6- RSI And Stoma Flashcards
What does RSI stand for
Rapid Sequence Intubation
What is the purpose of RSI
Take the airway from the patient and control it for them
Indications of RSI (3)
- Impending respiratory failure
- Cardiac compromise
- Endangered airway
Most important sign/symptom for RSI and 5 others
-ALTERED MENTAL STATUS
- <10 or >30 respiration’s per minute
- Cyanosis
- SaO2 less than 90%
- Extensive secretions or other airway blockage
- Facial trauma
Should you RSI based off of only 1 sign/symptom
NO!!!
Contraindications for RSI (3)
- For behavioral control/mechanism of restraint
- Lack of airway rescue device
- Improper training and comfort
The 6 P’s of RSI
- Prepare
- Preoxygenate
- Premedicate
- Paralyze
- Place tube
- Post intubation management
Key points of preparation (3)
- Assess difficulty for intubation
- Prepare drugs and equipment
- Explain procedure to patient
Difference between Mallampati and Carmack-Lehane
- Mallampati scale- Assess open mouth of conscious patient
- Carmack-Lehane grade- Assess glottis opening of an unconscious patient
Key points of preoxygenation (4)
- 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)
Meds, dosages and indications for premedication (If indicated)
- Lidocaine: 100mg IV for increased ICP/head injury
- Atropine: .5mg IV for bradycardia
Meds, dosages and indications for sedation
Etomidate: .2-.4 mg/kg IV, If hemodynamically unstable
Midazolam (Versed): 5mg slow IVP, If hemodynamically unstable, SBP over 100
Meds, dosages and indications for pain
Fentanyl: 50mcg (Titrate) IV
How does a neuromuscular blocker work and the 2 types
- Binds with nicotinic receptors for ACH
- Produces muscle paralysis
- Deporlarizing
- Non-depolarizing
How do depolarizing agents work (5)
- Quick onset, short duration
- Bind to receptors for ACH
- Cause muscle excitement
- Muscle contraction leads to paralysis
- Causes fasciculations (uncontrolled muscle twitching)
How do non-depolarizing agents work (4)
- Long onset, long duration
- Bind to receptors for ACH
- Also block uptake of ACH
- Prevents excitement of muscle
What categories of meds are administered simultaneously
- Potent sedative
- Neuromuscular blocking agent
What is important for the placement during RSI (2)
- Confirm ET placement (Capnography is best)
- Secure the tube
What to remember for post intubation
- Maintain sedation
* Versed 2-5 mg every 20 min - Maintain paralysis
* Vecuronium 10 mg IV ONCE!
2 types of stoma sites and what are they
Laryngectomy- Larynx surgically removed
Tracheostomy- Surgical opening to trachea
What is the main problem with stomps
Excessive secretions (plugged)
What is a total laryngectomy and importance
Breathes completely through the stoma
- Can’t be ventilated by mouth
What is a partial laryngectomy and importance
Breathes some through nose and some through mouth
*May have to close off mouth if ventilating
through stoma
Key points of stoma suctioning (2)
- Limit to 10 seconds
- Sterile technique if time allows
Meds, dosages and indications for paralysis
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
