BOOOOOOOOM Flashcards
What is airway management of a patient who is breathing fairly adequately?
Giving oxygen if needed
Positioning to maximize air exchange
What is airway management of a patient who has labored breathing?
Continuous Positive Airway Pressure (CPAP)
Bilevel Positive Airway Pressure (BiPAP)
A patient comes in with angioedema: what should be speculated as the causative agent?
ACE inhibitors
What is airway protection?
Airway is fine…but there are other factors that might cause the patient to quit breathing (decreased LOC, absence of protective reflexes, apnea)
What are three reasons NOT to intubate?
Airway is adequately protected
Oxygenation can be done less invasively
The patient is DNI
If possible, what should be done prior to intubation?
Pre-oxygenating
Giving succinylcholine
Why is succinylcholine given?
Ultra short-acting muscle relaxant
Paralysis lasts 8-12 minutes
What are three back-up plans to intubation?
Combitube
King Airway
Laryngeal Mask Airway (LMA)
When should intubation be given up on in favor of a back-up plan?
If intubating failed twice (even after repositioning after the first failure)
What is a back-up to the back-up plans?
Cricothyroidotomy–between Adam’s apple and cricoid cartilage
What are some side effects of succinylcholine?
Bradycardia (treated with atropine)
Increased pressures (intragastric, intracranial, intraocular)
Increased serum potassium
Increased temperature
Who shouldn’t be given succinylcholine?
Burn patients (increases temp) Renal failure patients (increased K+)
How can succinylcholine affect a person’s appearance?
Eyes like a mole, moist as a slug, weak as a kitten
Muscarinic receptors –> salivation, lacrimation, urination, and defecation (SLUD)
Nicotinic effects –> fasciculation and weakness
What are examples of non-depolarizing neuromuscular blockers?
Vecuronium
Rocuronium
What is the MOA of vecuronium?
Competes at motor endplate for cholinergic receptor –> initiating flaccid paralysis
How long after giving vecuronium should the patient be intubated?
2.5-3 minutes
Where is vecuronium metabolized?
Liver and kidneys
Does renal failure affect recovery time of vecuronium?
No
Does liver failure affect recovery time of vecuronium?
Yes…may double recover time
Does vecuronium cause hypotension or tachycardia?
No
What is the rate of onset of rocuronium?
Close to succinylcholine
Barbiturates, rapid acting sedatives, can be used prior to intubation: what is a possible side effect?
Hypotension
What rapid-acting anesthetic that induces a disassociative state is used in kids, but is usually avoided in adults d/t a “bad trip”?
Ketamine
Besides being anesthetic/disassociating, what are some other benefits of ketamine?
Useful in trauma and hypotensive states
Bronchodilatory
Besides “bad trips”, what are some other negative side effects of ketamine?
HTN
Increased upper airway secretions (treated with atropine)
Benzodiazepines (midazolam) is a short acting CNS depressant that causes adequate sedation in 2-2.5 minutes: what is a possible side effect of this drug?
Slight drop in MAP
What are examples of rapid acting sedative hypnotics?
Propofol
Etomidate
What is the MOA of propofol?
Inserts into nerve membrane bilayer –> disrupts nerve conduction
What are some side effects of propofol?
Apnea
CV depressant –> hypotension
What sedative drug is ideal for hypovolemic/hemorrhagic shock patients?
Etomidate
What are some possible side effects of etomidate?
Vomiting
Myoclonus
What are the steps of intubation?
1- Pre-oxygenate/prepare 2- Pre-treat/prime 3- Paralyze 4- Intubate 5- Confirm tube placement 6- Medicate for long-term management
What is important to remember during step 2 (pre-treat/prime)?
Give drugs (lidocaine, fentanyl, vecuronium/rocuronium, atropine) enough time to work…2-3 minutes
If there is not enough time to wait, skip step
What is important to remember during step 6 (medicate for long-term management)?
Match long-acting paralytics to equally long-acting sedatives…make sure patient is not aware AND not in pain
