Management of Pain, Agitation, and Delirium (PAD)

Comprehensive vocabulary flashcards covering the assessment and pharmacologic management of pain, agitation, and delirium in the ICU, including sedative and paralytic agents.

Somatic Pain

Sharp pain or aching caused by the irritation of pain fibers on the body surface or deep tissues.

Visceral Pain

Pressure or squeezing resulting from the stimulation of internal organ pain receptors.

Neuropathic Pain

Burning or tingling caused by an alteration in the peripheral or central nervous system.

Self-reported pain

The gold standard for pain assessment in critically ill patients.

Fentanyl

A mu-opioid receptor agonist characterized by quick onset, short duration, and potential for muscle rigidity.

Naloxone (Narcan)

The reversal agent for opioids.

Ketamine

An N-methyl D-aspartate receptor antagonist that provides analgesic and sedative properties, anti-epileptic activity, and bronchodilation.

Richmond Agitation Sedation Scale (RASS)

A monitoring tool for agitation; light sedation is defined as a score of $0$ to $-1$, and deep sedation is defined as $-4$.

Dexmedetomidine (Precedex)

A highly selective alpha-2 agonist in the CNS that has no effect on respiratory drive and is not appropriate for deep sedation.

Propofol

A GABA-A agonist anesthetic formulated in a lipid emulsion that requires the patient to be intubated and has a starting rate of $5-10\,mcg/kg/min$.

Propofol Related Infusion Syndrome (PRIS)

A condition characterized by metabolic acidosis, cardiovascular collapse, and hyperkalemia caused by altered hepatic metabolism of lipid emulsion, typically at doses $> 50\,mcg/kg/min$.

Benzodiazepines

GABA-B agonists with sedative and amnesic properties that are associated with increased rates of delirium and tachyphylaxis.

Confusion Assessment Method for the ICU (CAM-ICU)

A tool used to assess delirium by monitoring acute change in mental status, inattention, altered level of consciousness, and disorganized thinking.

Haloperidol

A neuroleptic used for delirium; its use carries risks of QT prolongation and extrapyramidal effects.

Modified Ramsay Scale

A clinical scale where a score of $1$ indicates an anxious/restless patient and a score of $6$ indicates no response to tetanic stimulus.

Succinylcholine

A depolarizing neuromuscular blocking agent (NMBA) with a rapid onset of $30\,\text{sec}$, no reversal agent, and a risk of triggering malignant hyperthermia.

Non-depolarizing Paralytics

Agents such as Rocuronium, Vecuronium, Atracurium, and Nimbex that cause skeletal muscle paralysis without altering pain or anxiety.

Romazicon

The reversal agent used for benzodiazepines.