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Pain, Agitation and Delirium

MCA and Dols Guidance from the ICS and FICM 2017

Guidance on use of the mental capacity act and deprivation of liberty in intensive care. A summary of the Law in England

Published by the ICS and FFICM. An important topic relating to capacity, consent, best interest, use of restraint and deprivation in ITU. 

The deprivation of liberty Safe guarding (DOLS)process has been challenged and is now considered to be rarely required on ITU. 

This is an essential resource when considering Pain, Agitation and Delirium in ICU. As an absolute staple of what we do delirium is worth knowing about in detail and this document is certainly a safe bet to be asked about. There are iterations since but they probably summarise this.

Its a 44 page document but there is a summary of the evidence based reccomendations in the first four pages. So just go for that...

Confusion Assessment Method ICU (CAM ICU) Worksheet

The CAM-ICU assessment tool for use in intubated and non-intubated patients on ITU. GPICS guidelines say we should perform a delirium screen every 24hrs in our patients. Hypoactive delirium is often missed and the incidence is probably above 50% in our sick ventilated patients. You don't know if you don't check.

Remember to perform CAM-ICU you will need a Richmond Agitation-Sedation Scale(RASS) of zero. Hence you will need to know the RASS Scale also 

CAM-ICU Algorithm

CAM ICU Algorithm

Richmond Agitation-Sedation Scale

Richmond Agitation-Sedation Scale: An essential component of monitoring sedation levels in ITU. Also essential for the use of CAM-ICU for delirium in ITU.

The Critical-Care Pain Observation Tool (CPOT)

Assessment and management of Pain in ITU is a difficult process especially in intubated patients. whether utilising an analgesic based sedation approach or any other the assessment of pain using a validated tool is essential and recommended by guidelines. The CPOT tool is a common tool used in ITU and an appropriate answer to questions on the topic

Behavioural Pain Scale

An Alternate scale to the CPOT score

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