Sedation & Pain Scales for Intubated & Ventilated Patients - Analgosedation & Paralysis

Question 1

The Ornge MDSOs state all intubated and ventilated patients receiving sedation/analgesia should have which two scores calculated?

Answer 1

1. Pain Scale for Adult Intubated Patients

2. Sedation Score for Adults (Richmond Analgesia Sedation Score - RASS)

Question 2

Sedation and analgesia should be titrated to what scores on the Pain Observation Tool and the RASS?

Answer 2

Ornge states titrate to a sedation score of -4 and a pain score of 0-2.

Question 3

The Critical Care Pain Observation Tool is used as a pain scale for adults who are intubated and ventilated, what are the 4 catagories for assessment?

Answer 3

1. Facial expression (balanced/neutral, tense, grimacing)
2. Body movement (none, protection, restless)
3. Muscle tension (relaxed, tense/rigid, very tense)
4. a) Vent compliance (tolerating, coughing, fighting vent)
   b) Vocal (extubated: talking, sighing/moaning, crying/sobbing)

Question 4

What is the total range for the Pain Observation Tool and what is the analgesia goal?

Answer 4

Range: 0-8
Goal: 0-2

Question 5

In the Pain Observation Tool for intubated & ventilated patients what are the scores for the 3 aspects of Facial Expression?

Answer 5

Balanced/neutral = 0
Tense = 1
Grimacing = 2

Question 6

In the Pain Observation Tool for intubated & ventilated patients what are the scores for the 3 aspects of Body Movements?

Answer 6

Absence/none = 0
Protection = 1
Restlessness = 2

Question 7

In the Pain Observation Tool for intubated & ventilated patients what are the scores for the 3 aspects of Muscle Tension?

Answer 7

Evaluated by passive flexion & extension of upper extremities
Relaxed = 0
Tense/rigid = 1
Very tense/rigid = 2

Question 8

In the Pain Observation Tool for intubated & ventilated patients what are the scores for the 3 aspects of Compliance/Vocalization (depending on intubated vs extubated)?

Answer 8

Compliance with vent (intubated):
Tolerating = 0
Coughing but tolerating = 1
Fighting vent = 2

Vocalization (extubated)
Talking in normal tone or no sound = 0
Sighing/moaning = 1
Crying out/sobbing = 2

Question 9

In the Sedation Score (RASS - Richmond Analgesia Sedation Score) what is the range from “unarousable” to “combative”?

Answer 9

-5 (unarousable) to +4 (combative)

Question 10

What is the RASS goal for an intubated, ventilated patient?

Answer 10

-4 (deep sedation)

Question 11

All patients should receive both analgesia and sedation when intubated and ventilated, which medication can be used alone as it provides both?

Answer 11

Ketamine, baby!

Question 12

Which 2 analgesics may be used for management of intubated and ventilated patients?

Answer 12

Fentanyl (may initiate and maintain)
Hydromorphone (may maintain)

No patch for either

Question 13

Which 4 sedatives may be used for management of intubated and ventilated patients?

Answer 13

Midazolam
Propofol
Ketamine
Dexmedetomidine

No patch required for any of these

Question 14

Which 2 medications may be used for the management of sedation-related hypotension in intubated and ventilated patients?

Answer 14

Phenylephrine
Norepinephrine

No patch required for either