Sedation in ICU Patients (Part 2) - ICU Drips
ฝัง
- เผยแพร่เมื่อ 19 พ.ย. 2019
- ‼️🎓 Want to earn CE credits for watching these videos? Join ICU Advantage Academy. 👉🏼 adv.icu/academy
💰🤑 10% off Critical Care Academy (CCRN Review): 👉🏼 adv.icu/cca (USE CODE "icuadv10")
💰🤑 10% off EACH Month @ My Mastery Nursing membership: 👉🏼 adv.icu/mastery
This is the 2nd lesson covering sedation in ICU patients. In the last lesson we talk about what sedation was, as well as covered the various different reasons that we would use sedation, and finally covered the ways in which we monitor our patients on sedation in the ICU including the RASS scale.
In this lesson we take a look at all the medications and categories of medications that we use for ICU sedation. We start out talking about the 4 different categories that these medications fall in to. The first, being the benzodiazepams. These medications are all GABA receptor agonists and share a lot of unique traits. The 3 medications all very in the length of their duration, Midazalam (Versed) being short acting, Lorazapam (Ativan) being intermediating acting, and Diazepam (Valium) being long acting. Valium is also the only one that we don’t give continuous IV, and Versed is one of our most common ICU drips for sedation.
Next we quickly talk about the neuroleptics, which are not used as continuous IV drips, but do fall in this class of sedation medications. We quickly mention about Haloperidol (Haldol) and Quetiapine (Seroquel) and how they are good options for treating delirium.
The next category that we talk about is the barbiturates. These aren’t a commonly used group of medications, but they hold a special place when it comes to helping patients with high ICPs or unmanageable seizure activity. The one medication that we use here in a drip form is a medication called Pentobarbital and so we cover this and its associated doses.
The final category that we talk about is a group of 3 medications that are all quite different from one another and we call them the “other” or “miscellaneous” medications. The meds in this category are Propofol (Driprovan), Dexmetatomadine (Precedex) and Ketamine. We talk about the unique properties of each of these medications, show the special cases which make each of these different medications ideal in certain cases.
Hopefully after watching this lesson you will have a good basis of understanding of the different categories of ICU sedation medications, as well as the medications that are a part of each category and some of the defining characteristics of each and how they all differ from one another, yet are often used for the same purposes.
+-+-+-+-+-
Gear That We Use To Make These Videos
------------------------------------------------------------------
Apple Pencil: amzn.to/368qS83
iPad Pro 12.9”: amzn.to/367s2QV
Blue Yeti Mic: amzn.to/2Q7vrK9
MacBook Pro 15”: amzn.to/2tcDegM
Books We Recommend
-------------------------------------
Barron’s CCRN Exam: amzn.to/2MFWIkH
Pass CCRN!: amzn.to/36apxgN
AACN Essentials of Critical Care Nursing: amzn.to/2F5riQs
Kaplan Adult CCRN Review: amzn.to/37igv1t
Marino’s The ICU Book: amzn.to/2ZzKP4Y
Some of Our Favorite Nursing Gear
--------------------------------------------------------
3M Littmann Master Cardiology Stethoscope: amzn.to/2sn0wR5
Rip Shears - Trauma Shears: amzn.to/35diZwR
Leatherman - Raptor Shears: amzn.to/2MGF801
Stethoscope Tape Holder: amzn.to/2snWkAy
Pilot FriXion Erasable Pens: amzn.to/2Qw9pQg
Apple Watch: amzn.to/356wKgF
Apple Watch Sport Band: amzn.to/37lroQ0
Takeya Vacuum Stainless Water Bottle: amzn.to/37lqIKq
DISCLAIMER: Links included in this description are Amazon affiliate links. If you purchase a product or service with the links that I provide I may receive a small commission. There is no additional charge to you!
+-+-+-+-+-
Please if you enjoyed this video or found it useful, hit the like button as this greatly helps our channel out!
Also make sure and subscribe and hit the bell icon and select all notifications to stay up to date on our latest videos!
Finally make sure to make your way over to our Facebook & Instagram pages and give us a like and shout out over there!
/ icuadvantage
/ icuadvantage
+-+-+-+-+
Don't forget to check out the playlist for this series of lessons here: • ICU Drips
+-+-+-+-+
Track: whogaux - i don't care [NCS Release]
Music provided by NoCopyrightSounds.
+-+-+-+-+
#ICUDrips #Sedation #ICUAdvantage
🎓‼ Earn CE Credits! Pre-order ICU Advantage Academy: 👉🏼 adv.icu/academy
💲 10% off Critical Care Academy (CCRN Review): 👉🏼adv.icu/cca (USE CODE "icuadv10")
💲 10% off EACH Month @ Nurisng Mastery membership: 👉🏼 adv.icu/mastery
📝 NOTES available to members! ► TH-cam: adv.icu/ym | ► Patreon: adv.icu/pm
Thank you guys so much for watching! Please leave us a like if you enjoyed the video. We truly do appreciate it! Also we love hearing your comments so feel free to tell us what you think of the video. We hope that after this lesson, you will have a good understanding of the different medications that we use for sedation as well as the categories and effects that you would expect to see for each of them.
Check out the rest of the videos in this series here: th-cam.com/play/PL2oVjKTYocdPLrS0odnyih8wf6zZ7WfVW.html
Don't forget to check out these other great series of lessons that we have available!
Hemodynamics: th-cam.com/play/PL2oVjKTYocdMBZlcIcWlESbOFFaGugQS2.html
Shock: th-cam.com/play/PL2oVjKTYocdPP0K8Fi49GfUgprICS-xMf.html
Arterial Blood Gases: th-cam.com/play/PL2oVjKTYocdMz1qF-3iS6iUZ-R_fKbeJw.html
ECG/EKG Interpretation: th-cam.com/play/PL2oVjKTYocdPMaNwn4xbg6xAIaAnyraMj.html
Heart Failure: th-cam.com/play/PL2oVjKTYocdNdFoS31yGhylKwib9lRf73.html
Endocrine System: th-cam.com/play/PL2oVjKTYocdO74cmXgmKjexoq59j93-Wv.html
OR these individual lessons!
Blood Tubes - Order of Draw: th-cam.com/video/mAmwdDdbkUI/w-d-xo.html
Glasgow Coma Scale: th-cam.com/video/zYwJVPIjW6I/w-d-xo.html
Don't forget to check us out and give us a like on Facebook & Instagram as well!
facebook.com/ICUAdvantage
instagram.com/ICUAdvantage
Great great great .. amaaaaaazing
Aq
As an IM resident, my ICU rotation in my intern year couldn't be better without this video! Thank you so much!
This is so awesome! Thank you Ahmet!
Taking a Critical Care Course right now and I've been watching and understanding more of your content than what our lecturers do. Thank you so much!
As an RRT student, I love looking at not just respiratory but also other types of medications my patients are on. I'm learning so much from you! Knowing what each drip does and what are the side effects help me understand why my patient's labs may look a certain way or why their respiratory system may be affected as well. Thank you!
I want to return to ICU nursing so I'm binge watching all of your videos. They are so helpful and easy to follow. Thank you!
Awesome to hear this! Really glad you are finding them helpful and best of luck in your return to the ICU!
Great high yield overview, excellent presentation!
Thank you very much!
Thank you so much for your videos! I am currently taking my critical care course and these videos have helped me so much
Happy to be able to help!
you guys are the best, i've been making my way thru all our videos and taking notes.
Sweet! Thank you so much for this comment and hope they have been helpful for you!
I really enjoy watching these. There is so much great info.
Thank you! Appreciate that.
Im transferring to ICu from Tele and I find your videos for critical care very helpful. Thanks 😊
Awesome! Welcome to the world of critical care! Happy to hear my videos have been helpful for you and wishing you all the best in your new role.
Thank you for all your presentation videos. I am an experienced med surg RN taking a new position in ICU. These videos are very beneficial to me as I prepare for the transition into the critical care setting.
I wish you all the best in your transition Donna! It's a heck of a journey but one I wouldn't trade for anything. Glad you enjoyed these videos!
omg Im going from med surg to CICU and this helps so much! its two different worlds 😅
The draw back, is sedation, in ICU, can sometimes cause PICS, which is post ICU syndrome.
You are correct Natalia. There are certainly potential negative consequences for using sedation and should certainly always be considered when using. Thanks for taking the time to leave a comment!
What are the potential effects?
Honestly, you da real MVP. Very informative, good rationale & enjoy watching your videos. Just an idea! Maybe make a series on ACLS & the different algorithms w/ ROSC. Since ICU and ER (any unit really) deals with this kinda stuff & most people aren't too aware with ACLS algorithms
Thank you so much! I actually really want to do ACLS, but the problem is that it is licensed content. I have actually reached out to AHA to figure out what the process is to license the content to be able to make videos on it, but it's still early and I'm not sure what the price will be and if I can afford what they are asking. Stay tuned!
I really appreciate all your videos. Some are better than my lectures in school!
Thank you so much for the kind words! Glad that they have been helpful for you. 😊
Than you very much! Really appreciate your comprehensive and easily understandable overview.
You're very welcome Tony! So glad it was helpful for you.
Great presentation! I would add the issue of propylene glycol toxicity with high dose Ativan and that precedex is no longer indicated for bolus administration due to the severe bradycardia and hypotension. Otherwise awesome!!!
Love your work. Thank you.
Thanks for watching!
I just passed my nursing exam.Now i am working in ICU and learning a lot from you..
Love from INDIA
Congrats Ashish!!
great talk!!! however in the ketamine discussion you said without LOC but showed with LOC (c vs s).
That was very helpful. Thank you so very much!
Glad it was helpful!
You are amazing. I’m a nursing student 8 months away from graduation and excited to hopefully start in the ICU. Thank you for taking out the time to make these videos :-) God bless you! 😊
Truly my pleasure to be able to help. Glad you enjoy them and best of luck. You are almost there!
Love your videos as an ICU new grad in the Bay Area. Have subscribed and will continue to like each video to show support. Thank you for the free quality education!
Thank you so much Brennan! Welcome to the channel and thank you so much for your support and helping this grow! Day by day its able to reach more and more people, and so I really appreciate your help in that process. Also congrats on the new ICU position!
Great video!!
wow...great explained. Thanks
Glad you liked it
Thank you so much.
Thank you !
Hey Eddie, thanks for the video it was very well done and the information is concise. I wanted to ask you to make video regarding sedation vacay (sedation vacation), SBTs, extubation etc. Maybe I missed it, but I was looking through your videos and I haven't found it. Thank you.
-Javi
Hey Javi, thank you so much for the awesome comment and taking the time to do so. Your suggestion is a. good one and also one that I've received before. And you are correct that I haven't done one yet. I have added it to the todo list for a future lesson! Thank you for taking the time to comment and for the suggestion!
It was very useful
Thank you so much
Happy to hear this!
Thank you very helpful.
You're welcome!
Thanks for educating us and bringing up the blood levels it's interesting to see how certain meds change a person's internal chemistry. I have never seen a triglyceride blood test performed for outpatient propofol sedation during dental procedures or in oral surgeons' general anaesthetics. Maybe this will be a new requirement for office and hospital-based Anaesthesia.
Not really necessary to monitor triglycerides for short term use. More for longer duration infusions, like days.
thanks
Thank you
awesome video
I love all your videos
Yay! Thank you!
Thank you sm!
Informative!
Perfect!
so great!! I wish you could also include how it's metabolized not to be too picky lol but great content amazing!!
Yeah, in hindsight, that probably would have been good to include.
hi Eddie, Its very informative video lesson. Is it ok if you can make a video about conscious sedation?, thanks a lot. Im sharing your videos to our trainees.
with each video watched, Im giving a thumbs up and a comment! thank you
Thank you so much!!
Thanks so so much ❤️❤️
You're welcome!
Positive: you speak clear and even pace which makes easy to follow you and understand easily. Neutral : maybe the dosages discussed first and a bit more info on each medication. Negative: my goodness one should type or write larger and more clearly. I paused video way more often than should to ensure proper spelling while taking notes. Back to positive: thank you for taking the time to create your videos and sharing with the world.
Thanks for the feedback. I do plan on doing a series coming up soon with a quick lesson dedicated to 1 medication. Also the writing I've gotten that feedback a lot so since then I've worked to make my writing bigger as a lot of people tend to watch on mobile devices I've found out.
Thanks!
You're welcome!
Obrigado!
Thank you so much for this Ciro!
Hi, can you explain the role of fentanyl in terms of sedation? I have sometimes seen fentanyl used with versed or fentanyl with propofol? Thanks
So our pain meds work synergistically with our sedation and together can lead to decreased usage of both. The main takeaway though is that when patients are sedated, it obviously becomes hard to determine if they have pain, thus we have to look at vitals and other indicators to try and determine if they have pain. Especially for things that we would expect pain, we should expect to have pain meds along with sedation.
@@ICUAdvantage Thanks!
Hey Eddie new ICU nurse here, I recently had a patient going through severe ETOH withdrawal on a vent on multiple sedation drips. I know our RASS goal is normally 0 to -1 sometimes -2 or as ordered by our physicians, but for this patient I had difficulty titrating to a RASS that would keep them on track to a RASS closer to -1 while preventing them from awaking to a RASS of 2(agitation). In these moments, to prevent self-extubation and other harm to the patient, would a higher level of sedation to a RASS of -3 or -4 be acceptable since every moment of wakefulness the patient is agitated?
Yeah there's definitely times that we how lower RASS goals for these patients, but depending on how easily they are awaking to agitation, one could also argue they maybe really aren't a -1.
A15:36 you said ketamine "does this withOUT loss of consciousness" yet wrote with LOC.
Ahh yes! You are right! Should have been an 's'!!! Thanks for the good catch!
Hi I really like your class and write a note for each class. But could you do another style of writing so that it may be easy to see please? Thanks.
I can't see it either. It's like neon lines and that's about it.
How is the lipid composition of propofol affecting microbes growing in the IV tube?
They provide a source of food for any potential microorganisms that may make their way in due to contamination. Better breeding ground than if it was just a normal medication.
@@ICUAdvantage i see, thank you!!!
What would be a good RASS score for a vented patient?
Really depends. If theres no physiological reason to have them at a certain level, then ideally we'd like 0. Awake, alert and calm. But not everyone can tolerate this so really the closest to zero with the patients comfort and then physiological considerations in mind. -1 to -2 is common.
I like to reduce sedation to the minimum a patient can tolerate, but some of my collegues think its cruel and will turn up the drips to make the patient sleep. The result is a longer readaptation process, am i right? And increased Risk of delirium, wich should be avoided at all cost in my opinion.
@@marilynNV that really depends on the patient's condition and presenting pathology. And depends highly on which kind of sedative you have running. If you want a patient to be alert but it is necessary to run relaxants, it certainly would be cruel. Being awake, but not being able to move is not fun. The half vivid state of RASS - 2 to - 3 is also a tough one to go through, if you are confused and stressed out because of it. Something that can be an early indication of delirium, e.g. coming out of long trauma surgery, with prolonged low cerebral perfusion. It really depends.
What are the chances that one can suffer sedation overdose from the hospital in ICU. I have a sneaky suspicion that my husband lost his life this way a week ago? Do I insist on an autopsy or will his medical records show this?
this is very unlikely as a classic overdose is characterized by respiratory failure. In the ICU, patients sedated are mechanically ventilated through an artificial and secure airway also know as the ETT or breathing tube. The ventilator usually is set at a specific respiratory rate which would prevent this from happening. Now overdose scientifically refers to drug toxicity, which would also be shown in autopsy. You could request toxicity screens if you would like; however, this would also reflect on the patient’s labs since organ failure(s) would be present and practitioners would see clear signs. In other words, this is all very unlikely.
Can you turn on the subtitle please? English isn't my first language so that it's hard for me to understand all the things you said.
can i clarify, why you do not include fentanyl ?
That's analgesic not sedative.
@@ICUAdvantage True! But this opioid analgesic does, in fact, have sedating effect! That being said, even morphine can be used as a sedative "chemical restraint" for certain cardiac patients.
@@ticks4ticks4 Im certainly not saying it doesn't have sedating properties. But it is not classified as a sedative, and this lesson was on those medications. Fentanyl was covered in the analgesic lesson.
Mid-daz-o-land for Versed. ReVersed for Romazicon LOL
Info was very beneficial in the video! I am prepared for the resurgence of ketamine!
Yes!!! Me too! It's such a great drug with a lot of great uses! Thank you so much for taking the time to stop by and leave a comment.
On my experience, Ketamine is known to cause extreme bad trips and out of body feelings. Very surprised to Read your comment. Can you explain further?
Lost my Dad to Covid last week. He was diabetic, high BP, but both were under control...on 14th day of low grade fever and no other symptoms, he all of a sudden started desaturating and before we know, he was under invasive intubation for the next 12 days before he passed. I wanted to know whether he was under pain despite under heavy sedation during his stay in the ICU...we are actually shattered at the sudden loss...specially my Mother...a 54 year partnership...my Dad turned 83 this May. Kindly reply
I'm so sorry to hear about the loss of your dad! 😢 This is all so tough on so many people and it pains me to see all of this. My thoughts are with you and your family. We do everything to ensure our patients aren't suffering while they are going through whatever they are dealing with and I'm sure this was also the case for your dad too.
Midazolam lowers patients BP.
Yes it can, but is much less than others.
I am Marcia
Hi Marcia!
Ketamine is also a drug of abuse and some people who receive ketamine can get hooked on it.
All the sudden in the pan
Can you imagine Michael Jackson on propofol infusion "as a sleep aid" without an artificial airway?! Yikes.
Yeah crazy!
thanks