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Discussion

Feedback or what would you do?

Hey everyone,

First let me say that I absolutely love this site. I learn things all the time. So, I am fairly new to an adult cardiac surgical ICU--but we have all kinds of other pt's as well. Last night I had a pt. with goodpasteurs dz., the pt. was sedated with propofol (100 mcg/kg/hour) and 200mcg Fent. an hour--however the pt. was still restless and I suggested some versed to no avail. So, the pt. was constantly restless, coughing/gagging because he was intubated. My questions are: what would you have done in terms of sedation management. Thoughts/suggestions?

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Maybe a paralytic?

A paralytic would eliminate the movement, but if the patient is restless, paralyzing them sounds to me like treating a symptom. Sounds like the patient needed more sedation. We run fentanyl on a weight basis, up to 3 mcg/kg-hr. If large, maybe needed more pain medication as well?

I would have continued to ask for more Versed. And I probably would have been turned down too. But 200 of Fent is a lot, along with all that propofol.

If no Versed, perhaps I'd ask for prn Ativan IVP.

I don't know anything about goodpasture's so I don't know if anything is contraindication or whatever, but when you have a patient that is difficult to sedate, you have to try about everything. Ativan drips or prn pushes, Versed, Haldol, dialudid.

We currently have a young man who overdosed on a vent, and he gets very agitated. (brain is fried) He isn't even on Propfol. We have been giving him 2mg ativan, 2 mg morphine and haldol all at the same time.

If he has good pressures, I'd crank the propofol up till he is sedated.

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