Page 133 - Journal of Special Operations Medicine - Spring 2017

The remaining two appendixes are Richmond Agitation-
• The risks of regional anesthesia are increased in Sedation Scale score (Appendix F) and Planning Consid-
most PFC settings because of limited access to erations (Appendix G).
advanced cardiopulmonary life support (ACLS)
medications and defibrillators, as well as the
availability (or lack thereof) of lipid emulsion Disclosures
used as an antidote for anesthetic toxicity. The authors have nothing to disclose.
• Close monitoring for the first 15–20 minutes af-
ter a regional nerve block is imperative.
• Be prepared to treat seizure and cardiac arrest. Bibliography
• Before attempting, competency in this technique Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines
must be documented. for the management of pain, agitation, and delirium in adult
• Ultrasound guidance is the preferred method. patients in the intensive care unit. Crit Care Med. 2013;4:
263–306.
Buckenmaier C III, Bleckner L. Military advanced regional an-
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clinical-resources/dvcipm-maraa-book-project. Accessed 14
Analgesia and Sedation for February 2017.
Expectant Care (i.e., End-of-Life Care) Chang AK, Bijur PE, Meyer RH, et al. Safety and efficacy of
An unfortunate reality of our profession, both military hydromorphone as an analgesic alternative to morphine in
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sedative medications is therapeutic and indicated, even over time in ICU patients: reliability and validity of the Rich-
mond Agitation-Sedation Scale (RASS). JAMA. 2003;289:
if these medications worsen a patient’s vital signs (i.e., 2983–2991.
cause respiratory depression and/or hypotension). If a Felden L, Walter C, Harder S, et al. Comparative clinical effects
patient is expectant: of hydromorphone and morphine: a meta-analysis. Brit J An-
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Green SM, Roback MG, Kennedy RM, et al. Clinical practice
Call a telemedicine consult. guideline for emergency department ketamine dissociative
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• Prepare to Guldner GT, Petinaux B, Clemens P, et al. Ketamine for proce-
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the patient’s pain is relieved. If the patient is unable McGhee LL, Maani CV, Garza TH, et al. The intraoperative ad-
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worrying about the future but not complaining of tion Paper: Operational context for prolonged field care. J
pain) or he cannot express himself but is agitated Spec Oper Med. 2015;15(3):78–80.
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or the patient is sedated (i.e., is not feeling anxious alty Care guidelines. 3 June 2015. http://specialoperations-
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• Provide anything that gives the patient comfort (e.g., and delirium. 5 April 2013. http://www.usaisr.amedd.army
.mil/cpgs.html. Accessed 14 February 2017.
water, food, cigarette).
Disclosures
• Relief of suffering, primarily through pain re-
lief, is the goal during expectant care. The authors have nothing to disclose.

Call a telemedicine consult to discuss. Keywords: sedation; analgesia; prolonged field care;
guidelines

Guidelines: Analgesia and Sedation During PFC 109