Morning Report

Morning Report: 8/12/2014

by  •  • Comments Off on Morning Report: 8/12/2014

Today’s Morning Report is presented by Dr. Oiyemhonlan!

 

Analgesia and Sedation

Induction = Sedation = No Analgesia (exception Ketamine)

 

Paralytics (Muscle Relaxant): Blocks the transmission of the action potential at the neuromuscular junction causing paralysis. Does not provide Analgesia or Sedation; patients are still aware of pain even after full conduction block. Act post-synaptically

 

  • Non-depolarizing vs Depolarizing

 

  • Non- depolarizing – Competitively blocks the binding of Ach to its receptors; may also directly block ionotropic activity of Ach receptors

 

  • Depolarizing – Depolarizes the plasma membrane of the skeletal muscle fibers. This persistent depolarization makes the muscle fiber resistant to further stimulation by Ach

 

Board Review Question – Only Absolute Contraindication to Succinylcholine – Myasthenia Gravis (autoantibodies to the post-synaptic membrane)—prolonged paralysis; non-depolarizing agents much more harmful

 

Pediatric patients ( <8 yrs) due to possible muscular dystrophy and risk of hyperkalemic arrest

 

Overall Goal

  • Relieve patient anxiety and keep them comfortable

 

  • In the “ICU Book” the common denominator anxiety and delirium is the absence of well-being

 

  • Reduce anxiety and

 

  • Why reduce the anxiety of a ventilated patient?

 

    • Prevent breath stacking – Auto peep
    • Prevent pulling of lines
    • Prevent vital sign derangements – Tachycardia
    • Provide humane treatment
    • Reduce possibility of delirium

 

Analgesia

Fentanyl – synthetic potent opioid analgesic; mu receptor agonist

 

Sedation

Benzodiazepines – increases delirium

Dexmedetomidine (Precedex) – reducing norepi release from the locus ceruleus

 

Sedation Scales – Useful for assessing ventilated patients arousability

Richmond Agitation Sedation Scale (RASS) (+4-(-) 5) 10 point scale

Riker Sedation – Agitation Scale (SAS) 7-1 – Dangerous Agitation – Unarousable

Ramsey Scale – (1-6) Anxious – No response

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
The following two tabs change content below.
My Twitter profileMy Facebook profileMy Vimeo channel

Jay Khadpe MD

Editor in Chief of "The Original Kings of County" Assistant Professor of Emergency Medicine Assistant Residency Director SUNY Downstate / Kings County Hospital
My Twitter profileMy Facebook profileMy Vimeo channel

Latest posts by Jay Khadpe MD (see all)