Respiratory Emergencies - RSI

Question 1

List the three most commonly used paralytics for intubation in order of increasing onset? increasing duration?

Answer 1

Rocuronium < Succinylcholine < Vecuronium,

Succinylcholine < Vecuronium </= Rocuronium

Question 2

Name some sedatives used for intubation and their class. Which are the most commonly used?

Answer 2

Barb- Thiopental
Dissociative- Ketamine
Benzo- Midazolam
Non-receptor rapid-acting sedative hypnotics- Propofol, Etomidate (most commonly used)

Question 3

What are the most common side effects with succinylcholine?

Answer 3

hyperkalemia, muscle twitch (fasciculation)

Question 4

Which RSI sedatives cause hypotension?

Answer 4

Propofol and Midazolam

Question 5

Summarize the steps for RSI

Answer 5

1 pre-oxygenate
2 sedative (Etomidate)
3 paralytic (Succinylcholine)
4 intubation
5 assessment

Question 6

What does I SOAP ME (intubation prep steps) stand for?

Answer 6

I- IV
S- suction
O- oxygen
A- airway (ET tube or other device)
P-pharmacology (meds ready)
M- monitors
E- examine patient

Question 7

What is the gold standard for confirmation of endotracheal tube placement?

Answer 7

visualization through the vocal cords

additional: bilateral breath sounds, PCO2, CXR

Question 8

Name some “back ups” if RSI fails twice?

Answer 8

combitube, King airway, laryngeal mask airway (LMA), cricothyroidotomy

Question 9

What are some situations in which intubation might be warranted?

Answer 9

trauma, burns, illness/hypoxia (COPD), mechanical (compression, obstruction), loss of airway protection (LOC)