Fentanyl: 1-2 mcg/kg (comes in 50 ug/ml) (best for children)
Be wary of respiratory depression
Monitor patients with pulse oximetry and close observation
Titration to pain is often necessary
Repeat dosing (1/2 to full dose) every 15 minutes until desired effect is achieved
Be aware of dead space in delivery device
Failure to account for the device dead space may lead to under-dosing of these highly concentrated drugs.
Monitor patients with pulse oximetry and close observation
Repeat dosing (1/2 to full dose) every 15 minutes until desired effect is achieved
Failure to account for the device dead space may lead to under-dosing of these highly concentrated drugs.
Midazolam 0.3 to 0.5mg/kg (maximum = 10mg)  
Use the lower dose for minor, non-painful procedures such as radiographic imaging
Use the higher dose for better sedation prior to procedures such as laceration repair
Results in mild somnolence with resultant reduction in anxiety and probably amnesia
Be aware that midazolam causes some nasal burning benzyl alcohol preservative) for 30-45 seconds when administered.
In small children; lidocaine 2% or 4%: 0.2ml per nostril 5 minutes prior to the midazolam to stop the burning
Use only concentrated midazolam (5mg/ml) formulation
Use the lower dose for minor, non-painful procedures such as radiographic imaging
Use the higher dose for better sedation prior to procedures such as laceration repair
Results in mild somnolence with resultant reduction in anxiety and probably amnesia
Be aware that midazolam causes some nasal burning benzyl alcohol preservative) for 30-45 seconds when administered.
In small children; lidocaine 2% or 4%: 0.2ml per nostril 5 minutes prior to the midazolam to stop the burning
Use only concentrated midazolam (5mg/ml) formulation
Ketamine 3 to 9mg/kg (no routine recommendation yet)
Ketamine may result in deeper sedation and is dose dependent, utilize the initial dose at 6mg/kg and repeated doses at 3mg/kg until desired sedation is achieved.
Be aware that ketamine causes a bitter taste (lyophilized) when administered
Behavioral changes (nightmares, enuresis nocturna, and irritability) in children less than five (unable to understand reasons for experience)
Use only concentrated ketamine (100mg/ml) formulation
Ideal volume is 0.3 to 0.5 ml per nostril, maximum is 1ml per nostril, and more will just run out nose. If you need more – titrate to effect
Ketamine 1mg/kg may be used for pain control (not procedural sedation) 
Good adjunct to opioids or as an opioid-sparing agent
Ketamine may result in deeper sedation and is dose dependent, utilize the initial dose at 6mg/kg and repeated doses at 3mg/kg until desired sedation is achieved.
Be aware that ketamine causes a bitter taste (lyophilized) when administered
Behavioral changes (nightmares, enuresis nocturna, and irritability) in children less than five (unable to understand reasons for experience)
Use only concentrated ketamine (100mg/ml) formulation
Ideal volume is 0.3 to 0.5 ml per nostril, maximum is 1ml per nostril, and more will just run out nose. If you need more – titrate to effect
Good adjunct to opioids or as an opioid-sparing agent
Dexmedetomidine 1-2 μg/kg
Provides procedural analgesia and anxiolysis
Currently unavailable in most EDs
Provides procedural analgesia and anxiolysis
Currently unavailable in most EDs
Intranasal sedation
Advanced airway adjuncts
Magic mouthwash
Nasal intubation
Mechanical ventilation 
Procedural sedation 
Procedural sedation
Bag valve mask ventilation