First Things First (assess & treat for the following)

• Does pt have any life-threatening causes of agitation that require immediate attention?
  • Hypoxemia
  • Hypercarbia
  • Severe metabolic acidosis/alkalosis
  • Severe electrolyte abnormalities
  • Hypotension
  • CNS infection
  • Hypoglycemia
  • Drug toxicity, alcohol/drug withdrawal
  • CVA, intracranial hemorrhage
  • MI
  • Pneumothorax
  • Pulmonary edema
  • Seizure
  • Abdominal pain secondary to perforation, abscess, pancreatitis
  • Endotracheal tube malposition
• Does pt have any correctable causes of agitation?
  • Delirium/dementia
    • Hepatic encephalopathy
    • Renal failure, uremia
    • Meds/toxins
  • Ventilator dyssynchrony
    • Inadequate ventilation (hypercarbia)
    • Inadequate oxygenation
    • Inadequate tidal volume/flow
    • Obstruction of ETT
  • Endocrinopathies
    • Hypo/hyperadrenocortisolism
    • Hypo/hyperglycemia
  • Distended bladder
  • Sleep deprivation
  • Disorientation/fear
    • Inability to communicate
    • Noise
  • Pain
    • From procedures
    • Decubitus
    • Oral/nasal gastric tubes
    • Oral ulcerations
    • Invasive monitors