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57 Cards in this Set

  • Front
  • Back
return pt to a state in which safe discharge as determined by recognized criteria
goal of sedation
levels of sedation are defined by what (5)
airway control
resp responsiveness
gross motor skills
level of awareness
responsiveness to stimuli
level 1 sedation
anxiolysis
drug of choice for level 1 sedation
versed
minimal monitoring with 02 sat and pulse rate
level 1-anxiolysis
what is the procedural sedation goal
to never lose airway control
level 2 sedation
moderate sedation (conscious sedation)
characteristics of level 2 sedation (6)
*minimal discomfort
*small/mod degree of immobi
*may need to be cooperative
*responds to verbal/px stimuli
*maintains airway
*protective reflexes maintained
when is level 2 sedation used (3)
EEG
CT
EMG
agents for level 2 sedation
sedative hypnotics
level 3 sedation
deep sedation
agents for level 3 sedation (2)
sedative-anxiolytics
sedaticve analgesics
reasons for level 3 sedation (5)
LP
BMA
CT scan
MRI
eye exams
can easily lose airway control in this level
3 sedation
pt not easily aroused, partial or complete loss of protective reflexes and may not be able to maintain airway
deep sedation
level 4 sedation
general anesthesia
procedure characteristics for level 4 sedation (2)
mod-sever discomfort
low -mod immobilty
medically controlled state with loss of protective reflexes and cannot maintain own airway
level 4
who can do level 4 sedation
anesthesiologists
Pt prep for sedation (5)
NPo
baseline assessments
IV start if needed
informed consent
equipment set-up
Equipment should include (7)
positive pressure 02
suction
ambu bag
bp cuff
pulse ox
capnography
crash cart
what to think about when getting set up
D- rugs
E- mergency
M-onitoring
O-xygen
S-uction
what does the support personnel do with level 2 sedation (5)
mtr only
assists with support
knowledge of crash cart
rt reviews
BLC/ACLS
practitioner req's for level 2 sedation (2)
skilled in procedure& sedation
BLS
level 2 pt mtr (5)
baseline
VS q 5 min
check head position
VS q15 post
ambu bag
level 3 req's during sedation
same as level 2
what should be present before DC
taking fluids and keeping them down
induces sedation/sleep with no analgesia
pentobarbital
characteristics of pentobarbital (4)
titrate for best results
loading dose 1-3mg/kg
req's personnel& equip for airway
prolonged sleep for some
no antidote
SE of pentobarbital (2)
resp dep
prolonged sleep
what is the biggest problem with pentobarbital d/t to no antidote
res dep
med that has immobility, sedation, amnesia, and antianxiolytic
versed
what is versed used as
secondary d/t unpredictable as primary agent
characteristics of versed (5)
variety of routes
IV burns (10-15min)
req's cariac mtr
req's ability to support airway
antidote- flumazenil
100x more potent than MS
fentanyl
selective alpha 2 agent that decreases noepi release and inhibits sympathetic activity
precedex
what does precedex bind with in the medulla sleep center
A1 receptors in locus ceruleus
what properties does precedex have (3)
anxiolysis
arousable sedation
analgesia
SE of precedex
N/v
hypotension
bradycardia
what are the SE of precedex treated with
fluids
vasopressors
atropine
Precedex routes
PO, Bucally, IV, IM
half life of precedex
6 min
duration of precedex
4 hrs
rapid infusion of precedex causes what
hypotension and bradycardia
oral/bucal dose of precedex
2-4mcg/kg
IV loading dose of precedex
0.5-1mcg/kg over 10 min
hypnotic agent with little analgesic effect
propofol
how is propofol given
IV only and is painful
onset of propofol
30-60 sec
important with propofol
strict asepsis d/t lipid-emulsion
how often is bp monitored with propofol
3-5 min
purpose of con't sedation in ICU
facilitate oxygenation
decrease tissue needs
what are the common con't sedation agents (5)
pentobarital
propofol
ativan
morphine
fentanyl
measures con't EEG at the bedside to determine level/depth of sedation
BSI
BSI for awake adult
100
general anesthesia BSI level
40-60
what does PRIS result in (4)
cardiac failure
rhabdomyolysis
metabolic acidosis
renal failure