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EMS captain > DSI > Flashcards

DSI Flashcards

1
Q

Purpose or Goal or DSI is?

A

Not to blunt spontaneous ventilation or airway reflexes

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2
Q

Primary goal of any airway or respiratory emergency is maintaining?

A

Ventilation
Oxygenation
Perfusion

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3
Q

Indications for an advanced airway are:

A

Airway protection
Respiratory failure
Prolonged respiratory suppport

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4
Q

What equipment MUST be in place fro DSI?

A

Suction unit

Cardiac monitor, BP, SPO2, ETCO2

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5
Q

Positioning for DSI is?

A

Ear to the sternal notch
Head parallel with the ceiling
Stretcher elevated 15-30 degrees

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6
Q

The Pre-oxygenation step includes?

A

Maintaining of SP02 for 3min:
Positioning head
NC @ 15L/min
BVM w/ peep @ 10cm/h20
BVM with face seal

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7
Q

Definition of apenic in DSI?

A

Respirations < 4/min

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8
Q

The only time to give ventilations in the pre-oxygenate phase is?

A

Patient becomes apneic.

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9
Q

To fix perfusion in adult and infants for DSI what is used?

A

Adults:
1L saline
Infants:
20ml/Kg

If neither work - push press epi- 1:100,000 at 1ml/min. Max 30 ml . Concentration is 10mcg/ml

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10
Q

What is the contraindications for push pressor epi?

A

Hypotension secondary to blood loss.

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11
Q

DSI paralysis indications are?

A

Apneic Status epilepticus

Trismus

EMS captain or flight crew discretion

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12
Q

Contraindications to DSI paralysis is?

A

Allergy

Predicted difficult intubation

Inability to ventilate with a BVM

Major facial trauma

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13
Q

What are the doses for rocuronium for adult and pediatrics?

A

Adults 100mg
Pediatric 1mg/kg

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14
Q

What is the warning for rocuronium with patients?

A

Asthmatic patients may have a drop in BP that may result in Cardiac arrest.

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15
Q

Post intubation placement is ?

A

ETCO2 continually- initially, continuously, and upon transfer of care

Wave form with no less than 3 boxes

Auscultation of bi-lateral breath sounds

Placement of a gastric tube

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16
Q

Post intubation medications are MANDATORY for any?

A

ET tube or Igel

17
Q

What are the post intubation medications that can be used for DSI?

A

Ketamine Versed Fentanyl
Adult: 200mg 5mg 100mcg. (Contraindication of pregnancy near term >32 weeks)
Pedi: 2mg/kg 0.1mg/kg 1mcg/kg (Contraindication of <6mo.)

18
Q

Failed airway in adults or pedi is?

A

Surgical cric >13 yrs of age
Needle Cric < 12 yrs of age

19
Q

What is the precursor for the cyano kit?

A

Hydroxocabalamine

20
Q

What is the half life of the cyano kit

A

26-31 hours

21
Q

what is the onset time for the cyano kit?

A

2-15min

22
Q

Classification of esmolol

A

selective b1 class 2 antiarrhythmic

23
Q

what is the half life of esmolol?

A

2-9min

24
Q

what is the duration of etomidate?

A

3-5 min.

25
Q

what medication from the pharmacolgy medications has the longest list of side effects?

A

Etomidate

26
Q

What are ketamines mechanism of actions?

A

antagonist for NMDA and blocks these receptors

works on Na and Ca channels for pain relief

dissociation between the limbic and cortical systems

27
Q

what is the half life for Ketamine?

A

1-2 hours

28
Q

what is the duration of ketamine?

A

IV -10-15min

IM- 20-30 min

29
Q

contraindications of ketamine

A

pregnant females

Penetrating eye injures

Non- traumatic chest pain

significant HTN

30
Q

indications for Ketamine

A

Sezures

Violent/ impared

pain 7 or higher

pre sedation

post sedation

CPR induced consciousness

31
Q

What class of medication is rocuronium?

A

Non-depolarizing agent

32
Q

what si the mechanism of action for rocuronium?

A

binds to the cholinergic receptors in the motor end plate

33
Q

what is the onset of rocuronium?

A

30-60 sec

34
Q

What is the durations and half life of rocuronium?

A

Duration 30-60min

Half life- 14-18 min

35
Q

What are the contraidications for rocuronium?

A

Allergy

predicted difficult intubation

inability to use a BVM

major facial or laryngeal trauma

36
Q

per CQI, what other recommendation is added for ketamine?

A

High flow 02 per Scheppke

37
Q
A

EMS captain (25 decks)

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