Pain, Agitation, Delirium - Block 4 Flashcards
How long can someone be intubated?
14 days due to infection
What are causes of immediate pain?
- Catbolic hypermetabolism
- Increasing circulating catecholamines
- Insufficient sleep
- Suppression of natural killer cells
Causes of long term pain?
- Chronic pain
- Lower HRQoL
- Neuropathic pain
- PTSD
What are the types of pain evaluation tools?
ALert: numerical rating scale
Not alert: behavioral pain scale, Critical-Care Pain Observation Tool
What are you options for ICU pain?
- Opioids
- Non-opioids (APAP, Ketamine, Neuropathic analgesia)
- Anticonvulsants for neuropathic pain (gabapentin, pregabalin, carbemazepine)
Describe the tx for procedural pain managemetn?
- Opioids
- NSAIDs (discrete and infrequent procedures)
What medications should not be used for procedural pain management?
- Local analgesia
- NO
- Inhaled volatile anesthetics
What are the nonpharms for pain mnagemetn?
- Massage
- Music
- Cold packs
- Relaxation
What are key points to treat proceudral pain?
- Treat pain preemptively
- Recognize and treat pain promptly
- Involve patients and families in plan
- Reassess and adjust pain managemetn based on routine assessment
- Patient specific
- Universal analgesia
- Pain control alone may equal comfort
What are the causes of agitation?
- Alcohol withdrawal
- Delirium
- Hypoglycemia
- Hypotention
- Infection
- Pain
- TBI
- Withdrawal
Consequenses of agitation?
- Harm
- Interferes with monitoring
- Ventilator asynchrony
- increased oxygen consumption
- increased ICU length of stay
- increased risk of nosocomial infections
What are goals of sedation?
- Provide comfort by treating pain 1st
- Patient focused strategy
- Interdisciplinary planning and practice (SBT, SAT)
How do we determine if we should sedate a patient?
Riker Sedation-Agitation Scale (SAS)
Richmond Agitation-Sedation Scale (RASS)
What are the sx of oversedation?
- BRadycardia
- Coma
- Prolonged MV
- Prolonged LOS
- Infection
- Complications
- Increase diagnostic testing
- Inability to evaluate delirium
Sx of undersedation?
- Stress
- Ax
- Agitation
- Hypertension/tachy
- Hypoxia
- Patient recall
- Ischemia
What is the goal for sedation?
Target light sedation
How do we select the ideal sedative?
- Rapid onset
- Inexpensive
- No ddi
- Inactive/no metabolites
- Minimal respiratory depression
- No CV effect
- Independent of organ metabolism and elimination
Pharm for sedation?
- Analgesia frist
- Then, sedative next
How are CI from analgosedation?
- Alcohol withdrawal
- NMBA
- Refractory status epilepticus
Describe the tx options for sedation?