By Simon M. Whiteley
A pocketbook of extensive take care of junior doctors/residents engaged on the intensive/critical care unit.
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Additional info for Churchill’s Pocketbook of Intensive Care
Sedation scoring Sedation scoring systems may be useful in helping titrate levels of sedation. 4. Sedation-free periods Where drugs are given by continuous infusion accumulation can occur and studies have consistently shown that patients tend to be over-sedated. Regular reassessment of sedation, and the use of sedation-free periods or ‘sedation holds’ can reduce the duration of tracheal intubation and ventilatory support. Many units now consider sedation holds on a daily basis. Typically sedation (not analgesia) is stopped once a day, to allow assessment.
Respiratory: type and mode of ventilation, level of respiratory support progress made in weaning blood gases. g. conscious level, renal output, lactate). Gastrointestinal: nasogastric losses / bowel function / evidence of gastrointestinal bleeding tolerance of enteral feed (or parenteral nutrition) surgical drain losses. Renal: ﬂuid intake volume and quality of urine overall ﬂuid balance plasma and urinary electrolytes. CNS: consciousness level seizure activity sedation and analgesic requirement.
Side-effects include ﬁts, hypertension, and dysrhythmias. Do not infuse over long periods of time. Ventilate the patient and await resolution as redistribution and metabolism of drugs occur! 41 42 BASIC PRINCIPLES ᭤ S E D AT I O N Withdrawal phenomena / acute confusional states When drugs used before admission, or sedative drugs given in ICU are stopped, drug withdrawal states may develop. This may result in seizures, hallucinations, delirium tremens, confusional states, agitation and aggression.