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CRRAB II- Week 6 > Adams: Respiratory Emergencies > Flashcards

Adams: Respiratory Emergencies Flashcards

1
Q

How do you support a pt who is breathing fairly adequately?

A

Supplemental O2 (Nasal cannula or mask) and position them to maximize air exchange

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2
Q

How do you support a pt w/ labored breathing?

A

CPAP (sticking your head out the window) or BiPAP

-helps ppl w/ sleep apnea

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3
Q

How do you support a pt prior to intubation?

A

bag-valve mask

Turn O2 up to 15 L!

Only do this for a little bit b/c they will throw up!

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4
Q

What injuries might demand airway management?

A

facial
flail chest
neck

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5
Q

What illnesses can require airway management?

A 
Pulmonary edema
COPD
aspiration
infection
drugs
allergic reaction (anaphpylaxis, angioedema of the tongue--> ACE inhibitors)
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6
Q

What conditions leave the airway unprotected?

A

Decreased LOC: GCS hypercapnia and hypoxia

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7
Q

What are the primary reasons not to intubate?

A

Adequate airway protection is present

Oxygenation by other less invasive means is possible

Pt is DNI (do not intubate)

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8
Q

What are back ups to intubation?

A

combitube
king airway
laryngeal mask airway (LMA)

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9
Q

What do you do if your attempts at intubation fail?

A

Cricothyroidotomy

Don’t have to worry about blood as much!

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10
Q

What pts may be more difficult to intubate?

A 
short neck
prominent upper incisors
receding mandible
limited jaw opening
limited cervical spine mobility
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11
Q

What is RSI?

A

Rapid Sequential Intubation

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12
Q

What is Succinylcholine?

A

An ULTRASHORT acting skeletal muscle relaxant that combines w/ cholinergic receptors at the motor endplate to produce flaccid paralysis

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13
Q

Does succinylcholine bind more firmly than acetylcholine?

A

YES

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14
Q

What is succinylcholine broken down into?

A

Pseudocholinesterases break it down into succinylmonocholine

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15
Q

The depolarizing action of succinylcholine at muscle’s motor endplates is clinically visible as…

A

muscle fasciculations

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16
Q

How long does it take for succinylcholine to take effect, when is the optimal time to intubate and how long does the paralysis last?

A

30-60 seconds

60-90 seconds

8-12 minutes

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17
Q

What are SE of succinylcholine and how do you treat them?

A

Bradycardia- atropine

Increased:
IGP
ICP
IOP
serum K levels (if already high they can die from cardiac arrythmia)
temperature
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18
Q

What is the “appearance” of someone who has been given succinylcholine?

A

eyes like a mole
moist as a slug
weak as a kitten

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19
Q

What effects does succinylcholine have on muscarinic receptor and nicotinic receptors?

A

SLUD
salivation, lacrimation, urination and defecationa

Nicotinic>
striated muscle problems>
fasciculation and weakness

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20
Q

What are two non-depolarizing meuromuscular blockers?

A

vecuronium

Rocuronium

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21
Q

What is vecuronium?

A

Neuromuscular block
Competes for CHOLINERGIC RECEPTORS>
flaccid paralysis

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22
Q

If you use vecuronium when are the ultimate intubating conditions and how long does it last?

A

2.5-3 mins

25-40 mins

recovery 45-60

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23
Q

What is vecuronium metabolized by?

A

liver and kidneys

  • renal failure does NOT affect recovery time
  • liver failure/cirrhosis may DOUBLE recovery time
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24
Q

Does vecuronium cause problematic hypotension or tachycardia?

A

no

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25
Q

Why is rocuronium unique among neuromuscular blocking agents?

A

It’s onset of action is almost as quick as succinylcholine

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26
Q

What is rocuronium’s onset time, how long does it take to cause complete paralysis and how long does it act?

A

Onset muscle relaxation- 15-20 s (Fast as succinylcholine)

Complete paralysis- 45-60 s

Duration of action 25-60 minutes (takes a long time to start breathing again)

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27
Q

An ideal sedative has….

A 
rapid onset (20-30 s)
short half life
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28
Q

What is an example of a classic barbiturate that isn’t used any more?

A

Thiopental

*causes hypotension

29
Q

What is thiopental?

A

ultrashort acting anesthetic agent w/ a rapid onset of action

*also has antiepileptic properties

30
Q

When are peak concentrations of thiopental achieved in the brain?

A

w/in 30 s

31
Q

What is a SE of thiopental?

A

hypotension

32
Q

What is a non-barbiturate sedative?

A

ketamine

33
Q

What is ketamine?

A

rapid acting anesthetic that induces a DISSOCIATIVE STATE in which the pt is unaware of any sensory or painful stimuli that DOESN’T AFFECT RESPIRATORY DRIVE

34
Q

What causes ketamine’s effects?

A

disruption of conduction between the thalamocortical access

35
Q

When should you use ketamine?

A

SEDATION AND ANALGESIA for children undergoing complex LACERATION REPAIRS

36
Q

What are the optimal intubating conditions, peaking time and length of Ketamine’s effects?

A

30 s

peak 60-90

last 5-10

37
Q

Ketamine is also mildly sympathomimetic. Why is this useful?

A

trauma and HYPOTENSIVE states (doesn’t affect bp)

bronchodilatory property is useful in ASTHMATICS

38
Q

What are the SE of Ketamine?

A

Emergence reactions w/ vivid imagery, hallucinations and irrational behavior.

Hypertension

Increase in upper airway secretion (give atropine as needed)

39
Q

How do you treat emergence reactions?

A

co administration of BEZODIAZEPINES

40
Q

When using ketamine for RSI intubation what do you use to prevent emergency reactions?

A

longer acting sedative

41
Q

What is an example of a benzodiazepine?

A

midazolam

42
Q

What is midazolam?

A

short acting CNS DEPRESSANT which also causes a LACK OF RECAL

43
Q

What SE are associated w/ midazolam?

A

slight drop in MAP

44
Q

How long does it take to achieve adequate sedation w/ midazolam?

A

2-2.5 mins

45
Q

What are two non-receptor rapid acting sedative hypnotics?

A

propofol*

etomidate

46
Q

What is propofol?

A

Modified phenol that is extremely LIPOPHYLIC. IT INFILTRATES the lipid bilayer of the nerve cell’s membrane and DISRUPTS NERVE CONDUCTION

47
Q

Propofol:
Onset of action?
Peak affect?

A

W/in ONE circulation time between heart nad brain (10-20 s w/ IV bolus) VERY SHORT ACTING

Peak affect in 20-40 s

48
Q

What is unique about the offset of propofol?

A

RAPID offset

Duration of action is 8 minutes or less

49
Q

What are the SE of propofol?

A

APNEA (quit breathing)

Potential cardiovascular depressant> HYPOTENSION (BIGGEST ISSUE)

50
Q

What sedative is also an anti-emtic that can lower ICP and is often useful for brief procedures?

A

Propofol

51
Q

What is Etomidate?

A

An Imidazole

Rapid acting hypnotic NOT related to the others.f

Has NO ANALGESIC OR AMNESTIC properties

but can LOWER ICP

52
Q

What is the onset of action of etomidate and how long does it last?

A

20-30 seconds

last 20 mins

53
Q

What sedative is ideal for hypovolemic pts or those in hemorrhagic shock? Why?

A

etomidate

Doesn’t produce cardiovascular depression

54
Q

What are SE of etomidate?

A

vomiting and myoclonus

55
Q

What is an example of a typical RSI protocol?

A

-3 preoxygenate
-.55 Etomidate
-.45 Succinylcholine
0 intubation
+30 assess tube placement
8 check pt temp (b/c of succinylcholine)

56
Q

What are the 6 steps of intubation?

A
  1. Preoxygenate and prepare
  2. Pretreat/prime (fentanyl)
  3. Paralyze (succinylcholine or rocuronium; emotidate)
  4. Intubate
  5. Confirm tube placement
  6. Medicate for long term management
57
Q

How do you confirm tube placement?

A
  1. breath sounds in both axillae and not over stomach
  2. correct PaCO2 (purple BAD)
  3. Bulb suction device
  4. Maintenance of PaO2 (capnography)
  5. CXRAY
58
Q

A 39 y/o pt suffered from a 30% third degree burn 16 hrs ago. She is having increased respiratory difficulty and will need to be intubated. Which of the follwoing drugs is most liekly to cause potentially life-threatening arrythmia?

A

Succinylcholine

*worry about elevated K

59
Q

A four year old comes in w/ a laceration to the lip. What is the best choice?

A

Ketamine IM

midazolam works but makes kids hyper

60
Q

A 65 y/o in cardiogenic shock and respiratory distress. You need to use RSI and intubate them. Most useful drug is:

A

Etomidate

ketamine–don’t affect bp

61
Q

A 74 y/o pt w/ afib. Need to shock them. What do you use?

A

Propofol

62
Q

Which of the following is the most appropriate intervention if you can’t intubate a pt after two attempts?

A

Use a combitube

63
Q

Succinycholine SE?

A

Hyperkalemia

Muscle twitching

64
Q

Etomidate SE?

A

Muscle spasm

Adrenal suppression

65
Q

Propofol SE?

A

Hypotension

66
Q

Midazolam SE?

A

Amnesia

Hypotension

67
Q

Ketamine SE?

A

Hypertension

Increased ICP

68
Q

Rocuronium SE?

A

?

CRRAB II- Week 6 (4 decks)

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