NRNP6566KNOWLEDGECHECKWEEK8
2021
QUE
STI
ON1
A7
7y earol
dma nfellan
ds u f
fer
edal a
cera
tionacrosshi
supperri
ghtl
ip.
TheAPRNd ec
ide
st ou t
il
i
z eab l
ockforpaincontr
olwhi
chsutu
rin
gt he
lace
rati
on.Whatt
yp eofblockandwhatmed i
cati
onwoul
db ea
p pr
opri
ate
fort
hispati
ent
?
Forupperli
place
rati
on,a
ni nf
raorbi
talnerveblockcanb eused.The
anest
h e
ti
cofc hoi
ceispl
ainli
doc ai
nebu ti
ftherea r
ep r
ofuseblee
ding
exte
rnall
y,epi
nephr
ineca
nb ead dedforb e
tterhe modyn
a miccont
rol
.
Oncea nes
thesi
aisachi
eved,i
rri
g at
ethea r
e awithsali
ne.Lidoc
aine2%
shoul
db eusedasn e
rvebl
oc k
sf ori
ntraoralands upe
rfi
cialpr
ocedur
es.
Addingepine
phri
neproducesvasoconstri
cti
on .Thedosef o
rli
docain
e
wit
he pi
nephri
neis7mg/kgwithama xi
mu md os eof500mg
QUE
STI
ON2
A1
3y earol
dgir
liseva l
uat
edinurgentcareforalargewoundonh er
lef
tfore
arm.Shec omp l
ai
nsofs e
ve r
epa i
n,i
sc r
ying,
andisrocki
ng
ontheb e
dd u
et op ai
n.TheAPRNi spla
n ni
ngo nhowtorepairt
he
lac
erati
onandisco nsi
deri
nguti
li
zingketamineforproc
edur
a l
sedat
ion.Whataretheb en
efi
tsandrisksofthi
sd rug
?Wh at
mon i
tor
ingwouldb ei
ndicat
edifuti
li
zed?
Ketaminehasse v
eralad
v an
tagesov erothersedati
vesforp roc
eduralsedat
ion.
Accordi
ngtoBu ck(2016),
theuseofk etaminer e
sult
sinon lyminimalres
pir
a t
ory
depressi
onwithpreser
vedo re
xagge rat
edp haryngealandlaryngealr
efl
exes.I
ta l
so
re
sultstonormalorsli
ghtl
yincr
ease dmu scletonewithmin ori
ncreasei
nBP, heart
ra
tea ndcardi
acou t
put(Buck,
2016). Addit
ionall
y,i
tisrapida c
tin
ga sanane s
theti
c
wit
ha nal
gesicproper
ti
es.Somep oten t
ial
l
yl i
fe-
thre
ateninga dver
seeffe
ctsh a
ve
beena s
sociat
edwi t
hketamine,al
thoughrar e.
Th es
ein c
ludel a
ryngospas
m, apnea,
i
mp air
edc a
rdiacfunc
ti
on ,
incr
easedi nt
racrani
a l
pressurean ddiabet
esinsi
pidusso
, t
hep
ati
ent
ssh
oul
dbec
are
ful
l
ymon
itor
edf
ort
hes
e(Bu
ck,
201
6).
Re
fer
enc
e
Bu
ck,M.L.
(20
16)
.Ke
tami
nei
nfu
sion
sforp
edi
atr
ics
eda
tiona
nda
nal
ges
ia.
Pe
dia
tri
c
Ph
arma
cot
her
apy
,22
(6)
.ht
tps
://
med
.vi
rgi
ni
a.
edu
/pe
dia
tri
cs/
wp-
c
ont
ent
/up
loa
ds/
sit
es/
237
/20
15/
12/
Jun
e16
_Ke
tami
ne_
Ped
Pha
rma
co.
pdf
QUE
STI
ON3
A6
6yearol
dwomeni
nth
eICUi
sdiag
nose
dwit
hdeli
ri
um.
Wha
t
wou
ldbetheb
esta
ppr
oacht
otr
eati
ngh
erd
eli
ri
um?
2021
QUE
STI
ON1
A7
7y earol
dma nfellan
ds u f
fer
edal a
cera
tionacrosshi
supperri
ghtl
ip.
TheAPRNd ec
ide
st ou t
il
i
z eab l
ockforpaincontr
olwhi
chsutu
rin
gt he
lace
rati
on.Whatt
yp eofblockandwhatmed i
cati
onwoul
db ea
p pr
opri
ate
fort
hispati
ent
?
Forupperli
place
rati
on,a
ni nf
raorbi
talnerveblockcanb eused.The
anest
h e
ti
cofc hoi
ceispl
ainli
doc ai
nebu ti
ftherea r
ep r
ofuseblee
ding
exte
rnall
y,epi
nephr
ineca
nb ead dedforb e
tterhe modyn
a miccont
rol
.
Oncea nes
thesi
aisachi
eved,i
rri
g at
ethea r
e awithsali
ne.Lidoc
aine2%
shoul
db eusedasn e
rvebl
oc k
sf ori
ntraoralands upe
rfi
cialpr
ocedur
es.
Addingepine
phri
neproducesvasoconstri
cti
on .Thedosef o
rli
docain
e
wit
he pi
nephri
neis7mg/kgwithama xi
mu md os eof500mg
QUE
STI
ON2
A1
3y earol
dgir
liseva l
uat
edinurgentcareforalargewoundonh er
lef
tfore
arm.Shec omp l
ai
nsofs e
ve r
epa i
n,i
sc r
ying,
andisrocki
ng
ontheb e
dd u
et op ai
n.TheAPRNi spla
n ni
ngo nhowtorepairt
he
lac
erati
onandisco nsi
deri
nguti
li
zingketamineforproc
edur
a l
sedat
ion.Whataretheb en
efi
tsandrisksofthi
sd rug
?Wh at
mon i
tor
ingwouldb ei
ndicat
edifuti
li
zed?
Ketaminehasse v
eralad
v an
tagesov erothersedati
vesforp roc
eduralsedat
ion.
Accordi
ngtoBu ck(2016),
theuseofk etaminer e
sult
sinon lyminimalres
pir
a t
ory
depressi
onwithpreser
vedo re
xagge rat
edp haryngealandlaryngealr
efl
exes.I
ta l
so
re
sultstonormalorsli
ghtl
yincr
ease dmu scletonewithmin ori
ncreasei
nBP, heart
ra
tea ndcardi
acou t
put(Buck,
2016). Addit
ionall
y,i
tisrapida c
tin
ga sanane s
theti
c
wit
ha nal
gesicproper
ti
es.Somep oten t
ial
l
yl i
fe-
thre
ateninga dver
seeffe
ctsh a
ve
beena s
sociat
edwi t
hketamine,al
thoughrar e.
Th es
ein c
ludel a
ryngospas
m, apnea,
i
mp air
edc a
rdiacfunc
ti
on ,
incr
easedi nt
racrani
a l
pressurean ddiabet
esinsi
pidusso
, t
hep
ati
ent
ssh
oul
dbec
are
ful
l
ymon
itor
edf
ort
hes
e(Bu
ck,
201
6).
Re
fer
enc
e
Bu
ck,M.L.
(20
16)
.Ke
tami
nei
nfu
sion
sforp
edi
atr
ics
eda
tiona
nda
nal
ges
ia.
Pe
dia
tri
c
Ph
arma
cot
her
apy
,22
(6)
.ht
tps
://
med
.vi
rgi
ni
a.
edu
/pe
dia
tri
cs/
wp-
c
ont
ent
/up
loa
ds/
sit
es/
237
/20
15/
12/
Jun
e16
_Ke
tami
ne_
Ped
Pha
rma
co.
QUE
STI
ON3
A6
6yearol
dwomeni
nth
eICUi
sdiag
nose
dwit
hdeli
ri
um.
Wha
t
wou
ldbetheb
esta
ppr
oacht
otr
eati
ngh
erd
eli
ri
um?
