DSI

Question 1

Purpose or Goal or DSI is?

Answer 1

Not to blunt spontaneous ventilation or airway reflexes

Question 2

Primary goal of any airway or respiratory emergency is maintaining?

Answer 2

Ventilation
Oxygenation
Perfusion

Question 3

Indications for an advanced airway are:

Answer 3

Airway protection
Respiratory failure
Prolonged respiratory suppport

Question 4

What equipment MUST be in place fro DSI?

Answer 4

Suction unit

Cardiac monitor, BP, SPO2, ETCO2

Question 5

Positioning for DSI is?

Answer 5

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

Question 6

The Pre-oxygenation step includes?

Answer 6

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

Question 7

Definition of apenic in DSI?

Answer 7

Respirations < 4/min

Question 8

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

Answer 8

Patient becomes apneic.

Question 9

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

Answer 9

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

Question 10

What is the contraindications for push pressor epi?

Answer 10

Hypotension secondary to blood loss.

Question 11

DSI paralysis indications are?

Answer 11

Apneic Status epilepticus

Trismus

EMS captain or flight crew discretion

Question 12

Contraindications to DSI paralysis is?

Answer 12

Allergy

Predicted difficult intubation

Inability to ventilate with a BVM

Major facial trauma

Question 13

What are the doses for rocuronium for adult and pediatrics?

Answer 13

Adults 100mg
Pediatric 1mg/kg

Question 14

What is the warning for rocuronium with patients?

Answer 14

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

Question 15

Post intubation placement is ?

Answer 15

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

Question 16

Post intubation medications are MANDATORY for any?

Answer 16

ET tube or Igel

Question 17

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

Answer 17

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.)

Question 18

Failed airway in adults or pedi is?

Answer 18

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

Question 19

What is the precursor for the cyano kit?

Answer 19

Hydroxocabalamine

Question 20

What is the half life of the cyano kit

Answer 20

26-31 hours

Question 21

what is the onset time for the cyano kit?

Answer 21

2-15min

Question 22

Classification of esmolol

Answer 22

selective b1 class 2 antiarrhythmic

Question 23

what is the half life of esmolol?

Answer 23

2-9min

Question 24

what is the duration of etomidate?

Answer 24

3-5 min.

Question 25

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

Answer 25

Etomidate

Question 26

What are ketamines mechanism of actions?

Answer 26

antagonist for NMDA and blocks these receptors works on Na and Ca channels for pain relief dissociation between the limbic and cortical systems

Question 27

what is the half life for Ketamine?

Answer 27

1-2 hours

Question 28

what is the duration of ketamine?

Answer 28

IV -10-15min IM- 20-30 min

Question 29

contraindications of ketamine

Answer 29

pregnant females Penetrating eye injures Non- traumatic chest pain significant HTN

Question 30

indications for Ketamine

Answer 30

Sezures Violent/ impared pain 7 or higher pre sedation post sedation CPR induced consciousness

Question 31

What class of medication is rocuronium?

Answer 31

Non-depolarizing agent

Question 32

what si the mechanism of action for rocuronium?

Answer 32

binds to the cholinergic receptors in the motor end plate

Question 33

what is the onset of rocuronium?

Answer 33

30-60 sec

Question 34

What is the durations and half life of rocuronium?

Answer 34

Duration 30-60min Half life- 14-18 min

Question 35

What are the contraidications for rocuronium?

Answer 35

Allergy predicted difficult intubation inability to use a BVM major facial or laryngeal trauma

Question 36

per CQI, what other recommendation is added for ketamine?

Answer 36

High flow 02 per Scheppke