PADIS

Question 1

approach to analgesia and sedation

Answer 1

analgesia > sedation > delirium

Question 2

analgesia significant pain

Answer 2

CPOT: >2
BPS: >5

Question 3

morphine

Answer 3

onset: 5-10 min
bolus: 2-10mg
inf: 1-10mg/hr
-builds up in renal impairment

Question 4

fentanyl

Answer 4

onset: seconds
bolus: 50-100mcg
inf: 25-300 mcg/hr
-hepatic metabolism

Question 5

hydromorphone

Answer 5

onset: 5 min
bolus: 0.5-2mg
inf: 0.5-3 mg/h
-PCA

Question 6

Richmond agitation sedation scale (RASS)

Answer 6

+4 combative
+3 very agitated
+2 agitated
+1 restless
0 alert and calm
-1 drowsy
-2 light sedation
-3 moderate sedation
-4 deep sedation
-5 unarousable

Question 7

sedation agitation scale (SAS)

Answer 7

7 dangerous agitation
6 very agitated
5 agitated
4 calm and co-operative
3 sedated
2 very sedated
1 unarousable

Question 8

sedation options

Answer 8

propofol, precedex, BZDs

Question 9

analgesia options

Answer 9

opioids, acetaminophen, NSAIDs

Question 10

propofol

Answer 10

-non analgesic properties
-caution with egg, sulfites, soybean allergies
-resp. depression
-hypertriglyceridemia

Question 11

dexmedetomidine

Answer 11

-no resp. depression
-sedative and analgesic properties
-risk of drug tolerance

Question 12

BZDs

Answer 12

midazolam, lorazepam, diazepam

Question 13

BZD drawbacks

Answer 13

increase risk of delirium, time on ventilator and length of ICU stay

Question 14

BZDs continuous infusion reserved for

Answer 14

status epi, extreme alcohol withdrawal, severe ARDS requiring deep sedation

Question 15

ketamine uses

Answer 15

anesthesia, pain, RSI, status epi, PTSD, treatment resistant depression

Question 16

delirium risk factors

Answer 16

-prevention is key
-BZD use, blood transfusions
-increase age, dementia, prior coma, pre-ICU trauma

Question 17

non-pharm interventions for delirium

Answer 17

re-orient the patient, use of hearing aids or glasses, limit noise and light at night, encourage natural sleep wake cycle, early mobilization, family presence, music therapy, limit BZDs

Question 18

pharm options for delirium

Answer 18

opioids, dexmedetomidine, melatonin receptor agonists, antipsychotics (haloperidol, quetiapine, olanzapine)

Question 19

delirium prevention pearl

Answer 19

guidelines do not recommend any pharm agent in the PREVENTION of delirium

Question 20

neuromuscular blocker (NMB) indications

Answer 20

facilitate mechanical ventilation, minimize oxygen consumption (ARDS), increased muscle activity, surgical procedures, RSI, increased intracranial or intrabdominal pressure

Question 21

NMB advantages and disadvantages

Answer 21

advantages: eliminates work of breathing
disadvantages: can’t communicate, no analgesic or sedative properties (need RASS of -4 to -5)

Question 22

NMB monitoring goal

Answer 22

2 twitches = 80-90% blockage

Question 23

non-depolarizing NMB agents

Answer 23

cisatracurium, rocuronium, vecuronium

Question 24

depolarizing NMB agents

Answer 24

succinylcholine

Question 25

RSI pretreatment

Answer 25

lidocaine, fentanyl, midazolam

Question 26

RSI induction

Answer 26

midazolam, etomidate, ketamine, propofol

Question 27

RSI paralysis

Answer 27

rocuronium, vecuronium, succinylcholine

Question 28

etomidate

Answer 28

non-barbiturate general anesthetic

Question 29

CIWA

Answer 29

0-8: mild (monitor only) 9-15: moderate >15: severe (risk of DTs and seizures)

Question 30

alcohol withdrawal

Answer 30

lorazepam, diazepam, phenobarbital

Question 31

alcohol withdrawal adjunct therapy

Answer 31

dexmedetomidine (need to give BZD or barb regularly with), gabapentin