 Hi guys and welcome back to my video. Today I want to talk about sedated patients and being paranoid that they'll never wake up. I had a nurse that's new to ICU who reached out to me and asked me this question. She said that she was just very paranoid about her patients being sedated and what if they just don't wake up and or how can you tell if they're over sedated, under sedated. And so I thought I'd kind of do a general video on this topic when it comes to being a nurse, specifically an ICU nurse, but this may pertain to HACU, OR, different like endoscopy, IR, different areas might deal with this as well. So the most important thing when it comes to sedating your patients appropriately, there's so many things that I'm going to try and consolidate this down, but is proper assessments of your patients and what you're going to be looking for. It's always important to make sure your patient is sedated to whatever sedation levels ordered. So we go by RAS scale, which the RAS is basically a scale where it goes from minus five to plus four. So minus five, minus four, minus three, minus one, zero, plus one, plus two, plus three, plus four. Plus four would be like you are raging, swinging an IV pole, super agitated, restless, thrashing, like uncontrollable, that would be a plus four. Zero would be how I am right now. I'm calm, I'm alert, I'm talking to you, we're having a conversation. And then negative five would be a coma. So everywhere in between is everywhere, between the basically positives, you are more alert or restless and negatives, you are more sedated. So typically depending on the vented patient, which if you're sedating someone, a lot of times they're vented, not all the time if you're doing more of like a moderate sedation, conscious sedation, but if you are on like continuous drips to sedate someone, you probably are taking care of a ventilated patient. Most of the time in my ICU, we are sedating patients between a rash of negative one to negative four. Negative four would be like the extreme where maybe they are on road or prone or they've got super bad aards and we're trying to sedate them from fighting the ventilator. And then negative one would be just like you are easily arousable to like minor stimuli. Like if I talk to you, you open your eyes, if I kind of touch you, you open your eyes, but then you'll kind of drift back off to sleep. Sometimes our ventilated patients are a rash of zero, it just depends on what the order is. So most importantly, know your order and what you're sedating someone to. Now it's also important to know what to look for in each of those sedation areas and what people should be responding to. So if you're a rash of negative five, you're unarousable. You're not responding to anything. You are essentially brain dead or being induced into a coma. Like you are paralyzed, you are in heavy sedation. Some ways that I like to assess my ventilated patients is doing a good neuro exam on them. So how much stimuli does it take to arouse them? So even your most sedated patients that are on sedation, unless they're heavily sedated or paralyzed, they are going to respond to normal stimuli. Like if you induce a cough by suctioning them or induce a gag by doing oral care or if you start to rub them or you pinch their fingers, they're going to show you some sort of reflex that shows you that even though they're sedated, they can still feel things. They can still interpret those things. It's also really important to know your patient's baseline neuro status because that's going to be a good indicator. If your patient is a quadriplegic at baseline, then you may not get certain reactions out of them that you would if I was sedated and vented in order to answer your question about the paranoia about sedating your patients. As long as their vital signs are stable and you're doing your neuro assessments on them and titrating your medications to what your rash should be, then that should hopefully ease your mind a little bit. If you are supposed to have someone at a massive negative one and you go to suction them and they're not coughing or you go to external rub them or you're doing painful stimuli on them and they're not responding, lighten your sedation up a little bit and then reassess and see if they are responding to things. If they don't and your sedation eventually is off, then you have a different problem, but that would be something that you would be communicating with your ICU team about. Over time this gets easier. Sedating patients is kind of like an art or a science, I guess you could say, of how you properly sedate them, wake them up, transition them from deep sleep to now we are doing a sedation vacation for you. It's a learning curve and you get used to it as you become more experienced and hopefully the paranoia that you're experiencing lessens as you become more confident with your assessment skills and knowing what you're assessing and is that matching your orders, is that what you're expecting, what you're assessing, is that what you're expecting. If not, what can we do about it, do we need a lighten sedation, do we need to increase it, it really just depends on the situation of the patient. I hope this answers some of your questions, if you have any other questions leave them down below, give this video a thumbs up and subscribe to my channel. I'll see you guys next time. Bye.