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Loc & conscious sedation

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interThere are some important scales for assessment of Level of consciousness, Level of Agitation, Level of sedation. This lecture highlights what are the main aspects of these scales, what are the similarities and comparabilities. Mainly this lecture focusses on what is conscious sedation ? Where among these scales, the 'conscious sedation' lies. This lecture also simplifies the GCS to be easily interpreted and memorised.

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Loc & conscious sedation

  1. 1. Scales forMERC assessment of level of consciousness AN INTRODUCTION TO CONSCIOUS SEDATION Ravindar Bethi
  2. 2. Scales for Assessment of level of consciousnessSTIMULUS RESPONSE
  3. 3. Scales for Assessment of level of consciousnessSTIMULUS RESPONSE
  4. 4. Scales for Assessment of level of consciousnessSTIMULUS RESPONSE
  5. 5. Scales for Assessment of level of consciousnessSTIMULUS RESPONSE
  6. 6. Abbreviated Coma Scale ( ACS ) • Glasgow coma scale • Ramsay sedation scale • Riker’s sedation- agitation scaleSTIMULUS RESPONSE
  7. 7. Glasgow Coma Scale ( GCS ) Eye Verbal Motor opening Response Response Response PROGNOSISSTIMULUS RESPONSE
  8. 8. Glasgow Coma Scale ( GCS ) Eye opening ResponseSTIMULUS RESPONSE
  9. 9. Glasgow Coma Scale ( GCS ) Verbal Motor Response ResponseSTIMULUS RESPONSE
  10. 10. Glasgow Coma Scale ( GCS ) Verbal Motor Response ResponseSTIMULUS RESPONSE
  11. 11. Glasgow Coma Scale ( GCS ) Verbal Motor Response ResponseSTIMULUS RESPONSE
  12. 12. Glasgow Coma Scale ( GCS ) oriented Verbal Motor sentences Response Response words only sounds only no soundSTIMULUS RESPONSE
  13. 13. Glasgow Coma Scale ( GCS ) Motor Response no movementSTIMULUS RESPONSE
  14. 14. Glasgow Coma Scale ( GCS ) Motor Response extension no movementSTIMULUS RESPONSE
  15. 15. Glasgow Coma Scale ( GCS ) Motor Response flexion extension no movementSTIMULUS RESPONSE
  16. 16. Glasgow Coma Scale ( GCS ) Motor Response withdrawal flexion extension no movementSTIMULUS RESPONSE
  17. 17. Glasgow Coma Scale ( GCS ) Motor Response localisation withdrawal flexion extension no movementSTIMULUS RESPONSE
  18. 18. Glasgow Coma Scale ( GCS ) normal movements Motor Response localisation withdrawal flexion extension no movementSTIMULUS RESPONSE
  19. 19. Glasgow Coma Scale ( GCS ) Eye Verbal Motor opening Response Response Response PROGNOSISSTIMULUS RESPONSE
  20. 20. RAMSAY SEDATION SCALE1. Anxious and agitated or restless, or both2. Co-operative, oriented, and calm3. Responsive to commands only4. Exhibiting brisk response to loud auditory stimulus or light glabellar tap5. Exhibiting a sluggish response to loud auditory stimulus or light glabellar tap6. Unresponsive CONSCIOUS SEDATION Ramsay sedation scale ( GCS ) STIMULUS RESPONSE
  21. 21. Riker’s sedation– agitation scale ( GCS ) UncontrollableSTIMULUS RESPONSE
  22. 22. CONTINUUMOFDEPTH OFSEDATION
  23. 23. CONTINUUMOFDEPTH OFSEDATION
  24. 24. CONTINUUMOFDEPTH OFSEDATION
  25. 25. CONTINUUMOFDEPTH OFSEDATION
  26. 26. CONTINUUMOFDEPTH OFSEDATION
  27. 27. CONTINUUMOFDEPTH OFSEDATION
  28. 28. CONTINUUMOFDEPTH OFSEDATION
  29. 29. CONTINUUMOFDEPTH OFSEDATION
  30. 30. CONTINUUMOFDEPTH OFSEDATION ACLS
  31. 31. PROCEDURAL SEDATION “OFFICE BASED ANESTHESIA” “A technique of administering WHAT IS sedatives or dissociative agents CONSCIOUS SEDATION ? with or without analgesics to induce a state that allows the patient to tolerate unpleasant procedureswhile maintaining cardiorespiratory function.“
  32. 32. THE TEAM – PROCEDURAL PHYSICIAN – SEDATION PRACTITIONER – REGISTERED NURSE ASSISTANT
  33. 33. PATIENTS CRITERIAASA GRADING Class I No organic, physiologic, biochemical or psychiatric disturbance. (Normal, healthy patient) Class II Mild to moderate systemic disturbance; may or may not be related to reason for surgery (Ex: hypertension, diabetes mellitus under control) Class III Severe systemic disturbance. (Ex: heart disease, poorly controlled HTN, uncontrolled DM) Class IV Life threatening systemic disturbance (Ex: congestive heart failure, unstable angina pectoris, DKA) Class V Moribund patient. Little chance for survival. Surgery is the last resort. (Ex: uncontrolled bleeding from ruptured abdominal aortic aneurysm)
  34. 34. PATIENTS CRITERIAMALLAMPATI CLASS
  35. 35. PATIENTS CRITERIAMALLAMPATI CLASS
  36. 36. PATIENTS CRITERIAMALLAMPATI CLASS
  37. 37. PATIENTS CRITERIAMALLAMPATI CLASS
  38. 38. EXCLUSION CRITERIA
  39. 39. PROCEDURES
  40. 40. DESIGNATED PLACES
  41. 41. DISPLAY OF POSTERS• patient evaluation• dosing of drugs• check lists FACILITIES MUST MONITORING & EMERGENCY RESUSCITATION EQUIPMENT • Stethoscope, • ECG, NIBP, Pulse oximeter • Crash cart with defibrillator, • Airway & resuscitation devices, • Source of Oxygen • Suction source • IV supplies
  42. 42. DISPLAY OF POSTERS• patient evaluation• dosing of drugs• check lists FACILITIES MUST OTHER SUPPLIES & REQUIREMENTS • Means to safely preserve the narcotic and sedative drugs • Means for documentation. • Means for intra hospital communication.
  43. 43. DRUGS LOCAL ANESTHETICS NALOXONE NARCOTICS ATROPINE FLUMAZENILANXIOLYTICS
  44. 44. DRUGS NALOXONE NARCOTICS FLUMAZENIL ANESTHETICSANXIOLYTICS
  45. 45. PRE-PROCEDURE ISSUES HOSPITAL
  46. 46. NPO PROTOCOLS
  47. 47. REASSURANCE INTRA PROCEDURE DRUG ADMINISTRATION VIGILANCE MONITORING DOCUMENTATION
  48. 48. RECOVERY ANDDISCHARGE
  49. 49. CONSCIOUS SEDATION COMPARED TO ANESTHESIA• Less risk patients only• Minor procedure only• Moderate sedation only, with prior analgesia/LA• No OR, no anesthetist except as back support• Careful selection• Strict preparation APPARENTLY EASY• Stringent monitoring BUT• Extreme safety precautions RISK IS• Meticulous discharge protocols RELATIVELY NOT ACCEPTABLE
  50. 50. EXTREME EMERGENCEAGITATION PATHOLOGICAL MEDICAL PROCESS INTERVENTION AWAKE PATIENT Conscious sedation General anesthesiaDEEP COMA DEEP COMA “be meticulous…do no harm”
  51. 51. TAKE HOME MESSAGE• Conscious sedation is safe, reliable, economical• Sound airway management and resuscitation skills in back up Anesthetist must know everything about anesthesia Every body must and something know something about everything about anesthesia else and resuscitation
  52. 52. MERC Ravindar Bethi

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