6- Standard vs RSI Flashcards
What are the patient factors contributing to aspiration risk factors ?
Increased gastric content
Lower esophageal sphincter incompetence
Decreased laryngeal reflexes
Gender
Age
What are examples of increased gastric content?
Intestinal obstruction
Non- fasted
Drugs (Ozempic)
Delayed gastric emptying
What are examples of lower esophageal sphincter incompetence?
Hiatus Hernia
Gastro-sephageal reflux
Pregnancy
Morbid obesity
Neuro Muscular disease (NMD)
What are examples of Decreased laryngeal reflexes?
Head injury
Bulbar palsy
Gender
Male
Age
Elder
What are the Operation factors contributing to aspiration risk factors ?
Procedure
Position
What are examples of procedure?
Emergency
Laparoscopic
What are examples of position?
Lithotomy
What are the Anesthetic factors contributing to aspiration risk factors ?
Airway
Maintenance
What are examples of Airway?
Difficult intubation
Gas insufflation
What are examples of maintenance?
inadequate depth
What are the 3 main Aspiration risk factors?
1- Patient factors
2- Operation factors
3- Anesthetic factors
Define Standard Induction?
Assumes the patient is NPO/ not a “full stomach” and not aspiration risk
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
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
