Episode 61- PharmSoHard meets ER-Rx: ICU sedation


 

Episode Summary:

In case you missed our discussion on ICU sedation on the PharmSoHard podcast, we’re playing the episode on ER-Rx as well. Yes, it’s that important.

Show Notes:

Key Points:

“PharmSoHard meets ER-Rx: ICU sedation:”
– The Pain, Agitation, and Delirium guidelines (PAD; 2013 and PADIS; 2018) are clear on their recommendations for managing post-intubation pain and sedation
– Pain is monitored by validated scales such as the visual pain scale (if patients can self report) or the critical care pain observation tool (CPOT) (in patients that cannot self report)
– Sedation is monitored using validated scales such the the RASS and SAS. Guidelines stress the importance of light sedation; with RASS goals of -1 – + 1 and SAS scores of 3-4. This corresponds to a patient that is drowsy and awakens to voice or is fully alert. Deeper levels of sedation lead to increased lengths of stay and worse patient outcomes
– Always start with “A-1” sedation, or analgesia-first sedation post-intubation. Remember that opioids have sedating properties!
– Agents such as fentanyl, hydromorphone, and morphine can be used first with an as needed, bolus dosing strategy followed by a continuous infusion if bolus dosing does not adequately sedate your patient
– If the patient is still uncomfortable on the ventilator, sedative agents such as propofol, dexmedetomidine (Precedex), and ketamine can be used as adjuncts to the opioid infusion
– Benzodiazepines are strongly recommended against as they increase the risk of developing ICU delirium and they have been associated with worse patient outcomes. Only use these agents for specific patients (ex. those with seizures or withdrawal from alcohol/ benzodiazepines) or those requiring deep sedation (ex. those on continuous paralytic infusions or those undergoing therapeutic hypothermia)
ER-Rx Episode 61

Please click HERE to leave a review of the podcast!

References:


Leave a Reply

Your email address will not be published. Required fields are marked *

Recent Reviews/ Comments

“Perfect amount of knowledge in a great length to refresh ICU and ED topics. Explains concepts in an easy to understand fashion”

–  RxLaura, Apple Podcasts review

“I love listening to this podcast because I can listen to 1 or 2 on my way to work and it provides great info! As a paramedic, this podcast has really helped me understand the “why” we give certain meds.”

cresjr, Apple Podcasts review

“Ideal podcast to listen on the way to my shift. Learning points throughout!”

andmatjos, Apple Podcasts review

“I’m currently in my last year of pharmacy school […] I just happen to come across your podcast on YouTube as I was trying to find a good explanation regarding the misleading sulfa allergy in non-antibiotic sulfonamides. Your explanation was great. I can’t believe I’m only now finding out about your podcasts but please continue to make them for as long as you can. Prospective pharmacists, such as myself, really appreciate you taking the time to put such great educational content out there.”

– S.P., Pharmacy Student

“Adis does a wonderful job of gathering the evidence-based answers to the hard questions that we all get as pharmacists and putting them into a nice, neat package.”

– rebroush1, Apple Podcasts review

“This is a great podcast to listen to at work and is not too overwhelming and well put together. Highly recommended for anyone in healthcare, even outside of emergency medicine.”

Peelage, Apple Podcasts review

“Great reviews on drug-related topics with useful details on drug mechanisms, pharmacodynamics and administration considerations as well as data to support recommendations. Great for pharmacists, providers and learners!”

-JaayyZzee, Apple Podcasts review

“I found the topics very helpful. I have been recommending this show to pharmacy students and residents, who are also enjoying it.”

hvgjnfd, Apple Podcasts review

“As a PA, I found this very informative. I like that the episodes are short, making them easy to listen to on my way to and from work. Would love to hear more pediatric topics!”

-Pediatric PA, Apple Podcasts review

“Good podcast thats very informative for all healthcare providers. Very easy to listen to and enjoy.”

-Bradlley88, Apple Podcasts review