Moderate/Concious Sedation EHG questions and answers graded A+

What is moderate sedation - Answer-drug induced depression of consciousness (sedatives/sedation+analgesia) then titrated Different names for moderate sedation - Answer-conscious sedation, IV sedation,Procedural sedation Associated procedures for sedation - Answer-Bronchoscopy, Eye procedures, Biopsies, Lipo Characteristics of Moderate sedation - Answer-Patient is able to respond purposefully to verbal commands or light tactile stimulation Goals of moderate sedation - Answer--Altered mood • Maintain consciousness • Enhanced cooperation • Elevated pain threshold • Minimal variation of vital signs • Some degree of amnesia Minimal sedation - Answer-anxiolytic/analgesic drug Can i do deep sedation? - Answer-nah only CRNAs/Anesthesiologists contraindications for Moderate sedation - Answer--Mallampati score of >3 with abnormal airwa -Hx of CPAP -ASA 4 or unstable ASA 3 Pre-Procedure assessment - Answer-Vital signs, Aldrete,What does each scale measure: Aldrete, Ramsey/RASS, Numeric/Wong - Answer-Aldrete- Function Ramsey/RASS- Sedation Numeric- pain Assessing LOC - Answer-Sedation scales:Titrate sedation therapy to established clinical goals/ranges RASS - Answer-+4 Combative vs -5 unarousable Who can give Moderate sedation - Answer-RN's who are ACLS certified and complete the moderate sedation moduel NPO timeframe? - Answer-2 hours Necessar equipment - Answer-pulseox, bp,ekg,suction,oxygen, oral/nasal airways, intubation equipment, ambu bag, emergency drugs, crash cart, IV access Medications: IV - Answer-preferred. -Rapid onset -Adverse effects such as airway obstruction, cardiopulmonary arrest, and allergic reactions may occur rapidl Stuff to know about IV drugs - Answer-- Recommended dilution - Recommended dose - Time to onset and duration of action - Potential adverse reactions, and - Drug compatibility with other medications and solutionsMethods for IV sedation:Titration - Answer-Push: Titration: small increments of the medication are given until the desired clinical endpoints are achieved - sedation and analgesia. IV Sedation: Continuous infusion - Answer-Opioids are frequently supplemented by the administration of a benzodiazepine or hypnotic such as propofol. Analgesics for IV sedation - Answer-Fentanyl- 150mcg/IV/IM Morphine- 7.5-10mg Reversed with Narcan .1-.2mg IV Anxiolytics? Reversal agent? - Answer-Midazolam- 5-10mg IV/IM Lorazepam- .02 mg/kg IV/IM Diazepam- 5-10mg IV/IM Reversed with Flumazenil 0.2 mg IV Benzodiazepines - Answer-Amnesiac-sedative,muscle relaxant, anticonvulsant -minimal respiratory depression -Benzo+opioid = risk of resp depression Diazepam (Valium) Dosage, Peak, Half life, Duration - Answer--2.5-5mg, -10-15 minutes -20-80 hours -2-4 hours Lorazepam (Ativan) Dosage, Peak, Half life, Duration - Answer--0.5-2mg -15-20 mins-10-20 hours -6-8 hours Midazolam(Versed) Dosage, Peak, Half life, Duration - Answer-- .5-1mg - 3-5 minutes - 1-12 hours - 1.5-2 hrs Diazepam quick hits - Answer--Anticonvulsant/Anxiolytic -Painful upon injection -Forms precipitate with incompatible drugs Diazepam Contraindications - Answer-Hepatic/Renal compromised fx -combination with other CNS depressing drugs Diazepam dosage IV instructions - Answer-titrate until slurred speech (initial dose shouldn't pass 10mg) -Administer slowly over 1 minute for 5 mg injected Meds that inhibit benzos? potentiate? - Answer--Cimetidine -opioids, barbiturates, When would Lorazepam be used(duration) - Answer-procedure over 2 hours Lorazepam contraindications and precautions, age group - Answer-->50 -benzo hypersensitivity Lorazepam administration - Answer--dilute with equal amounts of compatible solution -inject slow through line (rate shouldn't pass 2mg/minute) -Don't dilute IMIV Versed administration - Answer-Rapid onset, short half life -IV 30-60 seconds Peak 10-15 minutes excreted in urine -give 1 hour prior to procedure (maintenance dose is 25% of initial dose) Never give rapid bolus, give over 2 minutes