PCP: Analgesia

• ⚠️ PCP: requires BCEHS-specific education (Flight Training Program; including IN ketAMINE endorsement)
• Intranasal
  • 0.75 mg/kg initial dose (usual dose 50-100 mg)
  • ☎️ Mandatory consult prior to administration with 1)CCP-A 2)EPOS 3) CliniCall
  • Maximum single dose 100 mg
  • 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
  • 0.3 mg/kg slow push
  • May repeat 0.15 mg/kg after 5 minutes
  • Maximum cumulative dose 0.6 mg/kg in 45 minutes
• Intramuscular
  • 0.5 mg/kg
  • May repeat 0.3 mg/kg after 45 minutes

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

• Intravenous/Intraosseous: 2 mg/kg if shock index < 1
• Intravenous/Intraosseous: 1 mg/kg if shock index ≥ 1

ACP: Maintenance of Anesthesia

• Half of required induction dose every 10-15 minutes as required

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 initial dose
  • ☎️ Mandatory consult prior to administration with 1)CCP-A 2)EPOS 3) CliniCall
  • Maximum single dose 100 mg
  • May repeat 1 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 (Aged > 6 months)

• Intravenous/Intraosseous
  • 0.3 mg/kg slow push
  • Maximum single dose 20 mg
  • Repeat every 2-3 minutes to a total cumulative dose of 0.6 mg/kg
• Intramuscular
  • 0.5 mg/kg
  • May repeat 0.3 mg/kg at 45 minutes
• Intranasal
  • 1.5 mg/kg
  • May repeat 1 mg/kg at 20 minutes
  • Maximum single dose 100 mg
  • See PR11: Intranasal Medication Administration procedure

ACP: Procedural Sedation

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

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