NRNP 6566 WEEK 8 KNOWLEDGE CHECK WITH
ANSWERS
Question 1
What type of ICU sedation would be appropriate for a 32 year old male patient who is
intubated with bilateral chest tube following a motor vehicle crash.
Correct
Answer: The Society of Critical Care Medicine publishes a guideline on sedation. It is:
Guidelines for the Prevention and Management of Pain, Agitation/Sedation,
Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU
(2018).
Light sedation is suggested for intubated ICU patients. Non-benzodiazepine
sedatives (either propofol or dexmedetomidine) are preferable to
benzodiazepine sedatives (either midazolam or lorazepam) in critically ill,
mechanically ventilated adults.
Question 2
Describe the levels of sedation (minimal, moderate, deep, general anesthesia, and
dissociation) and its affect on consciousness, airway, ventilation, and reflexes.
Correct
Answer: Sedation decreases a patient’s awareness to the environment and their
responses to external stimulation. Sedation occurs a long a continuum which
includes minimal, moderate, deep, general anesthesia, and dissociation.
Minimal sedation is a drug induced relief of anxiety or apprehension with
minimal to no affection on sensorium. Most often this is achieved with an anti-
anxiety medication.
Moderate sedation causes a depression of consciousness but the patient can
still respond to external stimuli. Airway, spontaneous ventilation, and
cardiovascular function are maintained.
Deep sedation causes a depression of consciousness in which the patient
cannot be aroused but responds purposefully to repeated or painful stimuli.
Cardiovascular function is maintained but airway and spontaneous ventilation
may be compromised.
General anesthesia is a state of unconsciousness where the patient is unable
to respond to any stimuli. Close monitoring of all airway, ventilation, and
cardiovascular function is essential.
Dissociation is considered to be a type of moderate sedation that occurs when
using medications in the phencyclidine group (such as ketamine). They cause
a dissociation of the limbic system preventing higher centers from receiving
sensory stimuli. Like moderate sedation, airway reflexes, spontaneous
ventilation, and cardiovascular function are all maintained.
Question 3
, The APRN has determined that a 21 year old motor vehicle crash victim needs a rapid
sequence intubation. The patient weighs 77 kg. What medications are indicated to
successfully achieve the rapid sequence intubation?
Correct
Answer: Rapid sequence intubation requires the use of induction agent to cause
unresponsiveness and a neuromuscular blocking agent to cause muscular
relaxation. It is the fast and most effective means of controlling the
emergency airway. There are no contraindications to using Etomidate and
Succinylcholine
Etomidate 23 mg IV and Succinylcholine 115 mg IV
Here are details about the different medications and their uses.
INDUCTION AGENTS
Etomidate
0.3mg/kg IV
onset: 10-15 seconds
Use: good option for most situations including hemodynamically unstable
patient. Avoid in sepsis or seizures
Can cause adrenal suppression, myoclonus, pain on injection
Ketamine
Dose: 1.5 mg/kg IV (4mg/kg IM)
Onset: 60-90 sec
Duration: 10-20 min
Use: good option for any RSI,especially if hemodynamically unstable. May be
used in TBI (no increase in ICP) and reactive airway disease (causes
bronchodilation)
Can cause an increase in secretions, caution in hypertension and tachycardia,
may cause laryngospasm and increased intra-ocular pressure.
Thiopentone
Dose: 3-5 mg/kg IV TBW
Onset: 30-45 sec
Duration: 5-10 min
Use: good option in hemodynamically stable patients, also for status
epilepticus
Causes histamine release, myocardial depression, vasodilation, hypotension
Propofol
Propofol 1.5-2.5 mg/kg x TBW as the general guide
Onset: 15-45 seconds
Duration: 5 – 10 minutes
Use: should be used in hemodynamically stable patients, appropriate for
patients with reactive airways disease or status epilepticus
Can cause hypotension, myocardial depression, reduced cerebral perfusion
muscular rigidity in high induction doses, bradycardia, tissue saturation at
high doses
PARALYTIC AGENTS
Suxamethonium (aka succinylcholine)
Dose: 1.5 mg/kg IV (2 mg/kg IV if myasthenia gravis) and 4 mg/kg IM (in
extremities)
Onset: 45-60 seconds
Duration: 6-10 minutes
ANSWERS
Question 1
What type of ICU sedation would be appropriate for a 32 year old male patient who is
intubated with bilateral chest tube following a motor vehicle crash.
Correct
Answer: The Society of Critical Care Medicine publishes a guideline on sedation. It is:
Guidelines for the Prevention and Management of Pain, Agitation/Sedation,
Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU
(2018).
Light sedation is suggested for intubated ICU patients. Non-benzodiazepine
sedatives (either propofol or dexmedetomidine) are preferable to
benzodiazepine sedatives (either midazolam or lorazepam) in critically ill,
mechanically ventilated adults.
Question 2
Describe the levels of sedation (minimal, moderate, deep, general anesthesia, and
dissociation) and its affect on consciousness, airway, ventilation, and reflexes.
Correct
Answer: Sedation decreases a patient’s awareness to the environment and their
responses to external stimulation. Sedation occurs a long a continuum which
includes minimal, moderate, deep, general anesthesia, and dissociation.
Minimal sedation is a drug induced relief of anxiety or apprehension with
minimal to no affection on sensorium. Most often this is achieved with an anti-
anxiety medication.
Moderate sedation causes a depression of consciousness but the patient can
still respond to external stimuli. Airway, spontaneous ventilation, and
cardiovascular function are maintained.
Deep sedation causes a depression of consciousness in which the patient
cannot be aroused but responds purposefully to repeated or painful stimuli.
Cardiovascular function is maintained but airway and spontaneous ventilation
may be compromised.
General anesthesia is a state of unconsciousness where the patient is unable
to respond to any stimuli. Close monitoring of all airway, ventilation, and
cardiovascular function is essential.
Dissociation is considered to be a type of moderate sedation that occurs when
using medications in the phencyclidine group (such as ketamine). They cause
a dissociation of the limbic system preventing higher centers from receiving
sensory stimuli. Like moderate sedation, airway reflexes, spontaneous
ventilation, and cardiovascular function are all maintained.
Question 3
, The APRN has determined that a 21 year old motor vehicle crash victim needs a rapid
sequence intubation. The patient weighs 77 kg. What medications are indicated to
successfully achieve the rapid sequence intubation?
Correct
Answer: Rapid sequence intubation requires the use of induction agent to cause
unresponsiveness and a neuromuscular blocking agent to cause muscular
relaxation. It is the fast and most effective means of controlling the
emergency airway. There are no contraindications to using Etomidate and
Succinylcholine
Etomidate 23 mg IV and Succinylcholine 115 mg IV
Here are details about the different medications and their uses.
INDUCTION AGENTS
Etomidate
0.3mg/kg IV
onset: 10-15 seconds
Use: good option for most situations including hemodynamically unstable
patient. Avoid in sepsis or seizures
Can cause adrenal suppression, myoclonus, pain on injection
Ketamine
Dose: 1.5 mg/kg IV (4mg/kg IM)
Onset: 60-90 sec
Duration: 10-20 min
Use: good option for any RSI,especially if hemodynamically unstable. May be
used in TBI (no increase in ICP) and reactive airway disease (causes
bronchodilation)
Can cause an increase in secretions, caution in hypertension and tachycardia,
may cause laryngospasm and increased intra-ocular pressure.
Thiopentone
Dose: 3-5 mg/kg IV TBW
Onset: 30-45 sec
Duration: 5-10 min
Use: good option in hemodynamically stable patients, also for status
epilepticus
Causes histamine release, myocardial depression, vasodilation, hypotension
Propofol
Propofol 1.5-2.5 mg/kg x TBW as the general guide
Onset: 15-45 seconds
Duration: 5 – 10 minutes
Use: should be used in hemodynamically stable patients, appropriate for
patients with reactive airways disease or status epilepticus
Can cause hypotension, myocardial depression, reduced cerebral perfusion
muscular rigidity in high induction doses, bradycardia, tissue saturation at
high doses
PARALYTIC AGENTS
Suxamethonium (aka succinylcholine)
Dose: 1.5 mg/kg IV (2 mg/kg IV if myasthenia gravis) and 4 mg/kg IM (in
extremities)
Onset: 45-60 seconds
Duration: 6-10 minutes
