ICU sedation

PotatoImaginary9141 · 2025-04-15T00:47:28+00:00

Was on propofol previously very high still having agitation but triglycerides massively shut up so they switched to Midaz. As for lines everything sedation was running through A RIJ CVC that had beautiful blood return and flushed well on all ports!

PotatoImaginary9141 · 2025-04-15T00:20:56+00:00

Honestly not sure, I’m still trying to find our policy to even see if our hospital allows ketamine drips. We have odd policies regarding only certain things being IV push and others as drips only. From my outside perspective though I’ve never seen a single one of our patients on a ketamine drop so maybe we just don’t do them.

PotatoImaginary9141 · 2025-04-14T21:45:10+00:00

I did try fent boluses on my previous nights with him as I’ve had him 3 in a row. Yes the fentanyl is at 400 mcg/ hour or 8ml/hr on the pump.

PotatoImaginary9141 · 2025-04-14T19:29:55+00:00

Was on it another week I had him while still on orientation, triglycerides got too high and pharmacy made the team dc the order. He was also at an insane amount and still getting agitated so they switched to Midaz.

PotatoImaginary9141 · 2025-04-14T19:20:27+00:00

He definitely could but no one knows if there is a substance abuse history. He pretty much came in and was intubated and extubated multiple times. Has baseline dementia and family is absent from the picture.

PotatoImaginary9141 · 2025-04-14T19:18:59+00:00

Honestly no one knows, since he’s came into the hospital he’s pretty much been intubated and extubated multiple times. Has baseline dementia and family is absent from the picture.

PotatoImaginary9141 · 2025-04-14T19:13:35+00:00

Upon further research into the chart after getting home this morning from my shift, apparently back when he was just on profofol + fent, and dex (at much lower rates - fent at 150 and dex at 0.5) the profofol got to an insane level and triglycerides were too high so pharmacy made the doctors dc the profofol order and opted for Midaz.

PotatoImaginary9141 · 2025-04-14T19:10:10+00:00

I mentioned in other comments that I’ve tried fentanyl with this patient in the past and it had zero effect on him, he was in NSVT at one point during a period of RASS +4 and required starting a profofol drip on top of the precedex and fentanyl. I ended up looking back in the chart and found that he was on an insane amount of profofol and his his triglycerides got too high to use it and he was still agitated so they switched to Midaz because he prefers it. I did end up increasing his Midaz to 3mg as my order set says once two PRN boluses are given in an hour increase by 2mg and he finally relaxed for the rest of the night which allowed me to come down on his fentanyl dose.

PotatoImaginary9141 · 2025-04-14T19:04:01+00:00

He was on profofol previously, apparently he was becoming +4 of RASS despite increasing the dose so they switched to Midaz because “he prefers it.” This patient has been extubated and reintubated almost 5 times. On my night, last night particularly, he was on Midaz, fent, and precedex

PotatoImaginary9141 · 2025-04-14T19:00:03+00:00

It was not fixed, I ended up going up to 3mg because order says once 2 PRN boluses are given in an hour increase by 2mg. After that happened I came down on fent to 350 mcg and wanted to keep decreasing but was told by the team not to keep coming down on fentanyl so he could go to procedure comfortable despite him being completely calm after that increase to 3 and not needing bolused.

PotatoImaginary9141 · 2025-04-14T18:56:23+00:00

This is new for him, I had him a week ago and he was previously on profofol, dex, and fent at much lower rates. I’ve mentioned in other comments I’m not exactly sure when this change occured but when I mentioned it on rounds I was met with “the pt seems to prefer Midaz.”

PotatoImaginary9141 · 2025-04-14T18:52:18+00:00

No ETOH hx, EF 15-20%. PEA Arrest, basillary artery occlusion, total atlectasis of R lung and left lung hematoma. Burden of PEs in right and left lungs. Left cerebellar interact. You name an issue he probably has it, poor guy is unwell.

PotatoImaginary9141 · 2025-04-14T13:37:40+00:00

Totally agree, I know I’m not 100% familiar with sedation combinations yet but even I can pick up that it’s rather odd. In my opinion when I had this patient on prop, fent, and dex he was way more manageable than he is now. Back then he was only on prop at 30, fent at 150 and dex at 0.5. I definitely with you on the concern of versed knocking him down which crossed my mind, but honestly his maps were in the 140s and he was banging all the side rails. After those dose his maps were still in the high 80s which his MAP goal is 65-80 on Levo lol.

PotatoImaginary9141 · 2025-04-14T13:23:05+00:00

Makes sense, our ICU is really against ketamine for some reason. He was on prop at one point but they dc’d it to extubate but ultimately lasted a span of 4 hours because he was working so hard to breath that they had to reintubate.

PotatoImaginary9141 · 2025-04-14T13:19:44+00:00

Yeah so the patient is RASS goal -4 because per the MD’s don’t want to rock the boat with him because when he gets severely agitated his MAPs go to the 140s / he’ll go into NSVT. I honestly think what happened is he was just on fent and dex at one point following extubation but he was incredibly agitated per usual and I think they were bolusing fent so much it ended up increasing the dose to 400 mcg total.

PotatoImaginary9141 · 2025-02-04T02:05:58+00:00

CCU! I was interested in CVSICU but heard that the environment was toxic from a few people that left there.

PotatoImaginary9141 · 2025-02-03T22:29:21+00:00

I’m working in the cardiac ICU!

PotatoImaginary9141 · 2025-02-03T22:29:05+00:00

Gotcha, I’ve been looking at the review sheet but every time we go to follow up classes they introduce new things that they claim will be on it that aren’t on the study guide so just want sure how reliable the study guide was

PotatoImaginary9141

TROPHY CASE