Sedation Flashcards
LOC with minimal sedation
normal
airway with minimal sedation
unaffected
spontaneous ventilation CV function in minimal sedation
unaffected
LOC with moderate sedation
purposeful to verbal or tactile
Airway with moderate sedation
no intervention required
spontaneous ventilation Cv function with moderate sedation
adequate
usually maintained
LOC with deep sedation
purposeful after repeated or painful
airway with deep sedation
intervention may be required
spontaneous ventilation CV function with deep sedation
may be inadequate
usually maintained
LOC with general sedation
unarousable
airway with general sedation
intervention often required
spontaneous ventilation CV function with general sedation
frequently inadequate
may be impaired
pre sedation care
- who should we recognize?
risk factors = increase complications
high level of anxiety
comorb
what scale do we use for airway assessment
mallampati scale
what are some other preanesthetic thing we should assess for
medications
- herbal, street, benzodiazepines, opioids
CPAP
BMI
ASA classification scale
1-5
what is the ASA classification based on
health status
ASA class 1 criteria
normal healthy patient
ASA class 2 criteria
mild to moderate systematic disturbances
ASA class 3 criteria
severe systemic disturbance or disease
ASA class 4 criteria
severe and life treating systemic disease
ASA class 5 criteria
unlikely to survive without the planned procedure
what ASA class?
- poorly controlled HTN
3
what ASA class?
- unstable angina
4
what ASA class?
- well controlled asthma
2
what ASA class?
- angina
3
what ASA class?
- ruptured aneurysm with severe shock
5
what ASA class?
- well controlled diabetes
2
what ASA class?
- anemia
2
what ASA class?
- massive pulmonary embolism
5
factors that make intubations more difficult
obesity with a short neck
inability to extend neck
facial abnormalities
mallampati score
mallampti score levels
1-4
who has the best airway, mallampati 1 or 4
1
what does mallampati indicate
difficulty intubating
what are the questions to ask if there is moderate or deep sedation
hospital policy?
ASA score
threshold for drug
how many medications and what they are
what three medications are always considered moderate/deep sedation
propofol, ketamine, versed
what happens if the medication is re dosed for the same procedure
monitor until back to baseline
optimum sedation occurs when
no airway interventions are required
all sedatives and narcotics casue
respiratory depression
do sedatives and analgesics have a cumulative effect
yes
effects of medications are what dependent
dose
types of opioids
demerol
moprhine
fentynal
types of benzos
versed
valium
Ativan
what is the other medication that we need to know
propofol
reversal agents for opioids
naloxone (narcan)
reversal agents for benzo
flumazenil (romazicon)
immediate interventions during intubation issues
stop sedation
check levels of consiousness
maintain airway
how do we maintain airway when someone is extubated or intubation is not working
chin lift
if a reversal agent is administers the patient must be observed for at least how long and what are we monitoring for
2 hours
changes in LOC and respiratory depression
