Acute Pain & Delirium Flashcards
What is physical dependence defined as?
The development of withdrawal symptoms after discontinuation of therapy
What is the difference between physical dependence and addiction?
Physical dependence produces withdrawal sx and addiction is psychological
How to treat mild to moderate pain initially?
With a non-opioid
What do you do if you give a non-opioid for mild-mod pain and pt still has pain?
Give an opioid
What do you do if you give a non-opioid and an opioid for mild-mod pain and pt still has pain?
Titrate up on the opioid by 25-50% and see how they do
How do you start treating mod-severe pain?
With an opioid
What is nociceptive pain?
Pain caused by inflammation in a nerve ending - commonly caused by injury, surgery
Does nociceptive pain respond well to opioids?
Yes
What is somatic vs visceral nociceptive pain?
Somatic = Localized, from tissue injury; somatic=not well localized, associated with internal organs
What is acute pain?
Lasts less than 3 months, response to a known painful stimuli
What is chronic pain?
Long-term, difficult to treat
Allodynia and hyperalgesia are characteristic of what type of pain?
Chronic pain
What is allodynia?
Pain response to stimuli that is not normally painful
Is neuropathic pain responsive to opioids?
Not as much
What is neuropathic pain?
Caused by nerve damage
What is breakthrough pain?
Pain that is felt despite having pain medication given
What type of pain occurs in response to a sudden pain stimulus?
Breakthrough pain
A numeric pain rating scale of what or greater is considered significant?
4
A CPOT score of what or greater is significant?
3
What kind of pain is a PCA good for?
Mod-severe pain that is expected to be for a brief duration
How much should you dose reduce by when switching between different opioids?
25-50%, unless pt is in severe pain (than can be more aggressive)
How much Narcan to start with for a spontaneously breathing pt?
0.4mg
How much Narcan to start with for an apneic pt?
0.4mg
How much Narcan to give for a pt in cardiac arrest with suspected opioid overdose?
2mg
What two opioids should you not use in acute care?
Meperidine and codeine
What is the Tylenol limit per day?
3g
What is Tylenol contraindicated in?
Liver failure
In what pts should you avoid NSAIDs?
High risk ortho pts (may inhibit bone healing)
What should gabapentin be started at?
300mg PO TID
What’s the max dose of gabapentin?
1200mg TID
What is a major side effect of gabapentin?
Sleepiness
What happens if you d/c gabapentin?
Withdrawal
INR above what is a contraindication to regional anesthesia?
Above 2
Platelets should be above what for regional anesthesia?
50k
Is increased ICP a contraindication for regional anesthesia?
Yes
When is IV lidocaine used?
When pt has contraindication for regional anesthesia
What is the therapeutic range for IV lidocaine?
1.5-5mcg/mL
What are sx of lidocaine toxicity?
Seizures, cardiac collapse
What are early signs of lidocaine toxicity?
Tinnitus, perioral numbness, metallic taste in mouth
What to give for cardiac collapse in lidocaine toxicity?
Intralipids
What is the primary side effect of ketamine?
Dissociation, hallucinations, tachycardia, hypertension
In what three pt populations is ketamine contraindicated in?
PTSD, cardiac disease, head injury
What is the most common cause of agitation in the ICU?
Untreated pain
What is the most common sedation scale?
RASS
What four classes of drugs are used for sedatives?
Benzos, propofol, opioids and alpha 2 agonists
What is the closest to ideal sedative class?
Alpha 2 agonists
Which sedative does not reduce respiratory drive?
Dexmedetomidine (Precedex)
Are benzos good for sedation?
No
What is the RASS goal?
0 to -2
What is delirium caused by?
Underlying illness or substance intoxication
Is hyper or hypoactive delirium more common?
Hypoactive
What assessment is used to ID patients who have delirium?
CAM-ICU
In what type of delirium would you use antipsychotics?
Hyperactive delirium
