Sedation and Pain Management in Critical Care

28 Questions

What is the primary goal in delirium management?

Prevention

What is the characteristic of morphine's lipophilicity?

Variable lipophilicity (+/-)

What is the RASS score for a patient who is agitated and frequently moves non-purposefully?

What is the primary challenge in managing sedation in critically ill patients?

Managing analgesia and delirium simultaneously

What is the duration of action of hydromorphone?

2-3 hours

What is the CAM-ICU feature that indicates a patient's level of consciousness is altered?

Altered level of consciousness

What is the primary goal of analgesosedation?

Pain management

What is the RASS score for a patient who is unarousable and unresponsive to voice or physical stimulation?

-5

What is the dosing range for fentanyl continuous infusion?

0.2-3 mg/hr

What is the primary mechanism of action of dexmedetomidine?

Alpha-2 agonist

What is a common adverse effect of propofol infusion?

Respiratory depression

What is the primary goal of sedation in ICU patients?

To facilitate ventilator tolerance

Which of the following sedative agents is not useful in suppressing seizures?

Dexmedetomidine

What is a challenge of sedation in ICU patients?

Blunting respiratory drive

What is the usual starting dose of dexmedetomidine for sedation?

0.2 mcg/kg/hr

What is the peak effect of propofol bolus dose?

Rapid onset

Which of the following sedative agents is a serotonergic agent?

Ketamine

What is the goal of light sedation in ICU patients?

To ease anxiety and facilitate nursing management

What is the primary objective for initiating analgesia and sedation in a critically ill patient?

To improve patient comfort and reduce stress

Which of the following pharmacologic agents is NOT commonly used for pain management in the ICU?

Metoprolol

A patient is experiencing agitation and delirium in the ICU. Which of the following medications is likely to increase the risk of delirium in this patient?

Benzodiazepine

A patient is being mechanically ventilated and is displaying signs of agitation. What is the most appropriate sedation level to target in this patient?

Moderate sedation

Which of the following sedation agents is associated with a decreased risk of delirium in critically ill patients?

Dexmedetomidine

What is the primary challenge in sedation management in the ICU?

Difficulty in assessing sedation levels

A patient is experiencing pain and agitation in the ICU. What is the most appropriate first step in managing this patient?

Assessing the patient's pain using a standardized tool

Which of the following is a risk factor for delirium in critically ill patients?

Use of benzodiazepines

What is the primary advantage of using the Critical Care Pain Observational Tool (CPOT) in pain assessment?

It is a behavioral tool that can be used in non-verbal patients

A patient is being treated for pain and agitation in the ICU. What is the most appropriate goal for sedation management in this patient?

Targeting a sedation level that facilitates ventilation and reduces agitation

Study Notes

Pain Assessment

The reference standard for pain assessment is the patient's self-report of pain.
Other methods include the verbal description scale, numeric rating scale, and visual analog scale.
The Critical Care Pain Observational Tool (CPOT) and Behavioral Pain Scale (BPS) are also used to assess pain.

CPOT and BPS

CPOT:
- Facial expression: relaxed (1), partially tightened (2), fully tightened (3), grimacing (4)
- Upper limbs: no movement (1), partially bent (2), fully bent with finger flexion (3), permanently restricted (4)
- Compliance with ventilation: tolerating movement (1), coughing but tolerating ventilation most of the time (2), fighting the ventilator (3), unable to control ventilation (4)
BPS:
- Facial expression: relaxed (0), tense (1), grimacing (2)
- Body movements: none (0), protection (1), restless (2)
- Muscle tension: relaxed (0), tense (1), rigid (2)

Agitation and Sedation

The Richmond Agitation-Sedation Scale (RASS) is used to assess agitation and sedation.
RASS scores range from +4 (combative) to -5 (unarousable).
Goals of sedation include patient comfort, ease of anxiety, control of pain, and facilitation of nursing management.

Delirium

Delirium is a priority to prevent in the ICU.
The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is used to assess delirium.
Features of delirium include acute onset, fluctuating mentation, inattention, altered level of consciousness, and disorganized thinking.

Pharmacologic Agents

Analgesic agents include morphine, hydromorphone, fentanyl, and adjunct medications like acetaminophen and gabapentin.
Sedative agents include propofol, benzodiazepines, dexmedetomidine, and ketamine.
Pharmacologic options should be tailored to the patient's specific needs and medical history.

Objectives

Recognize when to use scoring tools for pain, agitation, and delirium and interpret their results.
Explain the rationale for initiating analgesia and sedation in critically ill patients.
Differentiate agents used for pain and sedation in critically ill patients.
Identify risk factors and medications that increase the risk of delirium in critically ill patients.
Generate a patient-specific plan for pain, agitation, and delirium prevention in critically ill patients.

Test your knowledge on sedation and pain management in critical care, including medications, dosages, and goals of sedation. Learn about the effects of different medications on patients and how to manage pain and anxiety in critical care settings.

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