DSI Flashcards
Purpose or Goal or DSI is?
Not to blunt spontaneous ventilation or airway reflexes
Primary goal of any airway or respiratory emergency is maintaining?
Ventilation
Oxygenation
Perfusion
Indications for an advanced airway are:
Airway protection
Respiratory failure
Prolonged respiratory suppport
What equipment MUST be in place fro DSI?
Suction unit
Cardiac monitor, BP, SPO2, ETCO2
Positioning for DSI is?
Ear to the sternal notch
Head parallel with the ceiling
Stretcher elevated 15-30 degrees
The Pre-oxygenation step includes?
Maintaining of SP02 for 3min:
Positioning head
NC @ 15L/min
BVM w/ peep @ 10cm/h20
BVM with face seal
Definition of apenic in DSI?
Respirations < 4/min
The only time to give ventilations in the pre-oxygenate phase is?
Patient becomes apneic.
To fix perfusion in adult and infants for DSI what is used?
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
What is the contraindications for push pressor epi?
Hypotension secondary to blood loss.
DSI paralysis indications are?
Apneic Status epilepticus
Trismus
EMS captain or flight crew discretion
Contraindications to DSI paralysis is?
Allergy
Predicted difficult intubation
Inability to ventilate with a BVM
Major facial trauma
What are the doses for rocuronium for adult and pediatrics?
Adults 100mg
Pediatric 1mg/kg
What is the warning for rocuronium with patients?
Asthmatic patients may have a drop in BP that may result in Cardiac arrest.
Post intubation placement is ?
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
Post intubation medications are MANDATORY for any?
ET tube or Igel
What are the post intubation medications that can be used for DSI?
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.)
Failed airway in adults or pedi is?
Surgical cric >13 yrs of age
Needle Cric < 12 yrs of age
What is the precursor for the cyano kit?
Hydroxocabalamine
What is the half life of the cyano kit
26-31 hours
what is the onset time for the cyano kit?
2-15min
Classification of esmolol
selective b1 class 2 antiarrhythmic
what is the half life of esmolol?
2-9min
what is the duration of etomidate?
3-5 min.
what medication from the pharmacolgy medications has the longest list of side effects?
Etomidate
What are ketamines mechanism of actions?
antagonist for NMDA and blocks these receptors
works on Na and Ca channels for pain relief
dissociation between the limbic and cortical systems
what is the half life for Ketamine?
1-2 hours
what is the duration of ketamine?
IV -10-15min
IM- 20-30 min
contraindications of ketamine
pregnant females
Penetrating eye injures
Non- traumatic chest pain
significant HTN
indications for Ketamine
Sezures
Violent/ impared
pain 7 or higher
pre sedation
post sedation
CPR induced consciousness
What class of medication is rocuronium?
Non-depolarizing agent
what si the mechanism of action for rocuronium?
binds to the cholinergic receptors in the motor end plate
what is the onset of rocuronium?
30-60 sec
What is the durations and half life of rocuronium?
Duration 30-60min
Half life- 14-18 min
What are the contraidications for rocuronium?
Allergy
predicted difficult intubation
inability to use a BVM
major facial or laryngeal trauma
per CQI, what other recommendation is added for ketamine?
High flow 02 per Scheppke
