Rapid Sequence Intubation (RSI) - Neuromuscular Blockers (NMB's)

Question 1

The most common intercellular ion

Answer 1

K+

Question 2

This drug burns off quickly in fever

Answer 2

Succinylcholine

Question 3

Succinylcholine abbreviation

Answer 3

SCh

Question 4

Trade name for SCh

Answer 4

Anectine

Question 5

Succinylcholine is depolarizing or non-depolarizing?

Answer 5

depolarizing

Question 6

Depolarizing NMB agents cause

Answer 6

fasiculations (muscle twitching)

Question 7

Succinylcholine dose

Answer 7

1 -2 mg/kg

Question 8

Onset of SCh

Answer 8

1-2 minutes

Question 9

Duration of SCh

Answer 9

4-6 minutes

Question 10

SCh can cause what type of electrolyte imbalance?

Answer 10

Hyperkalemia

Question 11

SCh acts on which part of synapse?

Answer 11

post-synaptic membrane

Question 12

SCh is good for how many days after removed from refrigeration?

Answer 12

14

Question 13

Contraindications to SCh (7)?

Answer 13

Crush injuries
Eye injuries
Narrow angle glaucoma
History of Malignant Hyperthermia
Burns > 24 hours
Hyperkalemia
Any nervous system disorder (Guillain-Barre, Myasthenia gravis)

Question 14

SCh can cause:

Answer 14

MALIGNANT HYPERTHERMIA!!!!!

Question 15

Malignant hyperthermia (MH) is caused by a defect in the

Answer 15

skeletal muscle sarcoplasmic reticulum

Question 16

Signs & Symptoms of MH (6):

Answer 16

Masseter spasm/trismus (lockjaw)
Sustained tetanic muscle contractions
Rapid increase in temperature (can become as high as 110F)
Increased EtCO2
Tachycardia/HTN
Mixed acidosis

Question 17

Antidote for MH

Answer 17

Dantrolene sodium (Dantrium)

Question 18

Dantrolene dose for MH

Answer 18

3 mg/kg

Question 19

Do not give ______’s with MH! MH is due to a problem with Calcium removal from cells.

Answer 19

CCB’s

Question 20

Vecuronium and Rocuronium act on which part of the synapse?

Answer 20

Pre-synaptic membrane

Question 21

Vecuronium trade name

Answer 21

Norcuron

Question 22

Rocuronium trade name

Answer 22

Zemeron

Question 23

Vec and Roc are both what type of NMB’s?

Answer 23

Non-depolarizing

Question 24

Vecuronium is used after SCh to keep the patient

Answer 24

paralyzed (slow onset, long acting)

Question 25

Defasiculating doses of a non-depolarizing agent reduces increase in

Answer 25

ICP during intubation (LOAD)

Question 26

Vecuronium onset

Answer 26

4-6 min

Question 27

Vecuronium duration

Answer 27

30-45 mins

Question 28

Vecuronium loading dose

Answer 28

0.04-0.06 mg/kg IVP if following SCh

Question 29

Vecuronium maintenance dosing

Answer 29

0.01-0.015 mg/kg IVP 20-45 min post initial PRN

Question 30

Vec storage

Answer 30

powder for reconstitution

does not require frigeration

Question 31

Rocuronium used after SCh to keep pt

Answer 31

paralyzed (slow onset, long acting)

Question 32

Rocuronium onset

Answer 32

4-6 min

Question 33

Rocuronium duration

Answer 33

30-45 min

Question 34

Rocuronium dosing & maintenance

Answer 34

0.1-0.2 mg/kg IV q 20-30 min

Question 35

Rocuronium storage

Answer 35

good for 14 days after removal from fridge