CCMCP - Airway RSIP

Question 1

CCMCP - Airway RSIP - RSIP Overview (PPPIPPP)

Answer 1

Preparation
Preoxygenation
Pretreatment
Indiction
Paralysis
Pass the tube
Post intubation Management

Question 2

CCMCP - Airway RSIP - Position for trauma

Answer 2

Reverse trendelenburg

Question 3

CCMCP - Airway RSIP - Position for non-trauma

Answer 3

Upright sniffing

Question 4

CCMCP - Airway RSIP - Basic preoxygenation technique

Answer 4

NC @ 15 Lpm and NRB @ 15-25 Lpm

Assist ventilations as required

Question 5

CCMCP - Airway RSIP - Preoxygenation BVM assistance may be required for?

Answer 5

Apnea/inadequate respirations
Severe acidosis
Severe hypoxemia - SpO2 < 93% regardless of supplemental O2

Question 6

CCMCP - Airway RSIP - Considerations for possible hypotension?

Answer 6

Crystalloid infusion
Vasopressor infusion
Push dose vasopressors

Question 7

CCMCP - Airway RSIP - If pH <7.1 Tx?

Answer 7

Assist ventilations with paralytic

Sodium Bicarbonate 1 mEq/kg

Question 8

CCMCP - Airway RSIP - Consider atropine if?

Answer 8

Bradycardic or Succinylcholine on previous attempt
Adult - 0.5 mg RIVP
Ped - 0.02 mg/kg max of 0.5 mg

Question 9

CCMCP - Airway RSIP - Hypotension or risk of hypotension induction agent?

Answer 9

Ketamine 0.25-1 mg/kg IBW RIVP

Question 10

CCMCP - Airway RSIP - Normotensive induction agents?

Answer 10

Ketamine 1.5 mg/kg IBW RIVP
or
Fentanyl 2 mcg/kg IBW RIVP
Midazolam 0.1 mg/kg IBW RIVP max of 5 mg

Question 11

CCMCP - Airway RSIP - Adult paralytic agents?

Answer 11

Succinylcholine 1.5 mg/kg IBW RIVP

Rocuronium 1 mg/kg IBW RIVP

Question 12

CCMCP - Airway RSIP - Pediatric <10yo paralytic agents?

Answer 12

Succinylcholine 2 mg/kg IBW RIVP

Question 13

CCMCP - Airway RSIP - Intubation unsuccessful response?

Answer 13

Max 3 attempts
Consider:
Position
Bougie
ELM
Blade
VL

Question 14

CCMCP - Airway RSIP - Monitoring of intubated patient must?

Answer 14

Waveform capnography

Question 15

CCMCP - Airway RSIP - Fentanyl indications?

Answer 15

Analgesia prior to intubation in conjunction with midazolam

Question 16

CCMCP - Airway RSIP - Fentanyl dose?

Answer 16

2 mcg/kg rapid IV/IO ideal body weight

Question 17

CCMCP - Airway RSIP - Fentanyl contraindications?

Answer 17

Hypersensitivity
MAOI within last 14 days
Systolic BP less than 100 mmHg

Question 18

CCMCP - Airway RSIP - Fentanyl precautions?

Answer 18

Use with caution in myasthenia gravis

can induce post airway intervention hypotension

Question 19

CCMCP - Airway RSIP - Midazolam indications?

Answer 19

Sedation prior to intubation in conjunction with fentaNYL

Question 20

CCMCP - Airway RSIP - Midazolam dose?

Answer 20

0.1 mg/kg RIVP IBW max of 5 mg

Question 21

CCMCP - Airway RSIP - Midazolam contraindications?

Answer 21

Hypersensitivity to benzodiazepines
Myasthenia gravis
Systolic BP less than 100 mmHg
Compensated shock states

Question 22

CCMCP - Airway RSIP - Midazolam precautions?

Answer 22

Can induce post airway intervention hypotension Treatment is crystalloid solution 500 mL IV/IO bolus prn to maintain MAP of 65 mmHg

Question 23

CCMCP - Airway RSIP - Ketamine indications?

Answer 23

Analgesia / sedation prior to intubation – preferred in awake intubation, bronchospasm, airway burns, systolic BP < 100 mmHg

Question 24

CCMCP - Airway RSIP - Ketamine dose?

Answer 24

1.5 mg/kg rapid IV/IO IBW
Hypotension or at risk of hypotension
0.25 - 1 mg/kg rapid IV/IO iIBW

Question 25

CCMCP - Airway RSIP - Ketamine contraindications?

Answer 25

Hypersensitivity

Relative – conditions where a significant elevation of blood pressure is hazardous

Question 26

CCMCP - Airway RSIP - Ketamine precautions?

Answer 26

Can cause transient increases in HR and BP

Can induce hypersalivation and tracheobronchial secretions

Question 27

CCMCP - Airway RSIP - Succinylcholine indications?

Answer 27

Paralysis to facilitate intubation

Question 28

CCMCP - Airway RSIP - Succinylcholine dose?

Answer 28

Adult - 1.5 mg/kg RIVP IBW

Ped - 2 mg/kg RIVP IBW

Question 29

CCMCP - Airway RSIP - Succinylcholine contraindications?

Answer 29

Known or suspected hyperkalemia
Hypersensitivity
Family history of malignant hyperthermia
Myopathies associated with elevated CK

Question 30

CCMCP - Airway RSIP - Succinylcholine precautions?

Answer 30

Takes 60 – 90 seconds to take effect

Question 31

CCMCP - Airway RSIP - Rocuronium indications?

Answer 31

Paralysis to facilitate intubation

Question 32

CCMCP - Airway RSIP - Rocuronium dose?

Answer 32

1 mg/kg RIVP IBW

Question 33

CCMCP - Airway RSIP - Rocuronium contraindications?

Answer 33

Hypersensitivity

Question 34

CCMCP - Airway RSIP - Rocuronium precautions?

Answer 34

Should not be administered prior to sedatives or analgesics as neuromuscular blocking agents have no effect on pain sensation and mental status
May cause increased HR and BP
May induce bronchospasm
Wait 45 - 60 seconds and then check the adequacy of the neuromuscular blockade

Question 35

CCMCP - Airway RSIP - Atropine indications?

Answer 35

Administer 1 minute prior to intubation:
If succinylcholine given on previous attempt
If bradycardic

Question 36

CCMCP - Airway RSIP - Atropine dose?

Answer 36

Adult - 0.5 mg RIVP

Ped - 0.02 mg/kg RIVP max of 0.5 mg

Question 37

CCMCP - Airway RSIP - Atropine contraindications?

Answer 37

Hypersensitivity

Question 38

CCMCP - Airway RSIP - Atropine precautions?

Answer 38

Slow administration may cause paradoxical bradycardia

Question 39

CCMCP - Airway RSIP - Sodium Bicarbonate indications?

Answer 39

Prior to intubation, if pH less than 7.1

Question 40

CCMCP - Airway RSIP - Sodium Bicarbonate dose?

Answer 40

1 mEq/kg RIVP prn

Question 41

CCMCP - Airway RSIP - Sodium Bicarbonate contraindications?

Answer 41

None when used in emergency situations

Question 42

CCMCP - Airway RSIP - Sodium Bicarbonate precautions?

Answer 42

Use with caution in CHF, severe renal impairment, concurrent corticosteroid treatment
Avoid extravasation