Week 5 Flashcards by caitlin gill

What is the presentation of Ketamine?

200mg in 2mL

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What is the treatment for a patient who falls under the mild/moderate agitation category?

Midazolam 5 - 10mg IM
repeat @10mins
Max dose 20mg

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What are some potential differential diagnosis of excited delirium?

serotonin syndrome
sympathomimetic syndrome
diabeteic hypoglycaemia
drug withdrawal
heat stroke

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When should sedation be administered for HYPERTHERMIC psychostimulant overdose?

administered early to help with cooling

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What is Instrumental aggression?

Premeditated ‘COLD’ goal directed

More proactive

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what are some psychiatric causes of excited delirium?

acute psychosis
mania
schizophrenia

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WHat are the side effects of midaz?

depressed level of consciousness
resp depression
loss of airway control
hypotension

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what is the peak time of midaz IM?

15 mins

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In all cases where sedation is administered, supportive care should be provided as required, this includes what?

airway management
supplmentary O2 if sedated with midaz of ket
perfusion management
temperature management
management of causes of agitation

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what factors contribute to aggression?

hypoglycaemia
psychiatric illness
substance abuse
head injury
hypoxia
metabolic imbalances
frustration

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What is the pharmacology of ketamine?

a rapid acting dissociative anaesthetic agent

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What does cocaine do to affect dopamine levels?

chronic use leads to dopamine depletion, affecting dopaminergic balance, leading to:

cardiac hypertrophy

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What is the pathophysiology of excited delirium?

Dopamine hypothesis:

depletion of dopamine levels fucks with them basically.

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What are the contras for ketamine?

hypersensitivity

sever hypertension >180

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When should you consult before administering sedatives?

if GCS 10-14

or if outside guidelines

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What is the treatment for a patient who falls under the extreme agitation category?

Ketamine IM
<60kg = 200mg
60-90kg = 300mg
>60kg = 400mg

If Ket unavailable:
Midazolma 20mgIM
Repeat @10min
Max 40mg

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What is the onset time of ket IM?

3-4 mins

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What are bath salts?

synthetic cathinones

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What are the risks of chemical restraint?

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decreased level of consciousness
resp depression
asphyxiation
hypotension

what are some metabolic/endocrine causes of excited delirium?

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electrolyte imbalances
hypoxia
hyperglycaemia
hypoglycaemia
uremia
thyrotoxicosis

what are some toxicological causes of excited delirium?

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alcohol
amphetamines
cocaine

What is the presentation of midazolam?

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5mg in 1mL

What are the elements of excited delerium?

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bizzare/aggressive behaviour
dilated pupils
fear and panic
hyperthermia
incoherent speech
tachypnoea
nakedness
profuse sweating
shivering
increased pain tolerance
unusual strength
mirror/glass attraction

What is the duration of ket IM?

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12-25 mins

What are the 5 steps in behavioural assessment for hostile aggression?

1. minor movements (clenching fists) 2. verbal abuse and threats 3. major motor movements (pacing) 4. aggression 5. exhaustion

How do bath salts work?

synthetic cathinones target monamine transporters: they disrupt the function of monoamine transporter proteins expressed on neurons in the central and peripheral NS

What are the potential clinical caused for agitation to considers as per AV CPG's?

``` AIEOUTIPS A- alcohol/drugs E - epilepsy I - Insulin or other metabolic cause O - overdose/oxygen U - underdose T - Trauma I - Infection/sepsis P - Pain/psychiatric S - stroke / TIA ```

How do you differentiate excited delirium syndrome (ExDS) from sympathomimetic syndrome?

more likely to dislpay bizarre abnormal behaviour with non-toxic amount of recent drug use such as walking through traffic/being naked in public etc

What are the side effects of ketamine?

increase BP and HR Resp depression emergence reactions enhanced skeletal tone nausea and vomiting Diplopia Nystagmus Lacrimation Salivation

What is the onset time of midaz IM

3-5mins

What is the duration if midaz IM?

30 minutes

what is the pharmacology of midaxzolam?

short acting CNS depressant

What are the risk factors for aggression and violence?

``` Past history of aggression Male Youth Anti-social traits Substance misuse Intoxication Impulsivity Irritability Suspiciousness Mental Illness ```

What is the treatment for an elderly/frail patient who falls under the mild/moderate agitation category?

Midazolam 2.5 - 5mg IM repeat @10mins Max dose 20mg

What is the preferred site for IM administration?

antereo-lateral mid thigh

What are some of the more potential signs of aggression?

``` under influence slurred speech sarcastic and abusive intruding on personal space hostile facial expressions blood stained clothes possession of a weapon obvious motor restlessness ```

what are some neurogenic causes of excited delirium?

dementia head injury seizure post-ictal state

what is aggression?

any offensive action, attach, or procedure or encroachment upons ones rights Psychiatric definition: overt or suppressed hostility, either innate or resulting from continued frustration and directed outwards

What is hostile aggression

im[ulsive 'HOT' unplanned and driven by anger reactive

What are two types of aggression?

Hostile aggression | Instrumental aggression

What are the contraindications of midazolam?

hypersensitivity to benzodiazepines

What other causes of agitation should you consider apart from AIEOUTIPS?

extreme grief

What is the target therapeutic dose of ketamine for patients affected my methamphetamines and classed under extereme agitation?

4mg/kg IM or 1mg/kg IV

what are some signals of agitation?

``` restlessness/fidgeting may try to remove IV or O2 no intent to injure may fight against interventions appear anxious ```

Define agitation?

the act or process of agitating, state of being agitated it is an unpleasant state of extreme arousal, increased tension, irritability, restless or anxious

what are some causes of agitation?

``` Drugs/alcohol Head injury Intyracerebral pathology (eg dementia) Hypoglycaemia Hypoxia Post-ictal Extreme emotion, stress Psychiatric condition Pain or discomfort Delirium ```

What is the dose for ketamine administration in extreme agitation?

Ketamine IM <60kg = 200mg 60-90kg = 300mg >60kg = 400mg

Week 5 Flashcards

(47 cards)