clinical monitoring in sedation

Question 1

why do we need to monitor

Answer 1

• Check the depth of sedation
  
  • To check for adverse reactions
  • To detect respiratory problems
  • To detect cardiac problems
    Medico legal

Question 2

what can we monitor

Answer 2

appearance
conscious level
airway
breathing
circulation
oxygen saturation
blood pressure

Question 3

what should we notice about appearance

Answer 3

• They may have less muscle tone and movements are slower but should be alert
  
  • At deeper levels of sedation, the patient may close their eyes and can be difficult to see over sedation

Question 4

what signs can we see for conscious sedation

Answer 4

Prompt response to verbal suggestions at light levels
Slower response as it increases

Question 5

what indicates over sedation

Answer 5

Unconscious

Question 6

what can we look for in airways

Answer 6

• Listen to clarity of airway
  
  • Look for potential obstructions
    Remove potential obstructions

Question 7

what can we look for in breathing

Answer 7

• Respiratory movement
  
  • Movement of chest
  • Breaths- deep or shallow?
    Normal resp rate is 12-15 bpm

Question 8

what can we look for in the pulse

Answer 8

• Rate
  
  • Character
    Regularity

Question 9

what does an oxygen dissociation shift to the left show

Answer 9

• High pH
  
  • Low CO2
  • Low temp

More oxygen taken up in the lungs
Less available in the tissues

Question 10

what does an oxygen dissociation shift to the right show

Answer 10

• Low pH
  
  • High CO2
  • High temp
    Less oxygen taken up in the lungs more available in the tissues

Question 11

why might pulse ox be unreliable

Answer 11

Peripheral shut down due to cold/anxiety
Pigmented skin and blue/black/green nail polish
Movement of finger
Under UV light