Respiratory Intubation Emergencies

Question 1

Does airway management mean intubation?

Answer 1

NO
if patient is breathing adequately --> give supplemental oxygen and position to maximize exchange
1. Nasal Cannula
2. Mask
3. CPAP or BiPAP
4. Bag-valve assist (15 L O2)

Question 2

Pearl of epiglotitis presentation

Answer 2

Youngs unimmunized kids –> drooling and sniffing a rose

Question 3

Airway is fine but unprotected

Answer 3

Decreased LOC (GCS <8)
Absence of protective reflexes (gag, cough)
Apnea
Hypoventilation leading to hypercapnia

Question 4

Intubation

Answer 4

ELECTIVE emergency procedure –> make sure you have your shit together before you try –> have a back-up plan –> consider RSI

Question 5

Difficult Intubations

Answer 5

Short necks
Prominent Incisors
Receding Mandible
Limited Jaw Opening
Limited Cervical Spine Mobility

Question 6

Succinylcholine

Answer 6

ultra-short acting muscle relaxant –> acts on cholinergic receptors to produce flaccid paralysis (binds more firmly than ACh)
rapidly broken down by pseudocholinesterase
Takes effect in ~1 min, lasts 8-12 min
S.E. = bradycardia –> tx with atropine, serum K may go up

Question 7

Vecuronium

Answer 7

neuromuscular blocker that competes at motor endplate for cholinergic receptors –> flaccid paralysis
Takes effect in 2-3 min, lasts 25-40 min
DOESN’T CAUSE HYPOTENSION OR TACHYCARDIA

Question 8

Rocuronium

Answer 8

unique non-depolarizing blocker that has onset quicker than succinylcholine but lasts longer (30-60 min)

Question 9

Ideal Sedative

Answer 9

Very rapid onset, short half life, no S.E.

Question 10

Barbiturates

Answer 10

anesthetics with rapid onset of actions

HYPOTENSION risk

Question 11

Ketamine

Answer 11

non-barb sedative
rapid-acting sedative that induces dissociative state (LSD-type trip)
Uses: sedation and analgesia for kids
S.E. = LSD-type trip, HTN, increased intracranial pressure, increase airway secretions

Question 12

Midazolam

Answer 12

benzodiazepine –> short acting CNS depressant –> lack of recall (amnesia)
Acts in 2-3 min
S.E. = slight drop in MAP

Question 13

Propofol

Answer 13

modified phenol –> extremely lipophylic
infiltrates lipid bilayer of nerve cell membrane –> disrupts nerve conduction
Onset –> 10-20 seconds
Offset –> both dose related

Question 14

Etomidate

Answer 14

rapid-acting hypnotic –> sedative with no analgesic or amnestic properties
Onset - 20-30 secs
Offset - 20 minutes
DOESN’T produce any CV effects, ideal for hypovolemic patients
Can cause vomitting