renal or Hepatic Failure
 Severe agitation may give Versed (Midazolam) bolus 2 to 5 milligrams IV every 20 min prn per RASS score of 3 or 4.
 Versed (Midazolam) bolus 2 to 5 milligrams IV every 2 - 4 hr prn .
 Versed (Midazolam) drip. Bolus 2 to 5 milligrams IV. Titrate drip 1 to 2 milligrams every hour prn. Every increase in dose is
accompanied by a bolus dose. Maximum drip rate 30 milligrams/hr. Higher doses require a separate Dr Order.
Propofol: Use for Sedation less then 48 hour. Patient must have a Protected Airway
 Propofol Drip start at 5 to 10 micrograms/kg/min. Can increase IV infusion by 5 micrograms/kg/min every 10 min prn until
desired RASS score. Dose range 5 to 50 mcg/kg/min. Higher doses >50 mcg/kg/min assess need for analgesia.
Analgesia Protocol Bolus Dosing and Continuous Drip
 Morphine Sulfate bolus 2 to 4 milligram IV every 1 to 4 hr prn pain Titrate to pain score. Re-bolus if needed.
 Morphine Sulfate drip. Bolus dose then start IV drip at 1milligram/hr. Increase drip 1 milligram/hr/prn Titrate to pain score.
Re-bolus before increasing drip. Consider use of Fentanyl in patients with CrCl < 15 ml/min or hypotension.
Fentanyl bolus 25 to 50 micrograms IV every 1 to 2 hr prn pain. (Preferred over Morphine for hemodynamic instability)
Fentanyl drip Bolus dose then start IV at 1micograms/kg/hr. Increase drip by 25 to 50 micrograms/hr. Titrate to pain scale.
Re-bolus if needed before increasing drip.
Agitation Dosing Recommendations
 Haldol 2 to 5 milligrams IV (Mild to Moderate Agitation) every 4 to 6 hours IV prn.
Haldol 5 to 10 milligrams IV (Severe Agitation) every 4 to 6 hours IV/prn. (EKG to be done Q24/hours to measure QTC)
Other Orders:
 ___________
 ___________
Physician Signature:_____________________________ Date: ____ Time: ______ Beeper: ________
Printed Name: _____________________________________
RN Signature: ______________________________________ Date: ____ Time: ______ Fax Time:
_____
1310 Vrsion 6/1/06 MEDICAL RECORD COPY