Sedation, Delirium & Weaning from Ventilator

Question 1

Toxicity from morphine & hydromorphone?

Answer 1

over-sedation w/ renal failure

Question 2

Toxicity of meperidine?

Answer 2

lowers seizure threshold

Question 3

Toxicity of methadone?

Answer 3

prolongs QTc

Question 4

Sedative that can give propylene glycol toxicity?

Answer 4

Lorazepam gtt

Question 5

Sx of propylene glycol toxicity?

Answer 5

NAMGA, ATN

Question 6

What is the definition of “context-specific half-life” regarding sedation? What is the best example?

Answer 6

Lipophilic sedatives have increased half-life after prolonged infusion, such as lorazepam. Propofol doesn’t do this.

Question 7

Sx Propofol Infusion Syndrome?

Answer 7

Rhabdo, hyperkalemia, NAGMA, arrhythmias, heart failure, AKI, hyper-TG, hepatomegaly.

Question 8

Blood pressure effects of precedex?

Answer 8

Hypertensive w/ bolus. Hypotensive w/ infusion.

Question 9

Antidote for precedex-induced bradycardia?

Answer 9

Glycopyrrolate

Question 10

Components of the ABCDEF bundle for delerium?

Answer 10

• Assess pain.
• Both SAT & SBT.
• Choose right sedative.
• Detect delerium.
• Early mobilization.
• Family engagement.

Question 11

Best ventilator mode for weaning / SBT?

Answer 11

PS

Question 12

RSBI has good PPV or NPV?

Answer 12

Good NPV.

Question 13

How to use NIPPV or HFNC in ventilator liberation?

Answer 13

NIPPV for high risk patients. HFNC for low risk patients. Using either for rescue is harmful.

Question 14

What is stiff chest syndrome, and what causes it?

Answer 14

skeletal (thoracic and jaw) tetany due to repeated opioid doses (e.g., conscious sedation).

Question 15

Tx (Stiff Chest Syndrome)?

Answer 15

Succinylcholine, BVM