Medications for RSI and Vasopressors. Flashcards
In pre-medication for RSI when is Atropine indicated and what are the dosages?
Peds< 1 year and adults to prevent bradycardia.
The dosage for Atropine is 0.02 mg/kg Iv IO Max 5 mg
What are the effects of Fentanyl on RSI? What is the dosage
what are the indications
To blunt the circulatory response to intubation,, tight brain and tight chest helps reduce HTN in patients with cardiac and CVA.
Dosage 1-3 mcg/Kg Max 250 Mcg
How do you mix a dirty Epi? What is the indication? What is the dosage?
1 Mg of 1:10,000 in 9 CCs of a saline flush. Makes 10Mcg/Ml
dosage is 5-20 Mcg Q 1-5 min
Indications Hypotension
Is a vaso-pressor considered a push pressor?
How do you Mix and what is the dosage?
Yes Mix 20 units in 100mls of NS= 1 unit per 5 ml
For flush mix 20 units is 9 mls= 2 units per ml
Dosage= 1 ml Q 2 min
Push dose Neo-Synephrine mix and dosage?
1 ml in 100 cc bag = 100mg per ml
dosage is 50-100 mcg q 1-5 min
What is shock index and what does it mean? What’s the formula
Shock index is a calculation to predict mortality in a patient anything < .9 has a high mortality rate.
the formula is pulse/systolic BP= SI
Describe sedation.
Depression of patient awareness of the environment and reduction to his responsiveness to external stimulation
Ketimine for indications?
Dosage?
Rout?
Contraindications?
indications include sedation for induction, RSI, Excited delirium, and pain management.
Dosage: RSI= 1-2 mg/kg
Excited delirium: 4Mg/kg IM
Pain management: 0.1-0.25 Mg/Kg
Contraindication= HTN
What is ketamine brain continuum what are the ranges?
The ketamine continuum is how dissociated your patient is on Ketamine.
Ranges:
10mg analgesia
30mg recreational
50mg partially dissociated
100mg fully dissociated
What is Larson Maneuver
pressure behind the ear along with a jaw thrust to help in laryngospasm
What are 2 pre-medications for RSI?
Indications?
Dosage?
Atropine and fentanyl
Atropine for bradycardia in pediatric patients < 1 year is 0.02 mg/kg Max .5
Fentanyl indications= blunt the circulatory response for intubation
Dosage is 1-3 mcg/ kg Max 250 Mcg
Dirty Epi Mix?
Concentration with a flush?
Dosage? indication?
Mix 1 mg Epi 1:10,000 in 9 ml of saline concentration is 10Mcg/ ML
dosage for hypotension is 5-20 Mcg Q 1-5 min
Name 3 Push pressors?
Mix?
Dosage?
dirty Epi
Vasopressin= 20 units in 100Ml bag. concentration is 1 unit/5 ml dosage is 10ml Q 2 min.
Vasopressin Saline flush Mix= 20units in 9 Mls= 2 units per ML
1 CC Q 2 min
Neo Mix 1 Ml in 100cc bag concentration 100Mcg/Ml
Dosage 50-200 Mcg Q 1-5 min
Neo-Synephrine
BP 66/73 Pulse 120 Etco2 22
What is the shock index?
What is normal and what does the shock index
indicate?
What is the formula?
Pulse/Systolic BP= 1.8
anything >.9 indicated high mortality.
HR/SBP= shock index
Etomidate indication?
Dosage?
Contra Indication?
sedation for induction
dosage is 0.3 Mg/Kg
Adrenal Insufficiency, hypotension and sepsis
Name a depolarizing neuromuscular blocking agent.
Indication?
Dosage?
Contraindications
Anecting= short-acting paralytic
The dosage is 1.5-2.0 Mg/Kg
onset 60-sec
duration 4-10 min
Contraindications= Hyperkelimia, burns, and crush injuries> 24 hours
Stroke
Non-depolarizing agents?
Zemuron (Rock)
Indications= long acting paralytic 30-60 min Dosage .6-1.2 Mg/Kg
Vec= Long-acting paralytic
Dosage .1 Mg/Kg
Onset 2 min duration 45-60 min
Both need a secure airway.
Nimbex ( cisatracurium )
Long-acting paralytic 40-60 min
Dosage .15-.2 mg/kg
Contra Bradycardia
Your patient is a 3-year-old patient. What is the patient tube size and dept?
NG-Tube size?
OG Tube size?
Chest tube size?
Age+16/4= tube size
The patient’s endotracheal tube (ETT) size can be used to determine their nasogastric tube, orogastric tube, soft tip suction catheter, and chest tube size by using this simple rule.
3x Et Tube dept
2 x ETT size = NG, OG, and suction catheter
4 x ETT size = Chest tube size
What is the primary way to confirm Et-Tube placement?
Visual
Etco2
Breath sounds
Secondary
Colorimetric
X-Ray
Which medication is recommended for induction in the high shock index or a low perfusion state?
Ketamine is the best medication with high shock index or low shock state due to its CNS stimulant properties through muscarinic receptor blockade.
The most common diagnostic finding in acute respiratory deterioration is?
PaCO2 > 50 mmHg
Match the contraindication with the correct medication:
Known sensitivity to medication
Laryngeal spasms
Malignant hyperthermia
Adrenal insufficiency
Roc
Ketamine
Succinylcholine
Etomidate
A patient is intubated and continues to desaturate with an increase in subcutaneous air noted. What would be the next best intervention for this patient?
Advance ETT into right mainstem
The patient has a bronchial tree tear
Esmolol Class
Indications
Dosage
Beta-blocker
HTN
500Mcg/Kg/Min
Labetalol Class
Indication
Dosage
Contraindication
Beta-blocker
HTN Cardiogenic Shock
10-20 Mg Slow
Asthma,
Metoprolol Class
Indication
Dosage
Beta Blocker
HTN
5Mg
Nicardipine ( Cardine) Class
Indications
Dosage
Contra
Calcium Channel Blocker
HTN
5MG/Hr
CHF
Chronotrope Medications effect?
Inotrope affects the?
Effect the heart rate
Contractility
Dopamine Class
Indications
Dosage
Contra
Inotrope
Hypotension, Low cardiac output
2-20 Mcg/Kg/Min
Milrinone Class
Indications
Dosage
Contra
Inotrope ( Contraction Force)
CHF, Pulmonary HTN
.25Mcg/Kg/Min
Caution with WPW
Neo-Synephrine (Phenylephrine) Class
Dosage:
Vaso pressor
Vasogenic and neurogenic and septic Shock
10-100Mcg/Min
causes reflex bradycardia
t-PA Class
Indications
Dosage
Thrombolytics (Clot Buster)
Stroke,STEMI
Stroke 0.9Mg/Kg
STEMI 15Mg IV over 1-2 min
