18G
Paramedic
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This is a common misconception. Movement, asynchrony, and even tachycardia and hypertension are not specific signs of awareness or pain.
Whether the appropriate response is to give more sedation, or more analgesia, or do something else depends on several factors. But more fentanyl and more propofol isn't always the best route.
Edit: in the OP's situation, more sedation was (unfortunately, at only 40 mcg) not an option.
The propofol with addition of fentanyl statement was not meant to be a blanket statement. You're right. It may not be the best route and some patients may require a different strategy. In my experience however, treating the patient with adequate doses of fentanyl often allows for lower doses of propofol and together you achieve a comfortable and well sedated patient.
I've heard the argument from a few others that all patient's should be paralyzed for transport and I personally do not subscribe to that practice. If it's necessary to gain ventilator compliance or control of the patient because it is difficult to put the patient down with sedation/analgesia alone, than ok I see the indication.