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5th ICP - Pain/ Anxiety > IV Sedation I > Flashcards

IV Sedation I Flashcards

1
Q

What is sedation?

A

Range extending from normal alert consciousness to complete unresponsiveness

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2
Q

What is conscious sedation?

A

Technique using drug/ drugs to provide depression of CNS enabling treatment to be carried out, verbal communication maintained

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3
Q

How is responsiveness, airway, ventilation and CV system affected in minimal sedation?

A

Responsiveness: normal
Airway: unaffected
Ventilation: unaffected
CV: unaffected

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4
Q

How is responsiveness, airway, ventilation and CV system affected in moderate sedation?

A

Responsiveness: response to verbal/ tactile stimulation
Airway: maintained w/o intervention
Ventilation: adequate
CV: maintained

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5
Q

How is responsiveness, airway, ventilation and CV system affected in deep sedation?

A

Responsiveness: to repeated or painful stimulation
Airway: intervention may be required
Ventilation: inadequate
CV: maintained

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6
Q

How is responsiveness, airway, ventilation and CV system affected in GA?

A

Responsiveness: unrousable
Airway: intervention
Ventilation: inadequate
CV: impaired

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7
Q

Function of respiratory system?

A

Ventilate lungs to allows gas exchange - addition of o2 and elimination CO2

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8
Q

5 steps of ventilation?

A
  1. ventilation - gas in and out lungs
  2. diffusion - gas from lungs o blood
  3. transport - to/ from cells
  4. diffusion - gas blood to lungs
  5. oxidation - use oxygen too produce energy within cells
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9
Q

What are 2 main parts of ventilation?

A

Inspiration and expiration

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10
Q

What is inspiration

A

Active process initiated by diaphragm

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11
Q

What is expiration?

A

Passive process caused by recoil of lungs

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12
Q

Where does gas exchange occur and why?

A

Alveolus

Gases diffuse down concentration gradient

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13
Q

How is oxygen transported?

A

Oxygen binds to haemoglobin which is carried within the red blood cells - released when reaches tissue

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14
Q

How is breathing rate altered?

A

From [co2] in blood

Detected by peripheral chemoreceptors in aorta and carotid –> cause response central chemoreceptor in medulla

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15
Q

What are basic clinical signs to check respiration?

A

Respiratory rate
Depth breathing
Pattern breathing
Check cyanosis

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16
Q

What is average respiratory rate?

A

10-18

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17
Q

What are more advanced ways to check respiration?

A

Pulse oximetry

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18
Q

What can limit pulse oximeter?

A

Ambient light
Movement
Cold peripheries
Nail varnish

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19
Q

What is capnography?

A

Detects CO2 exhaled in Brea via nasal prongs

See is adequate ventilation

20
Q

Problem w/ capnography?

A

Requires nose breathing

21
Q

What are 2 respiratory complications seen in sedation?

A

Upper airway obstruction

Hypoventilation

22
Q

How does sedation cause upper airway obstruction?

A

sedation leads to decreased muscle tone

If pharynx lose tone can collapse, tongue falls against wall of pharynx leading to airway obstruction

23
Q

What are signs of airway obstruction?

A

Snoring
Stidor
Drop O2 sat

24
Q

Management of airway obstruction?

A

Supplementary oxygen
Basic airway opening manuevers
Airway adjunct
Careful titration sedatives

25
Q

How can hypoventilation occur in sedation?

A

Sedative drugs can sedate respiratory centre in brain and reduce recetor sensitivity to CO2 = reduced respiratory rate causing CO2 levels build

26
Q

Detect hypoventilation?

A

Monitor respiration rate

Drop O2 sats

27
Q

Manage hypoventilation?

A 
Reverse sedation (e.g flumazenil)
Assist ventilation e.g ambu bag
28
Q

What is function of CV system?

A

Deliver oxygenated blood to body organs and tissue

29
Q

What happens in cardiac ischemia?

A

Angina which can lead myocardial infarct

30
Q

What happens in cerebral ischemia?

A

Faint/ collapse –> stroke

31
Q

Main determinant of organ perfusion?

A

Blood pressure

32
Q

How is blood pressure displayed?

A

Systolic and diastolic

systolic over diastolic - 120/80

33
Q

How is blood pressure determined?

A

cardiac output

systemic vascular resistance

34
Q

What is cardiac output?

A

Amount of blood ejected by heart in minute

35
Q

What is systemic vascular resistance?

A

resistance produced by vascular system to flow of blood - predominately through small arterioles in body

36
Q

What is acute control of blood pressure?

A

Baroreceptors in aortic arch and internal carotids - autonomic nervous system alters heart contraction/ constriction blood vessels

37
Q

What is chronic control of blood pressure?

A

Renin-angiotensin system - via blood sodium [] and body fluid retention

38
Q

Basic clinic signs to monitor CV system?

A

HR
Consciousness level
Skin colour
Capillary refill

39
Q

Advanced ways to monitor CV system?

A

Non-invasive blood pressure

ECG monitoring

40
Q

What can blood pressure cuff be affected by?

A

Movement

Wrong sized cuff

41
Q

When should ECG monitoring be used?

A

Pt significant hx of cardiovascular disease

42
Q

What are 2 CV complications caused by sedation?

A

Hypotension

Cardiac arrhythmia

43
Q

How is hypotension caused in sedation?

A

Drugs cause vasodilation

Some drugs decrease strength heart contractions

44
Q

Tx hypotension?

A

Stop administering
Pt head down, feet elevated
IV fluids may be required

45
Q

How can cardiac arrhythmia be caused?

A

Precipitated by adrenaline in LA

46
Q

How manage cardiac arrhythmia?

A

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5th ICP - Pain/ Anxiety (10 decks)

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