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Seadation

Anxiolysis

  • a state of decreased apprehension concerning a particular situation in which the patient’s level of awareness does not change.

Analgesia

  • relief of pain without the intentional alteration of mental status, such as occurs in sedation. An altered mental state may be a secondary effect of the medications administered for this purpose.

Dissociation

  • a trancelike cataleptic state induced by an agent such as ketamine and characterized by analgesia and amnesia
    • Protective reflexes
    • spontaneous respirations
    • Cardiopulmonary stability are retained

Sedation

  • a controlled reduction of environmental awareness

PSA [Procedural sedation and analgesia]

  • technique of administering a sedative or dissociative agent, along with an analgesic, to induce a state that allows the patient to tolerate painful procedures while maintaining adequate spontaneous cardiorespiratory function.

Classification of Seadation

  1. minimal sedation
  2. moderate sedation
  3. deep sedation,
  4. general anesthesia
  5. dissociative sedation, has been adopted by ACEP alt text

PSA Durgs dose and Onset

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ER seadation for aggitation

  1. Alcoholic/ Agitated but co-operative/Non-dangerous

    • Lorazepam oral

  2. Intoxication , distrubtive/agitated/non-dangerous

  3. 5:2 ratio [ haloperidol 5mg + Lorazepam 2mg ]
  4. 1st Droperidol 5-10mg effective /saftest for undiffrentiated aggitation
  5. 2nd Midazolam 5-10mg => Respiratory depression - Paradoxical REsponse to Benzo {more aggitation} - Benzo resistance
  6. Haloperidol
    • as best as Droperidol ,slow acting than Midaz
    • Unmonitered pt Haloperidol 10mg + Midaz 2mg

  7. Exicted/Delirius/Dangerous pt

    • rare , yelling,thrashing things,un-co-operative at normal state

  8. Physical restraint - 5 people => each limb per person - Prone position intitially - high flow O2 support immediately at any position with straps
    - Reduce spitting of pt - O2 support in hypoxia aggitation - remove neck restraint , chest compression by knee - THen to Chemical restrain immediatly

    1. Chemical Restraints
      • IM via anterio-lateral thigh , deltioid via clothes
      • No care for Respiratory depression and side effects
      • Dissociative dose Ketamine im 4-6mg/kg {OR} 500mg action in few minutes
      • head elevation to 45degree
      • CBG
      • vital monitering
      • Room air saturation
      • IVF fluids

      • Mng of causes

      • hypoxia,hyperthermia,hypoglycemia,hypoerfusion
      • Hyperkalemia,acidemia,ICH,CNS infection
      • Withdrawl from drugs, thyriod thoxicosis,Rhabdomyolsis,trauma