L7 IV sedation

Question 1

What ASA rating should patients be do to IV?

Answer 1

ASA I or II

Question 2

How much time must elapse for stomach emptying to occur?

Answer 2

6-8 hours

Question 3

Large meals take how much time to empty?

Answer 3

8 hours

Question 4

Light meals take how much time to empty?

Answer 4

4 hours

Question 5

Medication and sip of water take how much time to empty?

Answer 5

Anytime, minimal

Question 6

What affect does fear and anxiety have on stomach emptying?

Answer 6

Delays emptying

Question 7

Why is the dorsum of the hand used more?

Answer 7

Doesn’t need splinting

Easier handling

Question 8

What is the benefit of the antecubital fossa veins?

Answer 8

1. Visible, easy to find
2. Large lumen veins
   - AKA good for large amounts of fluids
3. Veins are less mobile than dorsum of hand

Question 9

What are the 3 main veins of the anticubital fossa?

Answer 9

Cephalic (lateral)
Basilic (medial)
Median cubital (connection)

Question 10

which vein in the anticubital fossa is medial?

Answer 10

Basilic

Question 11

Which of the two is largest?

Answer 11

Median basilic is larger than median cephalic

Question 12

Which vein should be selected for the novice for IV placement - why?

Answer 12

The median cephalic
Number of important structures that lie below the median basilic vein
a. brachial artery
b. ulnan nerve

Question 13

What are the disadvantages of using antecubital fossa

Answer 13

1. Veins are deeper
2. Arm needs to be splinted
3. Medial aspect has important anatomical structures which if injured –> morbidity

Question 14

Indication of dorsum of hand?

Answer 14

When large bore access is not needed

Question 15

What are the problems with using the dorsum of the hand?

Answer 15

Small veins, that have valves, and are slightly mobile

Question 16

What are the 5 effect’s of Benzos?

Answer 16

1. Anxiolytic
2. Amnesic
3. Sedative
4. Muscle relaxant
5. Anticonvulsant

Question 17

What is not an effect of a benzo?

Answer 17

Analgesic

Question 18

What receptors do Benzo’s act on?

Answer 18

GABA receptors = inhibitory neurotransmitters to remain longer and hyper polarize

Question 19

Which has the shortest onset and shortest duration?? Diazepam, midazolam, lorazepam?

Answer 19

Midazolam

1-2 mins, 10-20 mins

Question 20

Which does not have active metabolites?? Diazepam, midazolam, lorazepam?

Answer 20

Diazepam

Question 21

What are the drugs of choice for:
A. seizure
b. sedation
c. sleeping pills

Answer 21

A. seizure - diazepam

b. sedation - midazolam
c. sleeping pills - lorazeopam

Question 22

How do you treat a midazolam overdose?

Answer 22

Flumazenil
Vasopressor
Oxygen
Resuscitation if needed

Question 23

What is the midazolam dose for adult vs. kid

Answer 23

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

Question 24

What is the most used narcotic analgesic?

Answer 24

Fentanyl

100x more potent than morphine

Question 25

What does fentanyl bind to?

Answer 25

Opioid receptors in the CNS system altering pain perception

Question 26

Recommended dose of fentanyl?

Answer 26

1-2 um/kg

microgram = um

Question 27

What reverses fentanyl

Answer 27

Naloxone / 2 min until reversal but MAX 2 mg

each dose = 0.1-0.2 mg/2 min

Question 28

How long after the procedure should patients we walking and talking? vital signs stable

Answer 28

30-60 minutes.

no driving for 24 hours though