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ROSEN > PROCEDURAL SEDATION > Flashcards

PROCEDURAL SEDATION Flashcards

1
Q

SEDATION

A

CONTROLLED REDUCTION IN AWARENESS OF ENVIRONMENT

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2
Q

ANXIOLYSIS

A

MILD SEDATION
STATE OF REDUCED APPREHENSION
-RESPOND NORMALLY TO VERBAL STIMULI
- CO-ORDINATION / COGNITION MAYBE IMPAIRED
-CARDIORESPIRATORY FUNCTIONS INTACT

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3
Q

DISSOCIATIVE ANALGESIA

A

EG/ KETAMINE
TRANCE LIKE CATALEPTIC STATE - WITH ANALGESIA AND AMNESIA

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4
Q

MODERATE SEDATION

A
  • RESPONDS PURPOSEFULLY TO VERBAL + /- TACTILE STIMULI
    -CARDIORESPIRATORY FUNCTIONS INTACT
  • CONSCIOUS SEDATION
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5
Q

DEEP SEDATION

A
  • RESPONDS PURPOSEFULLY TO PAINFUL STIMULI
  • NOT EASILY AROUSABLE
  • RESPIRATORY FUNCTIONS MAYBE IMPAIRED
    -CARDIAC FNS INTACT
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6
Q

GENERAL ANASTHESIA

A

CARIORESPIRATORY FNS NOT INTACT
NOT AROUSABLE

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7
Q

PROCEDUAL SEDATION

A

USING A SEDATIVE/DISSOCIATIVE AGENT +/_ ANALGESIA TO MAKE UNPLEASANT PROCEDURES TOLERABLE

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8
Q

SOAPME

A
  • SUCTION
    -OXYGEN
    -AIRWAY
    -PHARMACY/ POSITION
    -MONITOR / MEDS
    -EQUIPEMNT
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9
Q

WHEN IS MAX RISK OF DETERIORATION

A

WHEN THE PAINFUL STIMULI IS REMOVED

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10
Q

ASA CLASSIFICATION

A

1 - NO CO-MORB
2- MILD SYSTEMIC DISSEASE WITHOUT FUNCTIONAL LIMITATION
3- SEVERE SYSTEMIC DISEASE WITH FUNCTIONAL LIMITAION
4- DISEASE WITH CONSTANT THREAT TO LIFE
5- MORIBUND MAYNOT SURVIVE WITHOUT PROCEDURE

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11
Q

PREPROCEDURAL FASTING

A
  • NOT REQUIRED
  • MAYNOT REDUCE EMESIS OR ASPIRATION
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12
Q

OXYGEN SUPPORT

A
  • MAY CAUSE DELAYED DETECTION OF HYPOVENTILLATIONOR APNEA
    -USE CAPNOGRAPHY
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13
Q

BIS

A
  • NOT USED IN INFANTS
  • DEPTH OF SEDATION (EFFECT OF DRUG ON CORTEX RATHER THAN CONSCIOUSNESS IS ASESSED)
    -0-100
    -40-60 FOR GA
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14
Q

PROPOFOL ADVANTAGE

A

-ANTIEMETIC
-SHORT ACTIMG
-RAPID ONSET

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15
Q

PROPOFOL DISADVANTAGE

A

-HYPOTENSION
-RESPIRATORY DEPRESSION

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16
Q

PROPOFOL DOSE

A

1-1.5 MGKG
INCREMENTS OF 0.5 MG/KG

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17
Q

ADVANTAGE OF KETAMINE

A

1.SEDATION (DISOOCIATIVE)
2.AMNESIA
3. ANALGESIA
4 MANITAIN CARDIORESPIRATORY FN
-PROTECTIVE AIRWAY REFLEX
-SPONT RESPIRATION
-INCREASE BP
-INCREASE HR/CO
-MYOCARDIAL O2 CONSUMPTION INCREASED
-BRONCHODIALATION

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18
Q

DISADVANTAGE OF KETAMINE

A
  1. APNEA
  2. LARYNGOSPASM (MAYBE RELIEVED BY REPOSTION, PPV, O2 , 10% NMB)
    3.EMESIS
  3. EMERGENCE REACTION (MIDAZOLAM 0.03 MG/KG)
  4. INCREASED SALIVATION (GLYCOPYROLATE)
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19
Q

GLYCOPYROLATE OVER ATROPINE

A
  1. LESS ARRYTHMIA
  2. BETTER SIALAGOGUE
  3. DONOT CROSS BBB
    MAY CAUSE HEADACHE
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20
Q

EMERGENCE REACTION AKA

A

RECOVERY AGITATION

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21
Q

EMESIS WITH KETAMINE SEEN IN

A

HIGH DOSE / IM

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22
Q

KETAMINE DOSE

A

1-2 MG/KG IV (0.5- 1 MG/K ALLOQUITE)
4-5 MG/KG IM
5-7 MG/KG PO

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23
Q

KETOFOL DOSE

A

0.5-0.75 MG/KG BOTH
1:1 IN SYRINGE
REPAEAT PROPOFOL 0.1-0.5 MG/KG SOS

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24
Q

KETOFOL ADVANTAGE

A
  • HR/BP MAINTAINED BY KETAMINE
  • ANALGESIA BY KETAMINE
  • ANIT EMETIC BY PROPOFOL
    -DECREASED DOSE OF DRUG
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25
Q

ETOMIDATE

A

0.3 MG/KG
1 MIN (ONSET)
10 MINS (ACTION)

  • PAIN ON INJECTION
  • MYOCLONUS
    -ADRENAL SUPRESSION
26
Q

MIDAZOLAM

A

0.05 - 0.1 MG/KG (5YR)
0.05-0.025 MG/KG (>5YRS)
0.02 MG/KG WHEN GIVEN WITH FENTA

3 MIN (ONSET)
60 MINS (DURATION)

PARADOXICAL AGITATION

27
Q

METHOHEXITAL

A

1-3 MG/KG

1 MIN (ONSET)
10 MIN (DURATION)

EXTRAVASATION ACUSING NECROSIS
C/I IN PORPHYRIA

USE IN MALIGNANT HYPERTERMIA AND TBI

28
Q

PHENOBARBITAL

A

1-6 MG/KG

1 MIN (ONSET)
10 MIN (DURATION)

EXTRAVASATION ACUSING NECROSIS
C/I IN PORPHYRIA

USE IN MALIGNANT HYPERTERMIA AND TBI

29
Q

NITROUS OXIDE

A

30-70%

1 MIN (ONSET)
20 MIN (DURATION)

C/I TRAPPED AIR

30
Q

pain DEFNITION

A

VISCERAL OR SOMATIC UNPLESANT SENSATION A/W ACTUAL POTENTIAL OR PERCIEVED TISSUE DAMAGE

31
Q

NOCICEPTOR

A

FREE NERVE ENDINGS OF SENSORY NEURON THAT CONVERT CHEMICAL, MECHANICAL.THERMAL ENERGY TO ELECTRICAL ACTIVTY AND TRANSPORT TO DORSAL HORN

32
Q

TYPES OF PAIN

A

1.NOCICEPTIVE -
VISCERAL/SOMATIC
2. NEUROPATHIC

33
Q

TYPES OF PAIN ASESSMENT

A
  1. SELF REPORTING
  2. BEHAVIOURAL
  3. PHYSIOLOGICAL
34
Q

SELF REPORTING PAIN SCALES

A
  1. NRS
    2 VAS
  2. FACES
    -WONG BAKER PAIN SCORE
    -FACES PAIN SCALE REVISED
    (3-8 YRS)
35
Q

INFANT PAIN SCORE

A

1.PIPPS
2. CRIES
3. FLACC
4. OSBD
5. CHEOPS

36
Q

NEURO IMPAIRED (PAIN SCORE)

37
Q

NON PHARMACOLOGICAL TECHNIQUES OF PAIN MANAGEMENT

A
  1. DISTRACT
  2. PARENTAL PRESSENCE
  3. HYPNOSIS
  4. NON NUTRITIVE SUCKLING
  5. SUCROSE
  6. KANGAROO CARE
38
Q

TOPICAL ANASTHETIC ADVANTAGE

A
  1. PAINLESS
  2. NO NEEDLE
  3. DONOT DISTORT TISSUE
39
Q

EMLA

A
  1. EUTETIC MIXTURE OF LOCAL ANASTETIC
  2. 1:1 LIGNOCAINE AND PRILOCAINE
  3. ACTION 60 MIN
  4. 5-10 GM OCCLUSIVE DRESSING
  5. INTACT SKIN
  6. METHHEMOGLOBINEMIA
    - WITH G6PD DEFICIENCY
    -< 1 YR / EGA<37 WKS
    -ON METHHEMOGLOBIN INDUCING AGENTS
40
Q

LMX

A
  1. LIPOSOMAL ENCAPSULATED LIGNOCAINE
  2. 4/5 %
  3. INTACT SKIN
    4 30-60 MINS
    5 2.5 GM
41
Q

LET

A

LIGNOCAINE
EPINEPHRINE
TETRA CAINE

-OPEN DERMIS
-20-30 MINS
- 5ML
- DONOT APPLY AT END ARTERT/ COMPROMISED BLOOD SUPPLY

42
Q

VAPOCOOLANT

A

INSTANT
-OPEN/INTACT

43
Q

LOCAL ANSTHETIC AGENT ACTION

A

REVERSIBLE SODIUM CHANNEL BLOCKER

44
Q

TYPES OF LA

A

AMIDE
ESTER

45
Q

HOW TO MAKE LA LESS PAIN FUL

A
  1. TOPICAL AGENTS
  2. SMALL NEEDLE
  3. INJECT TO S/C TISSUE
  4. INJECT THROUGH WOUND
  5. SODIUM BICARB
  6. WARM SOLUTION
  7. INJECT SLOWLY
    8 MINIMIZE NUMBER OF PUNCTURE
46
Q

SIDE EFFECTS OF LA

A
  1. WITH EPI : VASOCONSTRICTOR
  2. ALLERGIC (ESP PROCSINE / BENZOCAINE)
  3. BUPIVACAINE - CARDIAC TOX
  4. BENZOCAINE / PRILOCAINE - METHHEMOGLOBINEMIA

MILD- TINGLING, NUMBNESS, TINNITUS, HEARING LOSS
MODERATE - SEIZURE, COMA DROWSINESS
SEVERE - MYOCARDIAL DEPRESSION AND CARDIAC ARREST

47
Q

LIGNOCAINE

A

4-4.5 MG/KG

48
Q

LIGOCAINE WITH EPI

49
Q

BUPIVACAINE

50
Q

TETRA CAINE

51
Q

ACETAMINOPHEN

A

PO 10-15 MG/KG ( MAX 4 GM /DAY) - Q4-6H
IV 15 MG/KG Q6H

52
Q

ASPIRIN

A

10-15 MG/KG Q4-6H
REYE SYNDROME (DONOT GIVE IN FLU/VARICELLA)

53
Q

IBUPROFEN

A

10 MG/KG Q6-8H

54
Q

HYDROCODONE
OXYCODONE

A

0.1-0.2 MG/KG Q4-6H

55
Q

MORPHINE

A

0.3 MG/KG Q3-4H - PO
0.1 MG/KG Q4H - IV

56
Q

TRAMADOL

A

1-2 MG/KG Q4H

57
Q

FENTANYL

A

0.5-1 MCG/KG Q2H

58
Q

KETROLAC

A

0.5 MG/KG Q6H

59
Q

LOW DOSE KETAMINE

A

0.15 MG/KG OR 0.1-0.2 MG/KG/HR

60
Q

NALOXONE

A
  1. 0.1 MG/KG (2 MG)
61
Q

FLUMAZENIL

A

0.01 MG/KG - UPTO 5 DOSE
MAX - 1 MG

ROSEN (3 decks)

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