6- RSI And Stoma

Question 1

What does RSI stand for

Answer 1

Rapid Sequence Intubation

Question 2

What is the purpose of RSI

Answer 2

Take the airway from the patient and control it for them

Question 4

Indications of RSI (3)

Answer 4

• Impending respiratory failure
• Cardiac compromise
• Endangered airway

Question 5

Most important sign/symptom for RSI and 5 others

Answer 5

-ALTERED MENTAL STATUS

• <10 or >30 respiration’s per minute
• Cyanosis
• SaO2 less than 90%
• Extensive secretions or other airway blockage
• Facial trauma

Question 6

Should you RSI based off of only 1 sign/symptom

Answer 6

NO!!!

Question 7

Contraindications for RSI (3)

Answer 7

• For behavioral control/mechanism of restraint
• Lack of airway rescue device
• Improper training and comfort

Question 8

The 6 P’s of RSI

Answer 8

• Prepare
• Preoxygenate
• Premedicate
• Paralyze
• Place tube
• Post intubation management

Question 9

Key points of preparation (3)

Answer 9

• Assess difficulty for intubation
• Prepare drugs and equipment
• Explain procedure to patient

Question 10

Difference between Mallampati and Carmack-Lehane

Answer 10

• Mallampati scale- Assess open mouth of conscious patient

- Carmack-Lehane grade- Assess glottis opening of an unconscious patient

Question 11

Key points of preoxygenation (4)

Answer 11

• 100% O2 for 5 minutes for a minimum of 90% SaO2
• Put the pulse ox on the patient
• Capnography or other confirmation device
• Remove blockages from airway (ex. dentures)

Question 12

Meds, dosages and indications for premedication (If indicated)

Answer 12

• Lidocaine: 100mg IV for increased ICP/head injury

- Atropine: .5mg IV for bradycardia

Question 13

Meds, dosages and indications for sedation

Answer 13

Etomidate: .2-.4 mg/kg IV, If hemodynamically unstable

Midazolam (Versed): 5mg slow IVP, If hemodynamically unstable, SBP over 100

Question 14

Meds, dosages and indications for pain

Answer 14

Fentanyl: 50mcg (Titrate) IV

Question 15

How does a neuromuscular blocker work and the 2 types

Answer 15

• Binds with nicotinic receptors for ACH
• Produces muscle paralysis
• Deporlarizing
• Non-depolarizing

Question 16

How do depolarizing agents work (5)

Answer 16

• Quick onset, short duration
• Bind to receptors for ACH
• Cause muscle excitement
• Muscle contraction leads to paralysis
• Causes fasciculations (uncontrolled muscle twitching)

Question 17

How do non-depolarizing agents work (4)

Answer 17

• Long onset, long duration
• Bind to receptors for ACH
• Also block uptake of ACH
• Prevents excitement of muscle

Question 18

What categories of meds are administered simultaneously

Answer 18

• Potent sedative

- Neuromuscular blocking agent

Question 19

What is important for the placement during RSI (2)

Answer 19

• Confirm ET placement (Capnography is best)

- Secure the tube

Question 20

What to remember for post intubation

Answer 20

• Maintain sedation
  * Versed 2-5 mg every 20 min
• Maintain paralysis
  * Vecuronium 10 mg IV ONCE!

Question 21

2 types of stoma sites and what are they

Answer 21

Laryngectomy- Larynx surgically removed

Tracheostomy- Surgical opening to trachea

Question 22

What is the main problem with stomps

Answer 22

Excessive secretions (plugged)

Question 23

What is a total laryngectomy and importance

Answer 23

Breathes completely through the stoma

- Can’t be ventilated by mouth

Question 24

What is a partial laryngectomy and importance

Answer 24

Breathes some through nose and some through mouth
*May have to close off mouth if ventilating
through stoma

Question 25

Key points of stoma suctioning (2)

Answer 25

• Limit to 10 seconds

- Sterile technique if time allows

Question 28

Meds, dosages and indications for paralysis

Answer 28

Succinylcholine: 1-2 mg/kg IV, depolarization agent

Rocuronium: .5-1 mg/kg slow IVP, non-depolarize game agent, 1min peak, 30 min duration

Vecuronium: 10 mg IV, 2 min peak, 45 min duration

Pancuronium: 10 mg IV, 3 min peak, 1 hr duration