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    Pain Anxiety Delirium: Rass CAM ICU

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    Nicholas Helmstetter

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    © All Rights Reserved
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    Pain Anxiety Delirium: Rass CAM ICU

    Uploaded by

    Nicholas Helmstetter
    35 views1 page

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    ICU_one_pager_PAD

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    35 views1 page

    Pain Anxiety Delirium: Rass CAM ICU

    Uploaded by

    Nicholas Helmstetter

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    MANAGING PAIN, ANXIETY, & DELIRIUM by Nick Mark MD onepagericu.

    com Link to the


    most current
    General guidelines: differentiate PAIN from ANXIETY from DELIRIUM, each should be assessed separately @nickmmark version →
    use a quantitative tool to assess each and be goal directed in interventions to treat

    PAIN ANXIETY DELIRIUM


    Direct: Ask RASS: +4 violent, dangerous CAM- 1. Fluctuating or change in baseline?
    +3 pulls T/L/D, aggressive ICU yes
    Pain scales numeric
    visual analog +2 freq movement, dyssnchrony 2. Inattention? (SAVE A HAART)
    +1 restless >2 errors “Tap each time you hear an A”
    0 alert, calm 3. Altered LOC? (check RASS)
    ASSESS

    Indirect: vital signs


    -1 awakens (>10 sec) to voice RASS ≠ 0
    Typical goal
    Tools: CPOT -2 awakens (<10 sec) to voice 4. Disorganized? (questions & commands)
    Does a stone float on water?
    many others (PAIN, NPAT, etc) -3 moves to voice, no eye contact Are there fish in the sea?
    >1 error
    -4 no response, moving Does 1 lb weigh more than 2 lbs?
    Goal for NMB Can you use a hammer to pound a nail?
    -5 no response, not moving Hold up two fingers?
    Delirious Do it with the other hand.

    Treat: causes Prevent and treat pain Treat: pain and anxiety
    Minimize: procedures, interventions (everything listed to the left) Minimize: deliriogenic meds
    PREVENT

    Position: for comfort Maintain: day-night cycle


    Premedicate: before procedures Provide reassurance Avoid: restraints, tubes/lines, noise
    Optimize: ventilator mode/settings Optimize: vision, hearing, mobility
    Have family present Use correct language, have family present
    Continue/restart home medications Mobilize patients early and aggressively

    Local: LIDOCAINE Many patients will not require any meds. Use non-pharmacologic modalities instead of
    Non-opiate: TYLENOL (PO, PR, PFT, and IV) mediations if possible.
    NSAIDS (Toradol, Motrin) GABAergic: PROPOFOL
    Adjuncts: GABAPENTIN, TCAs Stop possible offending medications before
    Opiates: PO OXYCODONE α2 Agonist: PRECEDEX adding more agents to control symptoms of
    TREAT

    MORPHINE delirium.
    (bolus vs gtt) IV FENTANYL BZDs: VERSED
    DILAUDID (preferably bolus instead of gtt) ATIVAN Typical: HALDOL

    v1.1 (2020-03-30)
    MORPHINE VALIUM Atypical: SEROQUEL
    Other Routes: Epidural, PNC, nerve block
    Consider patient controlled (PCA) Dissociative: KETAMINE Other: MELATONIN

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