Podcast Episode 16: Sedation
Being able to calm and sedate patient in operational or prolonged field care situations may be a valuable skill. Here are our thoughts on sedating your patients when patient comfort and safety are an issue?
Glasgow Comma Scale
Get your GCS before sedating you patient so that you can track trends later during your sedation wake-ups/holidays.
MSMAID
If you are doing sedation it is highly recommended that you prepare by going through the MSMAID acronym detailed in a previous post and podcast. This will ensure you have the minimum equipment, drugs and personnel required for the job.
Circle of Awareness
This is the same circle of awareness from last episode. Once you have your MSMAID plan for anesthesia you should monitor your patient and level of sedation using the circle of awareness ever 5 minutes until they have been off of anesthetic agents for an hour. Anytime you are giving drugs that can alter the patient’s respiration rate or hemodynamics you should have someone at the head of the patient monitoring the components of the circle of awareness. If you are using a push dose or bolus you should know how long the onset for the drug is and check the circle accordingly. It will keep you out of trouble.
- Sedation level (RASS)
- Airway Patency (Including ventilator if being used)
- Breathing Rate
- Circulation Rate
- Report Patient Status to the Surgical Team
- Record on Anesthesia Form 517
- Tasks
Richmond Agitation and Sedation Scale(RASS)
The Richmond Agitation and Sedation Scale is a standard scale used to quantify a patient’s level of consciousness. Tracking a RASS is another way to trend a patients condition while sedated. Hang this, along with the GCS card, next to your patient bed in your aid station for easy reference.
Guidelines-Pain-Agitation-Delirium
Doug’s Basic ICU Neuro Exam for a lightly sedated and Intubated or Criced patient:
Check Motor Cortex: Can the patient wiggle all toes and fingers or give the thumbs up
Check Frontal , Temporal and Occipital Lobes: check that both pupils are equal, reactive and accommodating with a pen light
Check Deep Brain Reflexes: Illicit a cough by suctioning the airway down to the carina with a sterile suction catheter like the Ballard inline suction
Check Brain Stem: Is the patient breathing spontaneously? If ventilated are they breathing more than the set rate.
Along with a GCS score, this exam will tell you in simple terms if the geographic areas of the brain are intact. It’s extra information in the case that you call
Take our sedation quiz and see if you are prepared to sedate your patient…
Further Reading
A protocol of no sedation for critically ill patients receiving mechanical ventilation
Your quiz is flawed. If someone is sedated at all they cannot have a RASS of 0
No patient will ever be “alert and calm” (RASS of “0”)if given any amount of sedative? Because that’s about how I felt during a certain male procedure, when sedated on a couple milligrams of versed. Am I missing something?
I the majority of sedation protocols a RASS of zero is the high end of your target range. If the patient starts out at +3 and you give him a sedative, now he is sitting at a 0, did you not sedate him?
http://intensiveblog.com/five-tips-for-icu-sedation/