6- Standard vs RSI Flashcards by A H

What are the patient factors contributing to aspiration risk factors ?

Increased gastric content

Lower esophageal sphincter incompetence

Decreased laryngeal reflexes

Gender

Age

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What are examples of increased gastric content?

Intestinal obstruction

Non- fasted

Drugs (Ozempic)

Delayed gastric emptying

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What are examples of lower esophageal sphincter incompetence?

Hiatus Hernia

Gastro-sephageal reflux

Pregnancy

Morbid obesity

Neuro Muscular disease (NMD)

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What are examples of Decreased laryngeal reflexes?

Head injury

Bulbar palsy

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Gender

Male

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Age

Elder

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What are the Operation factors contributing to aspiration risk factors ?

Procedure

Position

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What are examples of procedure?

Emergency

Laparoscopic

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What are examples of position?

Lithotomy

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What are the Anesthetic factors contributing to aspiration risk factors ?

Airway

Maintenance

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What are examples of Airway?

Difficult intubation

Gas insufflation

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What are examples of maintenance?

inadequate depth

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What are the 3 main Aspiration risk factors?

1- Patient factors

2- Operation factors

3- Anesthetic factors

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Define Standard Induction?

Assumes the patient is NPO/ not a “full stomach” and not aspiration risk

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What are the Airway steps of a standard induction before medication induction?

Position and pre-oxygenate the patient, “Nitrogen washout” with 100% O2 and a tight fitting mask

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What are the induction medications for a standard induction?

Midazolam

Fentanyl

Lidocaine

Propofol/ Etomidate

Prior to giving a paralytic what is be checked?

“bag” mask the patient, establish that we can actually oxygenate/ ventilate the patient

What is the SI for paralytic ?

Rocuronium- 0.6 mg/kg

Succinylcholine 1-1.5 mg/kg

What step is always taken into consideration before and after giving a paralytic in a Standard induction?

“bag” mask the patient, establish that we can actually oxygenate/ ventilate the patient

Once paralytic is given during an SI, what step follows?

proceed with laryngoscopy/ ETT placement or LMA placement

What steps are done after ETT placement or LMA?

Inflate cuff, close APL, give a few breaths (squeeze bag), look for misting, bilateral chest rise and breath sounds

What is the last step to an SI?

Begin manual/ machine ventilation, secure ETT

Define Rapid sequence induction?

Minimize the time when the patient’s airway is unprotected (time between in induction and intubation)

RSI induction indications?

Full stomach/ NPO status is questionable, aspiration risk (uncontrolled GERD, inability to protect airway).

What are some contraindication to RSI?

Known or presumed difficult airway

During an RSI what is important to check?

ensure and check suction

True or False: During an RSI you still position and pre oxygenate the patient, "nitrogen washout" with 100% O2 with a tight fitting mask

True

What is a TRUE RSI? and what is the induction meds?

When the stomach is full or bleeding is noticed Propofol/ Etomidate + paralytic ( Roc 1.2mg/kg, Suc 1-1.2 mg/kg)

What meds could be used for patient comfort/ reduce sympathetic surg from laryngoscopy?

Benzodiazepines, Lidocaine, and Opioids

What is a huge NO while masking the pt with RSI?

DO not manually mask ventilate- passive oxygenation ONLY!

What sign are we waiting for before we intubate laryngoscopy and after a paralytic (Succinylcholine)?

Fasciculations

Once Fasciculations are seen, what is the nest step?

1- Intubate, inflate cuff, close APL, give a few breaths (squeez bag), look for misting, bilateral chest rise and breath sounds 2- begin manual/ machine ventilation/ secure ETT

What are the NPO guidelines for Clear fluids?

2 hours

What are the NPO guidelines for breast milk?

4 hours

What are the NPO guidelines for nonhuman milk?

6 hours

What are the NPO guidelines for light mean?

6 hours

What are the NPO guidelines for regular meal?

8 hours