Pain, Agitation, and Delerium

Behavioral pain scale (BPS)
Critical-Care pain observation tool (CPOT)

Assessed every 4 hours/very regularly

>5=pain

>3=pain

Tolerated better than alternatives in patients with hemodynamic instability
Can accumulate in when used for long periods or with hepatic impairment
tachyphylaxis after prolonged use (tolerance)
Serotonin syndrome*
Most commonly used medication

Accumulation in hepatic failure
Longer duration

Histamine mediated hypotension, avoid in hemodynamically unstable patients
Accumulation in renal and hepatic failure
Morphine metabolite accumulation can lead to additional side effects, especially in renal failure:
morphine-3-glucuronide: can cause seizures and agitation
morphine-6-glucuronide: can cause more sedation and respiratory depression

Not commonly used, long half life doesn't make it suitable for as needed use
QTC prolongation
accumulation in hepatic failure

Not commonly used, but used when transitioning patient to oral agent
accumulation in renal and hepatic failure

Acetaminophen
Ketamine
Anticonvulsants for neuropathic pain

NSAIDs can be considered but only for short durations

3-4

0 to -2

Propofol
Dexmedetomidine

Avoid benzos

No analgesia
Can cause respiratory depression
Can cause brayarrythmias and hypotension
High dose infusions >48hours can cause hypertryglyceridemia
More effective at reaching deeper sedation levels
Monitor for PRIS

Vitals
SCr, UOP (urine output), triglycerides, amylase/lipase

Propofol infusion syndrome, discontinue immediately if there are signs/symptoms

Occurs at high doses when used for >48 hours

acute liver failure or pancreatitis patients, hard to tell PRIS symptoms apart from their baseline

Good for light sedation, not deep
May be analgesic
Can cause hypotension and bradycardia
Monitor for vitals and discontinue slowly due to dependence

>4=dilirium

50mg Q12H, with a max dose of 200mg Q12H, best evidence out of antipsychotics

0.3mg/kg IVP

1-2mg/kg IVP

1-2mg/kg IVP

1-1.5mg/kg IVP

1mg/kg IVP