Pre-Quiz: Post-Intubation Sedation

A 65-year-old man weighing 75 kg and standing 176 cm tall arrives in the ER after a motor vehicle accident that resulted in multiple fractures necessitating intubation. He has a history of hypertension, for which he takes amlodipine 5 mg daily, and type 2 diabetes mellitus managed with metformin 1000 mg twice daily. His laboratory values are within normal ranges. His vital signs include a blood pressure of 180/90 mm Hg and a heart rate of 107/min. He has received fentanyl and has a PRN order for morphine to maintain a CPOT score of below 3. However, he is dyssynchronous with the ventilator, exhibiting a CPOT score of 1 and a RASS score of +2. Considering his current symptoms and vitals, which of the following would be the most appropriate medication choice for managing this patient’s sedation?

A 56-year-old female was presented to the emergency department having been diagnosed with acute respiratory distress. Her clinical status has now stabilized after she was intubated and placed on a mechanical ventilator. Given the progress made, the medical team decides to reduce and eventually cease the use of sedatives and analgesics before extubation. What drug would provide the most optimal and suitable light sedation in anticipation of extubation?

A 45-year-old male with severe pneumonia is admitted to the ICU. Due to respiratory distress, he requires intubation and mechanical ventilation. He is extremely agitated, and the healthcare team considers using a neuromuscular blocking agent to enhance ventilator synchronization. The Richmond Agitation-Sedation Scale (RASS), used to assess patient responsiveness, ranges from +4 (combative) to -5 (unarousable). At what RASS score would it be most appropriate to administer a neuromuscular blocking agent to this intubated patient?

You are on your morning shift in the emergency department when a 62-year-old female patient, who had been admitted after a road traffic accident, catches your attention. On arrival, the patient was vitally unstable with her blood pressure being low, necessitating mechanical ventilation. However, after stabilization, she appears to be grimacing, restless, and pulling on intravenous lines. Currently, her regimen includes propofol at 40 mcg/kg/min IV and fentanyl at 25 mcg/hr IV. Her latest Richmond Agitation Sedation Scale (RASS) score is 2, whereas her Critical Care Pain Observation Tool (CPOT) score is 4, and her Intensive Care Delirium Screening Checklist (ICDSC) score registers as 0. The vital signs are as follows: blood pressure is 135/85, heart rate is 99 beats per minute, temperature is 98 Fahrenheit, and respiratory rate stands at 16 breaths per minute. What is the most appropriate management strategy for this patient’s current situation?

A 45-year-old male cyclist is brought to the emergency department (ED) by the Emergency Medical Services after a head-on collision with a truck. Upon arrival, his Glasgow Coma Scale score is 6, indicating severe brain injury. You initiate immediate intubation to secure his airway. The following CT scan confirms a traumatic brain injury with increased intracranial pressure. The objective now is to select a sedative agent that suits the goals of facilitating mechanical ventilation, enabling frequent neurological assessments without increasing intracranial pressure. Which of the following is the most appropriate drug to administer for sedation in this context?