Sedation and Rapid Sequence Intubation Flashcards
______ is a big reason we are going to sedate a patient along with intubation
pain
Perception, Expression, & Tolerance of pain are influenced by:
Psychological factors
Social factors
Cultural factors
patients pain level is __________________, it can be influenced by psychological social and cultural factors.
what they say it is
_____ can cause more pin (previous hospital visit where pain wasn’t managed),
anxiety
Unrelieved pain:
Inadequate sleep
Exhaustion
Anxiety
Disorientation
Agitation
PTSD
Post Intensive Care Syndrome
____________________
____________________
Can increase morbidity
Can increase length of stay
patients in the ICU (50%) get some kind of PTSD — this is called ___________________________
post intensive care syndrome
Getting enough _____________ is even more important to our physical and mental health than diet and exercise.
quality sleep
- Quality sleep becomes more difficult as we _____, but it’s still as important.
age
Two-thirds of adults throughout all developed nations fail to obtain the recommended eight hours of nightly sleep.
The shorter your sleep, the shorter your ___________.
Human beings are theonly species that will deliberately deprive themselves of sleepwithout legitimate gain.
The physical and mental impairments caused by one night of bad sleep dwarf those caused by an equivalent absence of food or exercise.
______ is the single most effective thing we can do to reset our brain and body health each day.
life span, Sleep
Sleep:
Restores the brain’s capacity for ______
makes room for new memories.
The more sleep spindles an individual has at night, the greater the restoration of overnight learning ability come the next morning.
Is like clicking the “save” button.
Protects newly acquired information against forgetting.
Transports memories from a temporary storage hold (hippocampus) to a more secure, permanent home (the cortex).
Sleep clears out the cache of short-term memory for the new imprinting of facts, while accumulating an ever-updated catalog of past memories.
Sleep salvages memories that appeared to have been lost soon after ______.
learning, learning
Sleep:
Vehicle accidents caused by ______ exceed those caused by alcohol and drugscombined.
After being awake for ____________, people who were sleep-deprived were as cognitively impaired as those who were legally drunk.
Students who stay up late cramming for tests experience a 40% deficit in their ability to make new memories relative to those that get a full night of sleep.
Sleep is neurological sanitation.
Getting too little sleep across the adult life span will significantly raise your risk of developing ____________ disease.
drowsy driving, nineteen hours, Alzheimer’s
Adults 45+ who sleep ___ hours are 200% more likely to have a ________________________ compared to those sleeping 7-8 hours.
In the Northern Hemisphere, the switch to daylight savings time in March results in most people losing an hour of sleep opportunity. When viewed across the millions of daily hospital records, this seemingly trivial sleep reduction comes with a frightening spike in heart attacks the following day.
The less you sleep, the more you are likely to _____.
Chronic sleep deprivation is one of the major contributors to ____________.
Insufficient sleep is linked to ______.
Short sleep causes the body to deplete muscle mass and ______.
<6, heart attack or stroke, eat, type 2 diabetes, obesity, retain fat
Men who suffer from sleep disorders (sleep apnea and snoring) have significantly lower levels of _______________.
Your immune response suffers after a single night of reduced sleep
testosterone
Throughout the course of their residency, one in five medical residents will make a sleepless-related medical error that causes significant, liable harm to a patient.
One in twenty will ____ a patient due to a lack of sleep.
Medical errors are the ___________ of death among Americans after heart attacks and cancer. Sleeplessness undoubtedly plays a role in those lives lost.
If you are about to undergo an elective surgery, you should ask how much sleep your doctor as had.
One cannot “learn” how to overcome a lack of sleep and develop resilience.
kill
third-leading cause
anxiety:
Apprehension-Agitation-Autonomic arousal-Fearful withdrawal
Prolonged state of apprehension in response to a real or perceived fear
Assessed as whatever the patient reports
Inter-related with ____
Relationship between _____ and anxiety is cyclical
pain, pain,
Pain and anxiety __________ of one another
Pain leads to anxiety. Anxiety enhances pain. Further pain worsens anxiety, etc.
exacerbate
anxiety is high when we don’t get enough sleep
__________ –do as many things that you can for them at a time
patients anxiety is whatever they say it is
strong correlation between pain and anxiety –our job to do pharmacological and __________ interventions
bundle your care, nonpharmacological
anxiety contributes to pain perception by:
Activating pain ______
Altering the cognitive evaluation of pain
Increasing aversion to pain
Increasing the report of pain
Creating feelings of ______
Leads to greater __________, especially in patients with cardiovascular disease.
pathways, powerlessness, morbidity and mortality
Anxiety is escalated by:
Noise of alarms, equipment, personnel
Bright ambient lighting
Excessive stimulation from inadequate pain relief
Frequent ______
Repositioning
Lack of mobility
Uncomfortable __________
Sleep deprivation
Circumstances leading to admission
assessments, room temperatures
Pain:
Results from a signal cascade within the neurological network
______: comes from irritation or damage to the nervous system. bones muscles, soft tissue.
_______: Diffuse, poorly localized, often referred. from organs and blood vessels.
Is a ______ mechanism because it stimulates movement away from the thing causing harm
Somatic pain, Visceral pain, protective
Negative effects of pain & anxiety
Associated with a 10 year increase in mortality rate after PCI
__________ secondary to pain and anxiety is stressful because the rapid breathing increases patient effort
Hyperventilation
Negative effects of pain & anxiety:
Causes feelings of breathlessness that lead to __________ with the ventilator
_________________ can be a result of dyssynchrony
dyssynchrony, Alveolar damage
Physiological responses to pain and anxiety:
______
Cool extremities
Diaphoresis
__________________
Increased cardiac output
Increased______ production
Pupillary ______ (mydriasis)
Nausea
Pallor and flushing
Sleep disturbance
Tachycardia
Tachypnea
_______
Constipation, Hypertension, glucose, dilation, Urinary Retention
2 years post ICU stay study:
59% of patients still experienced general anxiety, depression, and PTSD
35% had PTSD symptoms during follow up
50 % had taken ___________ drugs
40 % required psychiatric treatment since hospital discharge
psychiatric
Agitation risk factors:
Extreme anxiety
Moderate to severe pain
Delirium
Mechanical ventilation
Smoking habits
Fun fact: Agitation increases days spent on _____
ventilator
for nurses :
avoid ______ when possible.
counseling can be good for nurses,
pet therapy can be good, art therapy can also be helpful,
drugs and alcohol
Results of delirium:
Sleep disturbances
Abnormal psychomotor activity
Emotional disturbances
If untreated, is a predictor of negative clinical outcomes in critically ill patients
Increased _____ , ______, ______
Long-term cognitive impairment consistent with _________
mortality
Increased length of stay
Increased cost of care
dementia-like state
American College of Critical Care Medicine & Society of Critical Care Medicine Comprehensive Guidelines:
Evidence based practice
Patient centered protocols
Treat ____
Treat ______
Consider Sedation
Focus on delirium, immobility and sleep disruption in critically ill patients
Recommends:
1. Validated monitoring instruments
2. Nonpharmacological AND pharmacological interventions
3. Coordinating care around the patient’s goals
Pain, Agitation,
What does the ABCDEF bundle mean?
Awakening and Breathing Coordination
Delirium monitoring and management
Early exercise and mobility (rehabilitation)
Family Engagement
AND SLEEP
What does the ABCDEF bundle result in?
Less time on mechanical ventilation
Less delirium
Early mobilization
Decreased length of stay in the critical care unit and the hospital
Pain assessment:
Thorough assessment
Ongoing assessment
Reassessment
Documentation of interventions and responses
Involves collecting the patient’s report and behavioral markers
Should identify and treat possible causes of anxiety too such as _______________________________________________, pain and withdrawal from drugs.
hypoxemia, hypoglycemia, hypotension
What is PQRST ?
provocation, quality, radiation, severity, and timing
What scale is used on patients who cannot communicate in the ICU?
Critical Care Pain Observation Tool (CPOT)
What is the max score on the CPOT?
8
What scale do we used for sedated patients?
CPOT
Goal: Maintain ______ effective sedation to achieve ______ duration of mechanical ventilation
lightest, shorter
- accumulation of medication
- increased hospital stay
- pneumonia
- delayed ventilator weaning
- immobility
consequences of too much sedation
- Agitation
- Inappropriate use of paralytics
- Increased metabolic demand
- Increased risk of myocardial ischemia
consequences of not enough sedation
check _____ to see how well gut is absorbing food.
residuals
Rass scale is how we determine if our patients are ______ appropriately.
sedated
- 10 point scale ranging from ______ (4+) to _____________ (-5)
- Patient is assessed for _____ seconds
- Light sedation: _________
- Light sedation is the ____________
combative
unarousable
30-60
(-2) up to (+1)
ideal range
_______ tells us if we need to turn sedation up or down.
rass
What is another scale beside the CPOT and RASS, what is its scale?
Sedation agitation scale. 1 (unrousable) to 7 (dangerous agitation)
Records spontaneous brain activity that comes from cells on the surface of the brain
Converts EEG signal into a numeric score 0-100 (100 = fully awake)
BIS monitor
________________ noninvasive, objective analysis on the level of the patient’s wakefulness
BIS provides
BIS has strong correlation with ?
RASS score
BIS BISPECTRAL INDEX SCORE
____= Full consciousness
_____=Deep sedation
___= Complete EEG supression
90
40-60
0
Measurement of pupil size and reactivity to light
Uses an infrared camera to noninvasively monitor pupil diameter changes
Allows for assessment of ______
opiod administration.
Pupil dilation reflex (pupillometry)
______ = significant central opiod effect, which indicates that the patient would be better treated with:
Regional block
Ketamine
Other non-opiod therapy
Pain + LOW PDR
Ketamine:
Anesthetic
Interrupts association pathways of the brain selectively
Provides sensory blockade
Can be used for _____ or _____
PAIN, RSI
What is ketamine dose for pain?
IV bolus 0.2-0.3 mg/kg with mas of .35 mg/kg
What is the RSI dose for ketamine?
2 mg/kg
What is a common side effect of ketamine?
nightmares
What does the RSI dose of ketamine do?
inhibit breathing
UNDERSTAND THAT THIS MAY MAKE YOUR PATIENT GOOFY, HALLUCINATION, DISORIENTED, INCREASES BP AND ICP
ketamine
