By Simon M. Whiteley

A pocketbook of extensive deal with junior doctors/residents engaged on the intensive/critical care unit.

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Competitive antagonist of benzodiazepine receptors* Used to reverse sedation and respiratory depression caused by benzodiazepines *Both drugs have a short half-life (approximately 20 min), leading to the risk of recurrence of respiratory depression and sedation. Side-effects include fits, hypertension, and dysrhythmias. Do not infuse over long periods of time. Ventilate the patient and await resolution as redistribution and metabolism of drugs occur! 41 42 BASIC PRINCIPLES ᭤ S E D AT I O N Withdrawal phenomena / acute confusional states When drugs used before admission, or sedative drugs given in ICU are stopped, drug withdrawal states may develop.

Examining the patient Once you have put together the information available from the history and the patient’s chart, you should examine the patient carefully. Remember hand hygiene and infection control issues. (See Hand hygiene, p. ) Before examining a patient, you should introduce yourself and explain what you are going to do, even if the patient appears unconscious. Remember that hearing may be the last sense to be lost under anaesthesia or sedation. Examine the patient systematically, assimilating the information available from the monitoring into your examination findings as you go.

For example, stethoscopes are generally provided at each bed space. You should not use your own, which might be a vehicle for cross-infection. Barrier nursing Some patients may be isolated because they have a serious infection or are colonized with an antibiotic-resistant organism that might be transmitted to other patients, or even on occasions to members of staff. These patients will be barrier nursed. The basic principles are: ● ● ● Do not enter the room unnecessarily. Wear an apron. Wash your hands and put on gloves.

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