ICU pain and delirium 2

Question 1

what is the only benzo with some adverse hemodynamic reaction

Answer 1

midazolam

Question 2

what should be monitored with lorazepam

Answer 2

serum osmolality or bicarbonate for propylene glycol toxicity

Question 3

what are some adverse effects of propofol

Answer 3

1. hypotentsion (dose dependent)
2. green urine
3. hypertriglyceridemia
4. propofol related infusion syndrome (PRIS)

Question 4

if triglycerides are greater than what, propofol should not be used?

Answer 4

greater than 400

increased risk of acute pancreatitis

Question 5

what are the symptoms of propofol related infusion syndrome

Answer 5

1. bradycardia
2. lactic acidosis
3. rhabdomyolysis
4. renal failure

Question 6

what should be done if propofol related infusion syndrome is suspected

Answer 6

stop infusion immediately

Question 7

who is propofol preferred for use in

Answer 7

acutely agitated patients and patients requiring sedation with frequent neuro checks

Question 8

what drug has sedative and mild analgesic properties with a similar mechanism to clonidine (alpha 2 agonist)

Answer 8

dexmedetomidine

Question 9

what are some common adverse effects with dexmedetomidine

Answer 9

1. bradycardia
2. hypertension
3. hypotension
4. cardiac arrhythmias

Question 10

when is hypotension most common with dexmedetomidine

Answer 10

with bolus doses

Question 11

what are the 4 places in therapy noted for dexmedetomidine

Answer 11

1. post-surgical sedation with an anticipated short inubation period
2. adjunct agent to benzodiazepines
3. procedural sedation
4. associated with less ICU delirium

Question 12

what are the two scales used for monitoring sedation

Answer 12

1. RASS

2. Rikers

Question 13

what is the target Riker score

Answer 13

4 on the sedation-agitation scale

Question 14

what is the first line drug of choice for non-neuropathic pain in critically ill patients

Answer 14

IV opioids

Question 15

what type of drugs are preferred for mechanically ventilated adult ICU patients

Answer 15

nonbenzos

propofol or dexmedetomidine

Question 16

what is the definition of ICU delirium

Answer 16

acute change in consciousness that develops over hours to days with fluctuations in mental status

Question 17

what are signs of hyperactive delirium

Answer 17

1. irritability
2. anger
3. comabiveness
4. laughter

Question 18

what are the signs of hypoactive delirium

Answer 18

1. slurred speech
2. apathy
3. lethargy
4. altered sleep patterns

Question 19

what are some consequences of ICU delerium

Answer 19

1. independent risk factor of 6 month mortality
2. increased length of stay
3. 9x higher incidence of cognitive impairment at discharge (permanent)

Question 20

what are the risk factors for ICU delirium (8)

Answer 20

sleep deprivation
withdrawal syndromes
age
metabolic derangements
pain
drugs (opiates, benzos...)
infection
CNS injury

Question 21

how can delirium in patients be monitored

Answer 21

1. Confusion assemssment method

2. Intensive care delirium screening checklist

Question 22

what are 5 ways of non-pharm delirium treatment

Answer 22

1. orient patient to room and time
2. give patient their eyeglasses or hearing aids if needed
3. calendars and clocks
4. reduce noise and distractions
5. place patient in a room with a window

Question 23

new practice guidelines suggest what?

Answer 23

1. no evidence that haloperidol helps
2. atypical antipsychotics may reduce duration of delirium
3. dexmedetomidine infusions rather than benzos in patients unrelated to Etoh or bdz withdrawal

Question 24

what are some strategies to manage pain agitation and delirium in the ICU

Answer 24

1. daily sedation interruption or light target level of sedation in mechanically ventilated patients
2. analgesia-first sedation in mechanically ventilated patients
3. promoting sleep in ICU patients
4. using interdisciplinary ICU teams and protocols

Question 25

what drug is preferred for treating ICU delirium?

Answer 25

there is no preferred drug for treating delirium