CCMCP Post intubation analgesia and sedation

Question 1

CCMCP Post intubation analgesia and sedation - Hypotension risk medications

Answer 1

500ml bolus prn to maintain MAP of 65
Consider ephedrine or norepi
Ketamine with or without Fentanyl

Question 2

CCMCP Post intubation analgesia and sedation - No risk of hypotension medications

Answer 2

Fentanyl with propofol or midazolam

Question 3

CCMCP Post intubation analgesia and sedation - hypotension precautions

Answer 3

Hypotension should be anticipated in ever intubation

In head or spinal injuries a MAP of <85 is considered hypotensive

Question 4

CCMCP Post intubation analgesia and sedation - pediatric fluid challenge dose

Answer 4

10ml/kg prn to maintain normotension for age

Question 5

CCMCP Post intubation analgesia and sedation - Ephedrine dose

Answer 5

0.2 mg/kg to single max of 10mg q 5 prn

Question 6

CCMCP Post intubation analgesia and sedation - Ephedrine indications

Answer 6

Temporizing measure during volume resuscitation or vasoactive agent initiated
Persistent post-intubation hypotension

Question 7

CCMCP Post intubation analgesia and sedation - Ephedrine EMS contraindications

Answer 7

Hypersensitivity to sympathomimetics

Question 8

CCMCP Post intubation analgesia and sedation - Epinephrine Infusion Indications

Answer 8

Symptomatic bradycardia
Shock with hypotension refractory to fluid resuscitation
Cardiogenic shock with refractory hypotension

Question 9

CCMCP Post intubation analgesia and sedation - Epinephrine infusion Dose

Answer 9

Start at 0.1 mcg/kg/min IV/IO to a maximum of 1 mcg/kg/min

Question 10

CCMCP Post intubation analgesia and sedation - Epinephrine infusion preparation and concentration

Answer 10

16mg epiNEPHrine into 250 mL D5W or normal saline = 64 mcg/mL

Question 11

CCMCP Post intubation analgesia and sedation - Fentanyl indications

Answer 11

Post-intubation analgesia

*Administer fentaNYL to all intubated patients (unless contraindicated) and add appropriate sedative

Question 12

CCMCP Post intubation analgesia and sedation - Fentanyl dose

Answer 12

0.5 - 1 mcg/kg IV/IO prn

Question 13

CCMCP Post intubation analgesia and sedation - Fentanyl infusion dose

Answer 13

50 - 200 mcg/hr IV/IO

Question 14

CCMCP Post intubation analgesia and sedation - Fentanyl EMS contraindications

Answer 14

Hypersensitivity

Monoamine oxidase inhibitor within 14 days

Question 15

CCMCP Post intubation analgesia and sedation - Fentanyl infusion preparation and concentration

Answer 15

500 mcg in 100 mL D5W or normal saline = 5 mcg/mL

Question 16

CCMCP Post intubation analgesia and sedation - Ketamine indications

Answer 16

Post intubation sedation

Question 17

CCMCP Post intubation analgesia and sedation - Ketamine dose

Answer 17

1 mg/kg IV/IO

Question 18

CCMCP Post intubation analgesia and sedation - Ketamine infusion dose

Answer 18

0.5 – 1.5 mg/kg/hr IV/IO

Question 19

CCMCP Post intubation analgesia and sedation - Ketamine EMS contraindications

Answer 19

Hypersensitivity

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

Question 20

CCMCP Post intubation analgesia and sedation - Ketamine infusion preparation and administration

Answer 20

200 mg in 100 mL of D5W or normal saline = 2 mg/mL

Question 21

CCMCP Post intubation analgesia and sedation - Midazolam indications

Answer 21

Post intubation sedation

Consult TP

Question 22

CCMCP Post intubation analgesia and sedation - Midazolam dose

Answer 22

0.05 mg/kg IV/IO to a single maximum dose of 5 mg q 5-10 min

Question 23

CCMCP Post intubation analgesia and sedation - Midazolam infusion dose

Answer 23

1 – 10 mg/hr IV/IO

Question 24

CCMCP Post intubation analgesia and sedation - Midazolam EMS contraindications

Answer 24

Hypersensitivity to benzodiazepines
Myasthenia gravis
Hypotension

Question 25

CCMCP Post intubation analgesia and sedation - Midazolam infusion preparation and administration

Answer 25

50 mg in 100 mL of D5W or

normal saline = 0.5 mg/mL

Question 26

CCMCP Post intubation analgesia and sedation - Norepinephrine indications

Answer 26

Symptomatic bradycardia
Shock with hypotension refractory to fluid resuscitation
Cardiogenic shock with refractory hypotension

Question 27

CCMCP Post intubation analgesia and sedation - Norepinephrine infusion dose

Answer 27

0.1 mcg/kg/min IV/IO and titrate to a maximum of

1 mcg/kg/min

Question 28

CCMCP Post intubation analgesia and sedation - Norepinephrine EMS contraindications

Answer 28

Mesenteric or peripheral vascular thrombosis
Pregnancy
Profound hypoxia
Hypovolemia

Question 29

CCMCP Post intubation analgesia and sedation - Norepinephrine infusion preparation and administration

Answer 29

16 mg in 250 mL D5W or normal saline = 64 mcg/mL

Question 30

CCMCP Post intubation analgesia and sedation - Norepinephrine precautions

Answer 30

MAOI or TCA – may precipitate hypertension

Check frequently for signs of extravasation;

Question 31

CCMCP Post intubation analgesia and sedation - Propofol indications

Answer 31

Post-intubation sedation for hemodynamically stable patients
Consult TP

Question 32

CCMCP Post intubation analgesia and sedation - Propofol infusion dose

Answer 32

1 – 3 mg/kg/hr IV/IO (15 - 50 mcg/kg/min)

Question 33

CCMCP Post intubation analgesia and sedation - Propofol EMS contraindications

Answer 33

Hypersensitivity to propofol or its components (soybean oil, egg lecithin, or glycerol)

Settings where general anesthesia is contraindicated

Question 34

CCMCP Post intubation analgesia and sedation - Propofol infusion preparation and administration

Answer 34

10 mg/mL = 10,000 mcg/mL

Question 35

CCMCP Post intubation analgesia and sedation - Propofol precautions

Answer 35

Potent respiratory depressant, especially when used with either opioids or benzodiazepines

Shake well before using

Question 36

CCMCP Post intubation analgesia and sedation - Rocuronium indications

Answer 36

Post-intubation paralysis if required after adequate sedation

Question 37

CCMCP Post intubation analgesia and sedation - Rocuronium dose

Answer 37

0.5 mg/kg = 30 minutes of paralysis

1 mg/kg = 60 minutes of paralysis

Question 38

CCMCP Post intubation analgesia and sedation - Rocuronium EMS contraindications

Answer 38

Hypersensitivity

Question 39

CCMCP Post intubation analgesia and sedation - Rocuronium Precautions

Answer 39

Medications such as gentamicin, tobramycin, vancomycin, corticosteroids, and calcium-channel blockers, can potentiate the effects of rocuronium