Analgesia, Anesthesia, And Procedural Sedation

Front 1

What portion of the spinal cord integrates and modulates pain?

Back 1

The dorsal horn of the spinal cord

Front 2

On the visual analogue scale, a change of how many millimeters along this scale is the minimally clinically significant change noticeable by patients?

Back 2

13 millimeters along this scale is the minimal clinically significant change noticeable by patients.

Front 3

An average decrease of how many millimeters on the visual analogue scale appears to be the minimally acceptable change when treating pain ?

Back 3

An average decrease of 30 millimeters on the visual analogue scale appears to be the minimally acceptable change.

Front 4

Which class of analgesic drugs are the cornerstone of pharmacologic management of moderate to severe acute pain in the emergency department?

Back 4

Opioids

Front 5

Hydromorphone is also known as what?

Back 5

Dilaudid

Front 6

Meperidine is also known as what?

Back 6

Demerol or Pethidine

Front 7

Name three reasons the use of meperidine (Demerol) has been discouraged in the ED.

Back 7

1. It is often underdosed.
2. It can interact with many drugs to precipitate a serotonin syndrome.
3. The metabolism of the parent drug to normeperidine, which has neuro- excitatory properties and a long elimination half-life (24 to 48 hours).

Front 8

Which of the following medications does not affect platelet aggregation and is not an anti inflammatory?

Back 8

A. Ibuprofen
B. Aspirin
C. Acetaminophen
D. Indomethacin

Front 9

All NSAIDs increase the risk of cardiac death in patients at risk for ischemic heart disease but what specific type of NSAID appears to carry the highest risk for this complication?

Back 9

Cyclooxygenase 2 specific agents such as celebrex

Front 10

In patients with renal failure what two opioids are preferred?

Back 10

Hydromorphone (dilaudid) and fentanyl

Front 11

The use of monoamine oxidase inhibitors with what opioid drug has been associated with severe adverse reactions, including death as the result of provoking a serotonin syndrome?

Back 11

meperidine or demerol

Front 12

NSAIDs should not be given to patients with major trauma. Risks include what?

Back 12

Excessive bleeding from platelet dysfunction and gastric stress ulcers and the potential for acute renal failure in the volume depleted patient.

Front 13

What are the two important principles that must be adhered to when planning and performing procedural sedation and analgesia?

Back 13

1. The lightest appropriate level of sedation should be used.
2. Plan for producing deeper levels of sedation, if needed, and plan for managing levels deeper than anticipated.

Front 14

Which level of sedation is characterized by anxiolysis but with normal arousal to verbal stimuli?

Back 14

Minimal sedation

Front 15

What level of sedation is characterized by a depressed level of consciousness and a slower but purposeful motor response to simple verbal or tactile stimuli?

Back 15

Moderate sedation

Front 16

During moderate sedation what percentage of patients will develop hypoxia and/or hypoventilation?

Back 16

10% to 30%

Front 17

During moderate sedation what percentage of patients will require temporary ventilatory support because of severe bradypnea or apnea?

Back 17

5% to 15 %

Front 18

Dissociative sedation falls under what level of sedation?

Back 18

Moderate sedation

Front 19

The reduction of a dislocated hip in the emergency department will likely require what level of sedation?

Back 19

Deep sedation

Front 20

Patients with no oral intake for more than how many hours before procedure PSA have a low risk of aspiration at any level.

Back 20

More than 3 hours

Front 21

If a procedure requiring sedation would be harmful to delay and the patient has had a light snack or a meal within 3 hours, what should the level of sedation be limited to?

Back 21

Moderate sedation

Front 22

What level of sedation can be used in a patient who is in urgent need of a procedure but who has had only clear liquid in the three hours before the procedure?

Back 22

Patients with only clear liquid intake in the 3 hours before PSA have a higher but acceptable risk of aspiration, so that procedures can be performed at any level of sedation.

Front 23

What is the only sedative agent that typically preserves the patient's ventilatory effort and has minimal effect on blood pressure?

Back 23

Ketamine

Front 24

Excellent agent for minimal sedation for Neuro imaging in children. Short acting and useful when the procedure itself is painless but the circumstances may cause anxiety.

Back 24

Pentobarbital

Front 25

What drug, what dose and under what circumstances can rigid chest syndrome be caused?

Back 25

Fentanyl at doses above 5 mcg per kilogram when given rapidly

Front 26

Describe the treatment for rigid chest syndrome.

Back 26

Intubation with rapid sequence induction and pharmacologic paralysis is usually required to ventilate the patient. Not reversible with opioid receptor antagonists.

Front 27

What sedation agent is contraindicated in pregnant patients due to its action as an inhibitor of folate metabolism?

Back 27

Nitrous oxide

Front 28

Which sedation agent may increase intracranial pressure but does increase intraocular pressure and should be avoided in patients with eye injuries or glaucoma?

Back 28

Ketamine

Front 29

Which sedation agent may promote expansion of internal gas filled structures and should be avoided in patients with pneumothorax, pneumocephalus, and vascular air embolism?

Back 29

Nitrous oxide

Front 30

This sedation agent has a rapid onset of action with an effective duration of 3 to 5 minutes. It is best used for brief moderate and deep sedation, such as that needed for joint dislocation reduction.

Back 30

Methohexital

Front 31

Using the Aldrete score the patient's recovery and safety for discharge can be assessed. What score indicates the patient is safe for discharge?

Back 31

A return to a pre procedure baseline score or a score of at least 18 indicates the patient is safe for discharge

Front 32

In an elderly patient with underlying clonus what agent should be avoided since it can exacerbate that symptom?

Back 32

Etomidate

Front 33

Propofol produces greater peak plasma concentrations after a specific iv bolus dose in the elderly, therefore how should this drug be dosed in the elderly?

Back 33

The initial and subsequent doses should be 50% of those recommended for younger adults and more cautious titration is needed.