Sedation Reading Test
Sedation Reading Test
Sedation Reading Test
PART A
Text A
Procedural sedation and analgesia for adults in the emergency department
Patients in the emergency department often need to undergo painful, distressing or
unpleasant diagnostic and therapeutic procedures as part of their care. Various
combinations of analgesic, sedative and anaesthetic agents are commonly used for the
procedural sedation of adults in the emergency department. Although combinations of
benzodiazepines and opioids have generally been used for procedural sedation, evidence
for the use of other sedatives is emerging and is supported by guidelines based on
randomised trials and observational studies.
Patients in pain should be provided with analgesia before proceeding to more general
sedation. The intravenous route is generally the most predictable and reliable method of
administration for most agents. Local factors, including availability, familiarity, and clinical
experience will affect drug choice, as will safety, effectiveness, and cost factors. There may
also be cost savings associated with providing sedation in the emergency department for
procedures that can be performed safely in either the emergency department or the
operating theatre.
Text B
International consensus guidelines recommend that minimal sedation – for example, with
50% nitrous oxide-oxygen blend – can be administered by a single physician or nurse
practitioner with current life support certification anywhere in the emergency department.
Guidelines recommend that for moderate and dissociative sedation using intravenous
agents, a physician should be present to administer the sedative, in addition to the
practitioner carrying out the procedure. For moderate sedation, resuscitation room
facilities are recommended, with continuous cardiac and oxygen saturation monitoring,
non-invasive blood-pressure monitoring, and consideration of capnography (monitoring of
the concentration or partial pressure of carbon dioxide in the respiratory gases). During
deep sedation, capnography is recommended, and competent personnel should be present
to provide cardiopulmonary rescue in terms of advanced airway management and
advanced life support.
Text D
Drugs used for procedural sedation and analgesia in adults in the emergency department.
Questions 1-7
For each question, 1-7, decide which text (A, B, C or D) the information comes from. You
may use any letter more than once. In which text can you find information about
Questions 8-14
Answer each of the questions, 8-14, with a word or short phrase from one of the texts.
Each answer may include words, numbers or both
8, What class of drug is traditionally administered together with opioids for the purpose of
procedural sedation?______________________
10, What is the only emergency department procedure for which it is appropriate to use
general anaesthesia?___________________
12, What class of drugs is unsuitable for patients who have a history of
psychosis?______________
13, What opioid drug should be administered using specific
equipment?____________________
Questions 15-20
Complete each of the sentences, 15-20, with a word or short phrase from one of the texts.
Each answer may include words, numbers or both.
16, General anaesthesia is the one form of sedation under which patients may have
reduced .
17, Patients under minimal sedation will react if they are given .
18, Care should be taken when administering Etomidate to patients who are likely to have
.
A, inside buildings.
B, without supervision.
C, on any uneven surfaces.
The active wheelchair is propelled manually and should only be used for independent
or assisted transport of a disabled patient with mobility difficulties. In the absence of
an assistant, it should only be operated by patients who are physically and mentally
able to do so safely (e.g., to propel themselves, steer, brake, etc.).
Even where restricted to indoor use, the wheelchair is only suitable for use on level
ground and accessible terrain. This active wheelchair needs to be prescribed and fit to
the individual patient’s specific health condition. Any other or incorrect use could lead
hazardous situations to arise.
Infection prevention
Infection control measures are intended to protect patients, hospital
workers and others in the healthcare setting. While infection
prevention is most commonly associated with preventing HIV
transmission, these procedures also guard against other blood borne
pathogens, such as hepatitis B and C, syphilis and Chagas disease.
They should be considered standard practice since an outbreak of
enteric illness can easily occur in a crowded hospital.
A, relatively infrequent.
B, clearly unrelated to its use.
C, caused by a combination of drugs.
Several occupational studies have shown adequate physical activity in the workplace also
provides benefits. Seat-bound bus drivers in London experienced more coronary heart
disease than mobile conductors working on the same buses, as do office-based postal
workers compared to their colleagues delivering mail on foot. The AHA recommends that all
Americans invest in at least 30 minutes a day of physical activity on most days of the week.
In the face of such unambiguous evidence, however, most healthy adults, apparently by
choice it must be assumed, remain sedentary.
The cardiovascular beneficial effects of regular exercise for patients with a high risk of
coronary disease have also been well documented. Leisure time exercise reduced
cardiovascular mortality during a 16-year follow-up study of men in the high-risk category.
In the Honolulu Heart Study, elderly men walking more than 1.5 miles per day similarly
reduced their risk of coronary disease. Such people engaging in regular exercise have also
demonstrated other CVD benefits including decreased rate of strokes and improvement in
erectile dysfunction. There is also evidence of an up to 3-year increase in lifespan in these
groups.
Among patients with experience of heart failure, regular physical activity has also been
found to help improve angina-free activity, prevent heart attacks, and result in decreased
death rates. It also improves physical endurance in patients with peripheral artery disease.
Exercise programs carried out under supervision such as cardiac rehabilitation in patients
who have undergone percutaneous coronary interventions or heart valve surgery, who
are transplantation candidates or recipients, or who have peripheral arterial disease result
in significant short- and long-term CVD benefits.
Since data indicates that cardiovascular disease begins early in life, physical interventions
such as regular exercise should be started early for optimum effect. The US Department of
Health and Human Services for Young People wisely recommends that high school students
achieve a minimum target of 60 minutes of daily exercise. This may be best achieved via a
mandated curriculum. Subsequent transition from high school to college is associated with
a steep decline in physical activity. Provision of convenient and adequate exercise time as
well as free or inexpensive college credits for documented workout periods could
potentially enhance participation. Time spent on leisure time physical activity decreases
further with entry into the workforce. Free health club memberships and paid supervised
exercise time could help promote a continuing exercise regimen. Government sponsored
subsidies to employers incorporating such exercise programs can help decrease the
anticipated future cardiovascular disease burden in this population.
General physicians can play an important role in counselling patients and promoting
exercise. Although barriers such as lack of time and patient non-compliance exist, medical
reviews support the effectiveness of physician counselling, both in the short term and long
term. The good news is that the percentage of adults engaging in exercise regimes on the
advice of US physicians has increased from 22.6% to 32.4% in the last decade. The
empowerment of physicians, with training sessions and adequate reimbursement for their
services, will further increase this percentage and ensure long-term adherence to such
programmes. Given that risk factors for CVD are consistent throughout the world, reducing
its burden will not only improve the quality of life, but will increase the lifespan for millions
of humans worldwide, not to mention saving billions of health-related dollars.
7 In the first paragraph, what point does the writer make about CVD?
A, measures to treat CVD have failed to contain its spread.
B, there is potential for reducing overall incidence of CVD.
C, effective CVD treatment depends on patient co-operation.
D, genetic factors are likely to play a greater role in controlling CVD
8 In the second paragraph, what does the writer say about inactivity? A, its role in the
development of CVD varies greatly from person to person.
B, its level of risk lies mainly in the overall amount of time spent inactive.
C, its true impact has only become known with advances in technology.
D, its long-term effects are exacerbated by certain medical conditions.
9 The writer mentions London bus drivers in order to
A, demonstrate the value of a certain piece of medical advice.
B, stress the need for more research into health and safety issues.
C, show how important free-time activities may be to particular groups.
D, emphasise the importance of working environment to long-term health.
10 The phrase 'apparently by choice' in the third paragraph suggests the writer
A, believes that health education has failed the public.
B, remains unsure of the motivations of certain people.
C, thinks that people resent interference with their lifestyles.
D, recognises that the rights of individuals take priority in health issues.
11 In the fourth paragraph, what does the writer suggest about taking up regular
exercise?
A, its benefits are most dramatic amongst patients with pre-existing conditions.
B, it has more significant effects when combined with other behavioural changes.
C, its value in reducing the risks of CVD is restricted to one particular age group.
D, it is always possible for a patient to benefit from making such alterations to lifestyle.
12 The writer says 'short- and long-term CVD benefits' derive from
A, long distance walking.
B, better cardiac procedures.
C, organised physical activity.
D, treatment of arterial diseases.
13 The writer supports official exercise guidelines for US high school students
because
A, it is likely to have more than just health benefits for them.
B, they are rarely self-motivated in terms of physical activity.
C, it is improbable they will take up exercise as they get older.
D, they will gain the maximum long-term benefits from such exercise.
14 What does the writer suggest about general physicians promoting exercise?
A, patients are more likely to adopt effective methods under their guidance.
B, they are generally seen as positive role models by patients.
C, there are insufficient incentives for further development.
D, it may not be the best use of their time.
Text 2: Power of Placebo
Ted Kaptchuk is a Professor of Medicine at Harvard Medical School. For the last 15 years, he
and fellow researchers have been studying the placebo effect – something that, before the
1990s, was seen simply as a thorn in medicine’s side. To prove a medicine is effective,
pharmaceutical companies must show not only that their drug has the desired effects, but
that the effects are significantly greater than those of a placebo control group. However,
both groups often show healing results. Kaptchuk’s innovative studies were among the first
to study the placebo effect in clinical trials and tease apart its separate components. He
identified such variables as patients’ reporting bias (a conscious or unconscious desire to
please researchers), patients simply responding to doctors’ attention, the different methods
of placebo delivery and symptoms subsiding without treatment – the inevitable trajectory of
most chronic ailments. Kaptchuk’s first randomised clinical drug trial involved 270
participants who were hoping to alleviate severe arm pain such as carpal tunnel syndrome
or tendonitis. Half the subjects were instructed to take pain-reducing pills while the other
half were told they’d be receiving acupuncture treatment. But just two weeks into the trial,
about a third of participants - regardless of whether they’d had pills or acupuncture -started
to complain of terrible side effects. They reported things like extreme fatigue and
nightmarish levels of pain. Curiously though, these side effects were exactly what the
researchers had warned patients about before they started treatment. But more astounding
was that the majority of participants - in other words the remaining two-thirds - reported
real relief, particularly those in the acupuncture group. This seemed amazing, as no-one had
ever proved the superior effect of acupuncture over standard painkillers. But Kaptchuk’s
team hadn’t proved it either. The ‘acupuncture’ needles were in fact retractable shams that
never pierced the skin and the painkillers were actually pills made of corn starch. This study
wasn’t aimed at comparing two treatments. It was deliberately designed to compare two
fakes.
Kaptchuk’s needle/pill experiment shows that the methods of placebo administration are as
important as the administration itself. It’s a valuable insight for any health professional:
patients’ feelings and beliefs matter, and the ways physicians present treatments to
patients can significantly affect their health. This is the one finding from placebo research
that doctors can apply to their practice immediately. Others such as sham acupuncture, pills
or other fake interventions are nowhere near ready for clinical application. Using placebo in
this way requires deceit, which falls foul of several major pillars of medical ethics, including
patient autonomy and informed consent.
Years of considering this problem led Kaptchuk to his next clinical experiment: what if he
simply told people they were taking placebos? This time his team compared two groups of
IBS sufferers. One group received no treatment. The other patients were
told they’d be taking fake, inert drugs (from bottles labelled ‘placebo pills’) and told also, at
some length, that placebos often have healing effects. The study’s results shocked the
investigators themselves: even patients who knew they were taking placebos described real
improvement, reporting twice as much symptom relief as the no-treatment group. It hints at
a possible future in which clinicians cajole the mind into healing itself and the body –
without the drugs that can be more of a problem than those they purport to solve.
But to really change minds in mainstream medicine, researchers have to show biological
evidence – a feat achieved only in the last decade through imaging technology such as
positron emission tomography (PET) scans and functional magnetic resonance imaging
(MRI). Kaptchuk’s team has shown with these technologies that placebo treatments affect
the areas of the brain that modulate pain reception. ‘It’s those advances in “hard science”’,
said one of Kaptchuk’s researchers, ‘that have given placebo research a legitimacy it never
enjoyed before’. This new visibility has encouraged not only research funds but also
interest from healthcare organisations and pharmaceutical companies. As private hospitals
in the US run by healthcare companies increasingly reward doctors for maintaining
patients’ health (rather than for the number of procedures they perform), research like
Kaptchuk’s becomes increasingly attractive and the funding follows Another biological
study showed that patients with a certain variation of a gene linked to the release of
dopamine were more likely to respond to sham acupuncture than patients with a different
variation – findings that could change the way pharmaceutical companies conduct drug
trials. Companies spend millions of dollars and often decades testing drugs; every drug
must outperform placebos if it is to be marketed. If drug companies could preselect people
who have a low predisposition for placebo response, this could seriously reduce the size,
cost and duration of clinical trials, bringing cheaper drugs to the market years earlier than
before.
15 The phrase ‘a thorn in medicine’s side’ highlights the way that the placebo effect
A, varies from one trial to another.
B, affects certain patients more than others.
C, increases when researchers begin to study it.
D, complicates the process of testing new drugs.
16 In the first paragraph, it’s suggested that part of the placebo effect in trials is due to
A, the way health problems often improve naturally.
B, researchers unintentionally amplifying small effects.
C, patients’ responses sometimes being misinterpreted.
D, doctors treating patients in the control group differently.
17 The results of the trial described in the second paragraph suggest that
A, surprising findings are often overturned by further studies.
B, simulated acupuncture is just as effective as the real thing.
C, patients’ expectations may influence their response to treatment.
D, it’s easy to underestimate the negative effect of most treatments.