L7 IV sedation Flashcards
What ASA rating should patients be do to IV?
ASA I or II
How much time must elapse for stomach emptying to occur?
6-8 hours
Large meals take how much time to empty?
8 hours
Light meals take how much time to empty?
4 hours
Medication and sip of water take how much time to empty?
Anytime, minimal
What affect does fear and anxiety have on stomach emptying?
Delays emptying
Why is the dorsum of the hand used more?
Doesn’t need splinting
Easier handling
What is the benefit of the antecubital fossa veins?
- Visible, easy to find
- Large lumen veins
- AKA good for large amounts of fluids - Veins are less mobile than dorsum of hand
What are the 3 main veins of the anticubital fossa?
Cephalic (lateral)
Basilic (medial)
Median cubital (connection)
which vein in the anticubital fossa is medial?
Basilic
Which of the two is largest?
Median basilic is larger than median cephalic
Which vein should be selected for the novice for IV placement - why?
The median cephalic
Number of important structures that lie below the median basilic vein
a. brachial artery
b. ulnan nerve
What are the disadvantages of using antecubital fossa
- Veins are deeper
- Arm needs to be splinted
- Medial aspect has important anatomical structures which if injured –> morbidity
Indication of dorsum of hand?
When large bore access is not needed
What are the problems with using the dorsum of the hand?
Small veins, that have valves, and are slightly mobile
What are the 5 effect’s of Benzos?
- Anxiolytic
- Amnesic
- Sedative
- Muscle relaxant
- Anticonvulsant
What is not an effect of a benzo?
Analgesic
What receptors do Benzo’s act on?
GABA receptors = inhibitory neurotransmitters to remain longer and hyper polarize
Which has the shortest onset and shortest duration?? Diazepam, midazolam, lorazepam?
Midazolam
1-2 mins, 10-20 mins
Which does not have active metabolites?? Diazepam, midazolam, lorazepam?
Diazepam
What are the drugs of choice for:
A. seizure
b. sedation
c. sleeping pills
A. seizure - diazepam
b. sedation - midazolam
c. sleeping pills - lorazeopam
How do you treat a midazolam overdose?
Flumazenil
Vasopressor
Oxygen
Resuscitation if needed
What is the midazolam dose for adult vs. kid
Child: 0.05 mg/kg (IV)
Adult: 2-10 mg (increment)
Titrate drug with initial 1-2 mg dose, then add every 2-3 minutes until desired dose is met
What is the most used narcotic analgesic?
Fentanyl
100x more potent than morphine
What does fentanyl bind to?
Opioid receptors in the CNS system altering pain perception
Recommended dose of fentanyl?
1-2 um/kg
microgram = um
What reverses fentanyl
Naloxone / 2 min until reversal but MAX 2 mg
each dose = 0.1-0.2 mg/2 min
How long after the procedure should patients we walking and talking? vital signs stable
30-60 minutes.
no driving for 24 hours though
