病房的镇静药物使用课件.pptVIP

* * Presentation of Case A 77-y/d man Hypertension and hypercholesterolemia, previous heavy alcohol intake, and mild cognitive impairment is admitted to the ICU after a Hartmann’s procedure for fecal peritonitis due to a perforated sigmoid colon. In septic shock, on mechanical ventilation with a low-tidal-volume protocol with positive end-expiratory pressure (PEEP) Norepinephrine infusion Analgesia : continuous morphine infusion Question What sedation should be provided to this patient?? Answer Major surgery : a laparotomy, Pain assessment and control Sedation to ensure ventilator synchrony and to prevent self-harm through the accidental removal of vascular access lines or the endotracheal tube. Benzodiazepines : most commonly Short-acting anesthetic agent : propofol α2-adrenoceptor agonist : dexmedetomidine, popular Previous heavy alcohol intake and mild cognitive impairment At high risk for delirium Riker Sedation–Agitation Scale (SAS) or the Richmond Agitation–Sedation Scale (RASS) Daily interruption of sedation Short-acting, minimum dose : be beneficial The avoidance of benzodiazepines : reduce the risk of delirium. Thanks for listening www.sylvianickerson.ca May start your ICU pharmaceutical service ! when Britain, France, and the Ottoman Empire (Turkey) declared war on Russia. Because of the lack of critical care and the high rate of infection, there was a high mortality rate of hospitalised soldiers, reaching as high as 40% of the deaths recorded during the war. Upon arriving, and practicing, the mortality rate fell to 2%. Nightingale contracted typhoid, and returned in 1856 from the war. A school of nursing dedicated to her was formed in 1859 in England The school was recognised for its professional value and technical calibre, receiving prizes throughout the British government. The school of nursing was established in Saint Thomas Hospital, as a one-year course, and was given to doctors. It used theoretical and practical lessons