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5th yr- AMS > Clinical monitoring in sedation > Flashcards

Clinical monitoring in sedation Flashcards

1
Q

Why do we need to monitor in sedation

A
  1. To check depth of sedation
  2. To check for adverse reactions to the drug or treatment
  3. To detect respiratory problems
  4. To detect cardiac problems
  5. Medicolegal reasons
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2
Q

What can we monitor

A
  1. Appearance
  2. Conscious level
  3. Airway
  4. Breathing
  5. Circulation
  6. Oxygen saturation
  7. Blood pressure
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3
Q

What is monitoring split into

A
  1. Clinical signs
  2. Electromechanical
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4
Q

How many people do we need to perform treatment under sedation

A

3
Operator
Assistant
Someone to monitor stats and patient

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5
Q

What do we look at appearance wise when assessing a sedated patient

A
  1. Less muscle tone and slower movements but still lightly alert
  2. Pt may close eyes but this can be a sign of over sedation
  3. Soft tissue colour eg cyanosis
  4. Check skin for rashes or allergic reactions
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6
Q

How do we assess conscious level and behaviour

A

Prompt responses to verbal suggestions at lighter sedation level

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7
Q

What can happen if a patietn is over sedated

A

May fall unconscious or be unco-operative

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8
Q

How do we assess a patients airway during sedation treatment

A
  1. Listen to the clarity of airway
  2. Look for potential obstructions and remove them
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9
Q

What is surpassed during sedation

A

Gag reflex

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10
Q

Having a suppressed gag reflex means what

A

If the airway is obstructed patietn will no cough it out so assistant needs to be vigilant an monitoring patient

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11
Q

How do we assess a patients breathing during sedation treatment

A
  1. Assess movements of the chest and abdomen
  2. Are the breaths deeps or shallow
  3. Check respiratory rate
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12
Q

State a normal resproatoqty rate

A

12-15bpm

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13
Q

How do we assess a patients circulation during sedation treatment

A
  1. Pulse rate
  2. Pulse character
  3. Pulse regularity
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14
Q

How can we assess the pulse of a sedated patietn mid treatment

A

Use pulse oximeter

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15
Q

What does a pulse oximeter measure

A

Oxygen saturation

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16
Q

What is oxygen saturation

A

The percentage of haemoglobin saturated with oxygen

17
Q

The levels of what in our blood drives respiration ?

A

Blood CO2

18
Q

What happens as blood CO2 increases?

A

Respiration increases to get rid of the CO2

19
Q

What does haemoglobin do

A

It releases oxygen into the tissues

20
Q

Why do we want the oxygen saturation to be high

A
  1. Oxygen dissociation curve
    2.
21
Q

What does the oxygen dissociation curve show us

A

That as one molecule of oxygen is lost it is easier to lose all the oxygen molecules

22
Q

What can cause the oxygen dissociation to shift to the right (right shift)

A
  1. Low pH
  2. High CO2
  3. High temp
23
Q

What does a right shift in the oxygen dissociation curve mean?

A

less oxygen take up in the lungs more available in the tissues

24
Q

What can cause the oxygen dissociation to shift to the left (left shift)

A
  1. high pH
  2. low CO2
  3. low temp
25
Q

What does a left shift in the oxygen dissociation curve mean?

A

More oxygen take up in the lungs less available in the tissues

26
Q

What can pulse oximetry show

A

Pulse rate and rhythm
Oxygen saturation of Hb

27
Q

What is anaemic hypoxia

A

Enough O2 but not enough haemoglobin

28
Q

When might pulse oximetry be unreliable

A
  1. Patient with anaemic hypoxia
  2. Patient with cytotoxic hypoxia
  3. Incorrect factory calibration
  4. Peripheral shut down due to cold or anxiety
  5. Pigmented skin
  6. Blue, black or green nail varnish
  7. Movement of finger eg tapping
  8. Under fluorescent and bright lights
29
Q

What might cause cytotoxic hypoxia

A

Cyanide or carbon monoxide poisoning

30
Q

What is cytotoxic hypoxia

A

When cells cannot use their O2

31
Q

What are the problems asscotedc with pulse oximetry

A

The pulse oximeter is alway behind events especially in acute situations as it takes an average of the patients blood saturation

32
Q

What are the early warning signs we must look out for on a pulse oximeter

A
  1. Saturation below 90%
  2. Pulse <50
  3. Pulse >120
33
Q

How do we monitor blood pressure and when

A

We use a non invasive blood pressure monitor at the start of treatment and every 5 mins

5th yr- AMS (11 decks)

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