IV Sedation I

Question 1

What is sedation?

Answer 1

Range extending from normal alert consciousness to complete unresponsiveness

Question 2

What is conscious sedation?

Answer 2

Technique using drug/ drugs to provide depression of CNS enabling treatment to be carried out, verbal communication maintained

Question 3

How is responsiveness, airway, ventilation and CV system affected in minimal sedation?

Answer 3

Responsiveness: normal
Airway: unaffected
Ventilation: unaffected
CV: unaffected

Question 4

How is responsiveness, airway, ventilation and CV system affected in moderate sedation?

Answer 4

Responsiveness: response to verbal/ tactile stimulation
Airway: maintained w/o intervention
Ventilation: adequate
CV: maintained

Question 5

How is responsiveness, airway, ventilation and CV system affected in deep sedation?

Answer 5

Responsiveness: to repeated or painful stimulation
Airway: intervention may be required
Ventilation: inadequate
CV: maintained

Question 6

How is responsiveness, airway, ventilation and CV system affected in GA?

Answer 6

Responsiveness: unrousable
Airway: intervention
Ventilation: inadequate
CV: impaired

Question 7

Function of respiratory system?

Answer 7

Ventilate lungs to allows gas exchange - addition of o2 and elimination CO2

Question 8

5 steps of ventilation?

Answer 8

1. ventilation - gas in and out lungs
2. diffusion - gas from lungs o blood
3. transport - to/ from cells
4. diffusion - gas blood to lungs
5. oxidation - use oxygen too produce energy within cells

Question 9

What are 2 main parts of ventilation?

Answer 9

Inspiration and expiration

Question 10

What is inspiration

Answer 10

Active process initiated by diaphragm

Question 11

What is expiration?

Answer 11

Passive process caused by recoil of lungs

Question 12

Where does gas exchange occur and why?

Answer 12

Alveolus

Gases diffuse down concentration gradient

Question 13

How is oxygen transported?

Answer 13

Oxygen binds to haemoglobin which is carried within the red blood cells - released when reaches tissue

Question 14

How is breathing rate altered?

Answer 14

From [co2] in blood

Detected by peripheral chemoreceptors in aorta and carotid –> cause response central chemoreceptor in medulla

Question 15

What are basic clinical signs to check respiration?

Answer 15

Respiratory rate
Depth breathing
Pattern breathing
Check cyanosis

Question 16

What is average respiratory rate?

Answer 16

10-18

Question 17

What are more advanced ways to check respiration?

Answer 17

Pulse oximetry

Question 18

What can limit pulse oximeter?

Answer 18

Ambient light
Movement
Cold peripheries
Nail varnish

Question 19

What is capnography?

Answer 19

Detects CO2 exhaled in Brea via nasal prongs

See is adequate ventilation

Question 20

Problem w/ capnography?

Answer 20

Requires nose breathing

Question 21

What are 2 respiratory complications seen in sedation?

Answer 21

Upper airway obstruction

Hypoventilation

Question 22

How does sedation cause upper airway obstruction?

Answer 22

sedation leads to decreased muscle tone

If pharynx lose tone can collapse, tongue falls against wall of pharynx leading to airway obstruction

Question 23

What are signs of airway obstruction?

Answer 23

Snoring
Stidor
Drop O2 sat

Question 24

Management of airway obstruction?

Answer 24

Supplementary oxygen
Basic airway opening manuevers
Airway adjunct
Careful titration sedatives

Question 25

How can hypoventilation occur in sedation?

Answer 25

Sedative drugs can sedate respiratory centre in brain and reduce recetor sensitivity to CO2 = reduced respiratory rate causing CO2 levels build

Question 26

Detect hypoventilation?

Answer 26

Monitor respiration rate | Drop O2 sats

Question 27

Manage hypoventilation?

Answer 27

``` Reverse sedation (e.g flumazenil) Assist ventilation e.g ambu bag ```

Question 28

What is function of CV system?

Answer 28

Deliver oxygenated blood to body organs and tissue

Question 29

What happens in cardiac ischemia?

Answer 29

Angina which can lead myocardial infarct

Question 30

What happens in cerebral ischemia?

Answer 30

Faint/ collapse --> stroke

Question 31

Main determinant of organ perfusion?

Answer 31

Blood pressure

Question 32

How is blood pressure displayed?

Answer 32

Systolic and diastolic | systolic over diastolic - 120/80

Question 33

How is blood pressure determined?

Answer 33

cardiac output | systemic vascular resistance

Question 34

What is cardiac output?

Answer 34

Amount of blood ejected by heart in minute

Question 35

What is systemic vascular resistance?

Answer 35

resistance produced by vascular system to flow of blood - predominately through small arterioles in body

Question 36

What is acute control of blood pressure?

Answer 36

Baroreceptors in aortic arch and internal carotids - autonomic nervous system alters heart contraction/ constriction blood vessels

Question 37

What is chronic control of blood pressure?

Answer 37

Renin-angiotensin system - via blood sodium [] and body fluid retention

Question 38

Basic clinic signs to monitor CV system?

Answer 38

HR Consciousness level Skin colour Capillary refill

Question 39

Advanced ways to monitor CV system?

Answer 39

Non-invasive blood pressure | ECG monitoring

Question 40

What can blood pressure cuff be affected by?

Answer 40

Movement | Wrong sized cuff

Question 41

When should ECG monitoring be used?

Answer 41

Pt significant hx of cardiovascular disease

Question 42

What are 2 CV complications caused by sedation?

Answer 42

Hypotension | Cardiac arrhythmia

Question 43

How is hypotension caused in sedation?

Answer 43

Drugs cause vasodilation | Some drugs decrease strength heart contractions

Question 44

Tx hypotension?

Answer 44

Stop administering Pt head down, feet elevated IV fluids may be required

Question 45

How can cardiac arrhythmia be caused?

Answer 45

Precipitated by adrenaline in LA

Question 46

How manage cardiac arrhythmia?

Answer 46

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