Avoiding Common Errors in the ED Flashcards
Ventilation means
The ability to exchange gas
Oxygenation means
The ability of oxygen to cross the alveoli and perfuse tissue
Bed position for preoxygenation
Elevated head of bed or reverse Trendelenburg
Length of time for adequate preoxygenation
3 minutes of tidal volume breathing or
8 vital capacity breaths over 60 seconds
Drugs used for sedation in RSI
Etomidate 0.3-0.4 mg/kg Ketamine 1-1.5 mg/kg Propofol 0.5 mg/kg Midazolam 0.3 mg/kg Fentanyl Thiopentone
Dose of etomidate for RSI sedation
0.3-0.4 mg/kg
When to use etomidate
suitable for most situations including haemodynamically unstable, other than sepsis or seizures
Etomidate is contraindicated in
Sepsis
Seizure
Dose of ketamine for induction RSI
1-1.5 mg/kg
When to use Ketamine in RSI induction
any RSI, especially if hemodynamically unstable (OK in TBI, does not increase ICP despite traditional dogma) or if reactive airways disease (causes bronchodilation)
Dose of succinylcholine for RSI paralysis
1.5 mg/kg
Contraindications to succinylcholine
recent burn crush injury denervation injuries if pt cannot handle rise in serum K concern for increased ICP or intraocular pressure
Dose of rocuronium for RSI paralysis
1 mg/kg
Etomidate effect on ICP
Lowers ICP
Ketamine for RSI induction is contraindicated in
Hypertensive patients
What is the recommended agent for lowering BP in ICH?
Nicardipine
Most missed diagnoses in the ED
The most common missed diagnosis is fracture, followed by acute myocardial infarction (AMI) and appendicitis.
Most common reason for lawsuits in the ED
Missed diagnostic test
