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