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But your nursing manager then informs you that the hospital is full, including the ICU.So now your severely septic patient will be boarding in the ED.When patients present to the emergency department (ED), treating the pain and anxiety that accompany the chief complaint are critical to patient satisfaction and quality of care.Nonetheless, clinicians may underuse sedation, usually from a lack of experience or from unchallenged myths regarding its use.

Inhalation sedation is also sometimes referred to as relative analgesia.

Pain is a common problem and may be worsened by invasive and unpleasant procedures.

The Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT) are the most valid and reliable behavioral pain scales for monitoring pain in medical, postoperative, or trauma (except for brain injury) adult ICU patients who are unable to self-report and in whom motor function is intact and behaviors are observable. We recommend that preemptive analgesia and/or nonpharmacologic interventions (e.g., relaxation) be administered to alleviate pain in adult ICU patients prior to chest tube removal ( 1C). We suggest that for other types of invasive and potentially painful procedures in adult ICU patients, preemptive analgesic therapy and/or nonpharmacologic interventions may also be administered to alleviate pain ( 2C). We recommend that intravenous (IV) opioids be considered as the first-line drug class of choice to treat non-neuropathic pain in critically ill patients ( 1C). All available IV opioids, when titrated to similar pain intensity endpoints, are equally effective (C). We suggest that nonopioid analgesics be considered to decrease the amount of opioids administered (or to eliminate the need for IV opioids altogether) and to decrease opioid-related side effects ( 2C). We recommend that either enterally administered gabapentin or carbamazepine, in addition to IV opioids, be considered for treatment of neuropathic pain ( 1A). We recommend that thoracic epidural anesthesia/analgesia be considered for postoperative analgesia in patients undergoing abdominal aortic aneurysm surgery ( 1B). We provide no recommendation for using a lumbar epidural over parenteral opioids for postoperative analgesia in patients undergoing abdominal aortic aneurysm surgery, due to a lack of benefit of epidural over parenteral opioids in this patient population (0, A). We provide no recommendation for the use of thoracic epidural analgesia in patients undergoing either intrathoracic or nonvascular abdominal surgical procedures, due to insufficient and conflicting evidence for this mode of analgesic delivery in these patients (0, B). We suggest that thoracic epidural analgesia be considered for patients with traumatic rib fractures ( 2B). We provide no recommendation for neuraxial/regional analgesia over systemic analgesia in medical ICU patients, due to lack of evidence in this patient population (0, No Evidence). Leo —-Original Message—- From: David Crippen Sent: Thursday, August 24, 2006 PM To: [email protected]: ccml sedation management in SICU Trauma Patient He is on industrial strength doses of meds and I can’t seem to get them down.

Examples of drugs which can be used for sedation include propofol, etomidate, ketamine, fentanyl, lorazepam and midazolam.

Sedation is typically used in minor surgical procedures such as endoscopy, vasectomy, or dentistry and for reconstructive surgery, some cosmetic surgeries, removal of wisdom teeth, or for high-anxiety patients.

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