Introduction
- Rapid sequence intubation (RSI) is a process whereby an induction agent and a neuromuscular blocking agent are given in rapid succession to facilitate endotracheal intubation
- The immediate post intubation period in the ED is a critical time for continued patient stabilization.
- While physical adjuncts like securing the tube, in line suctioning, and elevating the head of the bed are part of general post intubation management, post intubation analgesia and sedation is a key component to remember.
- Depending on the paralytic used, clinicians can be eased into the assumption that the patient is tolerating the ventilator and not in need of sedation or analgesia
- Administering analgesia and sedation is key to preventing patient awareness during paralysis and preventing PTSD
Script for the Episode
The Pharm So Hard Podcast
Episode 52: Just a Prop For Me Please: Post-Intubation
Guest Speaker: Jimmy L. Pruitt III, PharmD, BCPS, BCCCP
Host: Jimmy L. Pruitt III, PharmD, BCPS, BCCCP
- Theme Music Intro
- Brief intro of host
- Intro of the Guest
- Speaking Points
- Why this topic important?
- Briefly Describe the intubation process
- What are some common causes of Pain in the ED
- Acute pain can invoke a stress response, resulting in a hypercatabolic state, decreased tissue perfusion, and impaired wound healing. Uncontrolled pain decreases a patient’s immune response to infection by suppressing natural killer cell activity and neutrophil function.
- Are there any short and long term consequences of pain in critically ill patients?
- Acute pain can invoke a stress response, resulting in a hypercatabolic state, decreased tissue perfusion, and impaired wound healing. Uncontrolled pain decreases a patient’s immune response to infection by suppressing natural killer cell activity and neutrophil function.
- a traumatic injury.
- a. Health-related quality of life is decreased in up to 20% of patients.
- b. Chronic pain is reported in up to 40% of patients.
- c. Posttraumatic stress disorder is reported in 5%–20% of patients.
- Acute pain can invoke a stress response, resulting in a hypercatabolic state, decreased tissue perfusion, and impaired wound healing. Uncontrolled pain decreases a patient’s immune response to infection by suppressing natural killer cell activity and neutrophil function.
- What are the agents you use for analgesia for post-intubation analgesia
- Fentanyl
- Dose
- PK/PD
- Morphine
- Dose
- PK/PD
- Hydromorphone
- Dose
- PK/PD
- Fentanyl
- Ketamine
- Dose
- PK/PD
- Are there any data to support using bolus therapy versus infusions?
- How do you monitor Sedation in intubated patients?
- Is there a level of sedation that is preferred? Deep vs Light?
- What is analgosedation and how do you do it appropriately?
- What are the most common sedation agents
- Propofol
- Midazolam
- Dexmedetomidine
- Any Literature of the value of a pharmacist in post-intubation sedation?
Podcast: Play in new window | Download
Subscribe: Apple Podcasts | Google Podcasts | RSS | http://pharmsohard.com/