Page 197 - ATP-P 11th Ed

d. IF MENINGITIS IS SUSPECTED OR IF THERE IS A DECREASE IN
MENTAL STATUS, USE VALIUM WITH CAUTION DUE TO POSSIBLE
RESPIRATORY DEPRESSION, HYPOTENSION, AND MASKING OF PRO-
GRESSION OF DISEASE RELATED ALTERED MENTAL STATUS.
6. For acute agitation, combativeness, or violent behavior, restrain patient with at least
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four individuals and give ketamine (Ketalar ) 4–5mg/kg for a max dose of 500mg IM.
7. Apply physical restraints once patient is chemically restrained with ketamine,
then establish IV access. If emergence reaction occurs in the form of combativeness,
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give midazolam 1–2mg IV OR diazepam (Valium ) 2mg IV. Repeat after 3–5min prn
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for a max dose of 4mg of midazolam or 5mg of diazepam (Valium ). SECTION 2
8. If sedated or restrained, maintain constant vigilance for a change in the hemo-
dynamic status or loss of airway reflexes.
Disposition
Urgent evacuation

186 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 187