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Advanced Airway / RSI > Advanced Airway / RSI > Flashcards

Advanced Airway / RSI Flashcards

1
Q

Indications for Intubation

A

♦ Unable to Swallow / Ventilate Oxygenate

♦ GCS < 8

♦ Inhalation Burns / Circumferential Burns

♦ Anaphylaxis

♦ Apnea / Obstruction

♦ Respiratory Failure

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2
Q

Respiratory Failure =

A

♦pH < 7.2

♦ CO2 > 55

♦ PaO2 < 60

*only one value needs to be off to indicate the need to intubate*

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3
Q

Intubation Visualization Aids

A

♦ Selick’s Maneuver = Direct downward pressure on the thyroid cartilage, occludes the esophagus

♦ BURP = Backward, Upward, Rightward Pressure

**Do NOT Release Until Intubation is Complete**

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4
Q

Failed Airway Algotithm

A

♦ Patient Requires Secured Airway

♦ 3 Attempts of Direct Laryngoscopy Unsucessful

♦ Ventilate Pt by BVM/Simple Airway/Blind Airway

♦ Unable to Ventilate/Oxygenate SaO2 > 90%

♦ Cricothyroidotomy Indicated (Cric)

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5
Q

Placement Confirmation

A

♦ Chest XR - Gold Standard

♦ Distal tip of ETT should be 2-3cm above the carina or 1” above the carina Level of the T2 or T3 vertebrae

♦ Next most reliable confirmation method - visualization of tube passing through cords

***Distal cuff on ETT should be between 20-30 mmHg to prevent damage (*25)

(use only enough air required to make good seal)

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6
Q

7 P’s for RSI Success

A

Preparation - make sure equipment is servicable

Preoxygenate - 3-5 minutes, passive oxygenation via NC 10-15 + LPM

Pretreatment - LOAD medications if required

Paralysis w/ induction - Induction agent, paralytic, and pain control

Protect / Position - Ear to sternal notch, ramping, pad behind shoulders for pediatrics

Placement w/ proof - Visual confirmation, capnography, chest x-ray

Post Intubation Management - Maintain sedation and pain control, oxygenation, etc

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7
Q

LOAD (RSI Pretreatment)

A

Lidocaine - blunts the cough reflex preventing ICP increase

Opiates - Blunts the pain response

Atropine - Prevents reflex bradycardia in infants < 1 y/o

Defasiculating Dose - 1/10 dose of Rocuronium or Vecuronium

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8
Q

Succinylcholine (Anectine)

(pharmacodynamics)

A

Depolarizing neuro muscular blocking agent

depolarizes motor endplates at myoneural junction, leading to sustained flaccid paralysis

(stimulates muscle depolarization but remains bound to the receptor, preventing it from repolarizing and being triggered again)

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9
Q

Malignant Hyperthermia

A

Masseter Spasm (lockjaw)

Sustained tetanic musscle contractions

Rapid increase in temp (can be as high as 110 degrees)

Increased ETCO2

Tachycardia / HTN

Treat with Dantrolene Sodium

_**Do NOT give *calcium channel blockers*, you will kill this pt**_

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10
Q

Vecuronium (Norcuron)

(pharmacodynamics

A

Nondepolarizing neuromuscular blocking agent

Blocks acetycholine from binding to motor endplate receptors, inhibiting depolarization

(has slower onset and longer duration)

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11
Q

Rocuronium (Zemuron)

(pharmacodynamics)

A

Nondepolarizing Paralytic

Blocks acetylcholine from binding to the motor endplate receptors, inhibiting depolarization

(has slower onset and longer duration)

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12
Q

Etomidate (Amidate)

(pharmacodynamics)

A

Depresses the reticular activating system by stimulating GABA receptors

Depresses CNS function

Decreases oxygen cosumption and cerebral blood flow (ideal for ^ ICP)

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13
Q

Induction Agents (sedation)

Midazolam (Versed)

A

Used for sedation/anxiolysis with anterograde amnesia

Useful in seizures

Dose varies on intended use (protocols)

2.5-5 mg IV

Use lowest dose possible to achieve desired result

Do not use with other benzodiazepines

Flumazenil (Romazicon) is the reversal

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14
Q

Ketamine (Ketalar)

Pharmacodynamics

A

PCP derivative

Ketamine is a non-competitive NMDA receptor antagonist and dissociative, amnestic, analgesic, anesthetic agent.

Ketamine has a variety of effects, including: anesthesia, analgesia, hallucinogen, and sympathetic stimulation

Produces a rapid profound anesthetic or dissociative state

Ketamine is a Potent Bronchodilator,

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15
Q

Morphine

(Pharmacodynamics)

A

Binds with opiod receptors in the CNS preventing painful impulse transmission producing analgesia

reduces preload,reduces afterload which may lead to decreases in myocardial oxygen demand.

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16
Q

Fentanyl (Sublimaze)

(pharmacodynamics)

A

Synthetic Opiod Analgesic

(70-100 x more powerful than morphine)

Binds with ophoid receptors in the CNS, preventing painful impulse transmission

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17
Q

Ketamine (Ketalar)

(onset and duration)

A

IV = 30 sec / duration 5-10 min

IM = 3-4 min / duration 12-25min

(sedative effects can persist for 45 min - 2.5 hours)

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18
Q

Ketamine (Ketalar)

(side effects)

A

Elevates HR and B/P shortly after administration (typically return to baseline within 15 min)

Increased cerebral blood flow and metabolism

Increased salivary secreations

(atropine 0.4-0.6 IV Slow IVP before induction)

Emergence reactions –> tachycardia, ^b/p, nystagmus, and attempts at swallowing

(treat with benzos)

Rapid admin associated with respiratory depression, apnea, and higher than usual spikes in B/P. (Give IV/IM over 60 sec)

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19
Q

Ketamine (Ketalar)

(Contraindications)

A

< 3 mo of age

Known Schizophrenia

Severe HTN

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20
Q

Ketamine (Ketalar)

(Indications Adult)

A

Induction 2 mg/kg slow IO/IV push.

May repeat bolus of 1 mg/kg every 10 minutes

Post Intubation/Ventilation For mechanically ventilated patients, consider a continuous infusion of 1 mg/kg/hr, after the initial loading dose of 1 mg/kg

Pain Management/Sedation 0.1-0.5 mg/kg Sedation/Behavioral 4 mg/kg IM

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21
Q

Ketamine (Ketalar)

(Indications Pediatric)

A

Induction 2 mg/kg slow IO/IV push.

May repeat bolus of 1 mg/ kg every 10 minutes

Pain Management/Sedation 0.1-0.5 mg/kg IV/IO 1 mg/kg IN

Sedation/Behavioral 4 mg/kg IM

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22
Q

Morphine

(onset and duration)

A

IV = 10 minutes with a duration of action 3-5 hours.

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23
Q

Morphine

(Indications)

A

Pain Management

Pulmonary Edema

24
Q

Morphine

(Contraindications)

A

Avoid use with hypotension

Avoid in the presence of RV/ Inferior wall MI

25
Q

Morphine

(side effects)

A

Hypotension, AMS, Nausea/ vomiting, and respiratory depression

26
Q

Morphine

(adult dose)

A

0.1 mg/kg (up to 5 mg) IM/ IO/IV.

SBP must be > 90 mm Hg.

May repeat dose once to a max of 10 mg

*Higher doses may be required for patients with burn injuries

27
Q

Morphine

(pediatric dose)

A

0.1 mg/kg (up to 5 mg) IM/ IO/IV.

SBP must be > 90 mm Hg.

May repeat dose once to a max of 10 mg

*Higher doses may be required for patients with burn injuries

28
Q

Fentanyl (Sublimaze)

(onset and duration)

A

IV = onset 90 sec, duration 30 min

29
Q

Fentanyl (Sublimaze)

(Indications)

A

Airway: Rapid Sequence Intubation

Breathing: Use of Mechanical Ventilator

Acute Coronary Syndrome

Pain Management

30
Q

Fentanyl (Sublimaze)

(contraindications)

A

Bronchial asthma,

concomitant MAO inhibitors,

myasthenia gravis

31
Q

Fentanyl (Sublimaze)

(side effects)

A

Muscle rigidity, (tight chest)

respiratory depression,

bradycardia and hypotension

myoclonic movements,

tachycardia,

vein irritation,

dermatitis / flushing

urinary retention

32
Q

Fentanyl (Sublimaze)

(adult dose)

A

♦ 1 mcg/kg IM/IO/IV/IN
♦ Maximum 100 mcg

⇒ May repeat dose at 1 mcg/kg

33
Q

Etomidate (Amidate)

(onset and duration)

A

Peak effect = 1 minute

Duration 4-10 minutes

34
Q

Etomidate (Amidate)

(indications)

A

Airway: Rapid Sequence Intubation – for induction

(procedural sedation)

35
Q

Etomidate (Amidate)

(contraindications)

A

Adrenal Insufficiency,

Sepsis

36
Q

Etomidate (Amidate)

(side effects)

A

Respiratory depression,

venous pain, (use larger vessels)

skeletal muscle movement (myoclonus)

N/V on emergence

Uncontrolled eye movements

Hiccups

Apnea

Impaired cortisol synthesis

37
Q

Etomidate (Amidate)

(adult dose)

A

0.3 mg/kg IV push over 30 seconds

Maximum dose of 40 mg

38
Q

Etomidate (Amidate)

(pediatric dose)

A

0.3 mg/kg IV push over 30 seconds

Maximum dose of 40 mg

39
Q

Succinylcholine (Anectine)

(onset and duration)

A

Onset 30-45 sec / duration 4-6 min

40
Q

Succinylcholine (Anectine)

(indications)

A

Airway: Rapid Sequence Intubation

Skeletal muscle relaxation Facilitate management of patients undergoing mechanical ventilation

41
Q

Succinylcholine (Anectine)

(contraindications)

A

Malignant hyperthermia

Skeletal muscle myopathies

Penetrating eye injury

Acute crush injuries

Acute Spinal cord injuries

Chronic renal failure (hyperkalemia)

Relative - Closed head injuries (med induced ICP)

42
Q

Succinylcholine (Anectine)

(side effects)

A

Cardiac arrhythmias,

Increased intraocular pressure,

Muscle Fasciculation

Malignant Hyperthermia

Hypotension/Hypertension

Hyperkalemia

Bradycardia/Tachycardia

Increased ICP

Longer than normal duration of action to pt’s exposed to acetylcholinesterase inhibitors found in nerve agents and pesticides

43
Q

Succinylcholine (Anectine)

(adult dose)

A

2 mg/kg IO/IV over 30 seconds

Maximum dose of 200 mg

44
Q

Succinylcholine (Anectine)

(pediatric dose)

A

2 mg/kg IO/IV over 30 seconds

Maximum dose of 200 mg

45
Q

Vecuronium (Norcuron)

(onset and duration)

A

♦ onset = 2.5 - 3 min

♦ duration = 25 - 40 min

(complete recovery 45-65 min after initial bolus dose)

Manufactored as a powder and must be reconstituted with compatible diluent

46
Q

Vecuronium (Norcuron)

(indications)

A

Airway: Rapid Sequence Intubation

Facilitates endotracheal intubation by paralysis of skeletal muscle

Breathing: Use of Mechanical Ventilator

To increase pulmonary compliance during mechanical ventilation

47
Q

Vecuronium (Norcuron)

(adult dose)

A

0.1 mg/kg IO/IV over 30 – 60 seconds

Maximum dose of 10 mg

48
Q

Vecuronium (Norcuron)

(pediatric dose)

A

0.1 mg/kg IO/IV over 30 – 60 seconds

Maximum dose of 10 mg

49
Q

Rocuronium (Zemuron)

(indications)

A

Airway: Rapid Sequence Intubation

Facilitates endotracheal intubation by paralysis of skeletal muscle

Breathing: Use of Mechanical Ventilator

to increase pulmonary compliance during mechanical ventilation

50
Q

Rocuronium (Zemuron)

(side effects)

A

Hypotension,

Hypertension,

Increased pulmonary vascular resistance

51
Q

Rocuronium (Zemuron)

(adult dose)

A

1 mg/kg IO/IV

Maximum dose of 100 mg

52
Q

Rocuronium (Zemuron)

(pediatric dose)

A

1 mg/kg IO/IV

Maximum dose of 100 mg

53
Q

Ideal/Predicted Body Weight

(Males)

A

50 + 2.3 [height in inches - 60]

= Ideal/Predicted Body Weight

54
Q

Ideal/Predicted Body Weight

(Female)

A

45.5 + 2.3 [height in inches - 60]

= Ideal/Predicted Body Weight

55
Q

Ketamine

(Adult dose for RSI)

A

2 mg/kg SLOW IO/IV (Maximum dose of 200mg)

May repeat bolus of 1 mg/kg IV/IO post intubation every 10 minutes as needed or infuse at 1mg/kg/hr after the initial loading dose.

Ketamine should not be used as an induction agent for infants < 3 months old, patients with a known history of schizophrenia, or in patients with severe uncontrolled hypertension.

56
Q

Effects Succinlycholine has on K+

A

Normal muscle releases enough potassium during succinylcholine-induced depolarization to raise serum potassium by 0.5 mEq/L. Although this is usually insignificant in patients with normal baseline potassium levels, a life-threatening potassium elevation is possible in patients with burn injury, massive trauma, neurological disorders, and several other conditions.

Advanced Airway / RSI (1 decks)

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