pain and sedation

Question 1

SPICE III trial

• question
• answer

Answer 1

• question: does Precedex sedation for vented pts lead to improved mortality?
• answer: didn’t affect mortality but required more rescue sedatives and led to more adverse events (bradycardia, hypotension, asystole)

Question 2

how to apply physical restraints

Answer 2

6 people: 1 for head, 1 per extremity, 1 to apply restraints

legs to opposite sides of bed

Question 3

IM takedown meds (6 options)

Answer 3

• ketamine 4-5 mg/kg (i.e. 350-500 mg)
• Versed 2.5-5
• droperidol 2.5-5
• Zyprexa 10
• Haldol 2.5-10 q15m
• Ativan 0.5-2 q30m

Question 4

IV takedown meds (4 options)

Answer 4

• ketamine 1-2 mg/kg (i.e. 70-100 mg or 140-200 mg)
• Versed 2.5-5
• droperidol 2.5-5
• Ativan 0.5-2 q30m

*only difference btwn this and IM is ketamine dosage

Question 5

takedown meds in the elderly (2 options)

Answer 5

Haldol 0.25-0.5 IM

Ativan 0.5 mg PO

Question 6

pain meds in pregnancy

Answer 6

OK: opiates (unless imminent delivery), Tylenol, ketamine (class B3)

NOT OK: NSAIDs (compromise uterine blood supply, fetal pHTN, premature PDA closure)

Question 7

benzos in pregnancy?

Answer 7

no (class D)

Question 8

propofol in pregnancy?

Answer 8

yes