Stage of Injury | Background Anxiety | Background Pain | Procedural Anxiety | Procedural Pain |
---|---|---|---|---|
Acute Burn Ventilated | #1 Midazolam infusion | Morphine infusion | Midazolam boluses | Morphine boluses |
#2 Dexmedetomidine infusion | Morphine infusion | Dexmedetomidine higher infusion rate | Morphine boluses | |
#3 Antipsychotics | Morphine infusion | Haloperidol (very slow) boluses | Morphine boluses | |
#4 Propofol infusion (<48 h) | Morphine infusion | Propofol boluses | Morphine boluses | |
Acute Burn not ventilated | Dexmedetomidine IV Scheduled Lorazepam IV or PO | Morphine IV or PO | Lorazepam IV/PO | Morphine IV/PO or Ketamine IV |
Chronic Acute Burn | Scheduled lorazepam or antipsychotics (PO) | Scheduled morphine or methadone | Lorazepam or antipsychotics (PO) | Morphine PO or Oxycodone |
Fentanyl infusions could be substituted for morphine infusions.
In view of the increased incidence of delirium with benzodiazepines, minimal use of them is advocated.
IV = intravenous. PO = per oram (by mouth).