RESUS PROCEDURES Flashcards
3 CONDITIONS WHICH IS AGGRAVATED BY LARYNGOSCOPY, DUE TO ITS SYMPATHETIC RESPONSE
INCREASED ICP, CARDIAC ISCHEMIA, AORTIC DISSECTION
RESPIRATORY EFFECT OF LARYNGEAL STIMULATION
LARYNGOSPASM, COUGH, BRONCHOSPASM
HOW LONG SHOULD YOU WAIT TO START RSI, AFTER GIVING PRETREATMENT
3-5 MINUTES
THIS PRETREATMENT DRUG IS FOR SYMPTOMATIC BRADYCARDIA INCHILDREN
ATROPINE
INDICATIONS OF LIDOCAINE -3
DOSAGE
PRECAUTIONS
ELEVATED ICP, BRONCHOSPASM, ASTHMA
1.5 MG/KG IV OR TOPICAL
PRECAUTIONS-
INDICATIONS FOR FENTANYL
PRECAUTIONS
DOSAGE
INDIC- INCR ICP, CARDIAC ISCHEMIA, AORTIC DISSECTION
PREC-RESPIRATORY DEPRESSION, HYPOTENSION, CHEST WALL RIGIDITY
DOSAGE- 3MICROGRAM/KG
INDICATIONS FOR ATROPINE
DOSAGE
KIDS <5 WITH BRADYCARDIA, KIDS<10 ON SUX AND WITH BRADYCARDIA
BENEFITS OF ETOMIDATE CAVEATS DOSAGE ONSET DURATION
PROTECTS FROM MYOCARDIAL AND CEREBRAL ISCHEMIA
HAS MINIMAL HISTAMINE RELEASE, LITTLE HEMODYNAMIC DEPRESSION
CAVEATS- MYOCLONUS, SEIZURES AND VOMITING
DOSAGE =0.3-0.5MG/KG
ONSET <1 MIN
DURATION OF 10-20MIN
BENEFITS OF PROPOFOL CAVEATS DOSAGE ONSET DURATION
ANTICONVULSANT, ANTI-EMETIC AND DECR ICP, DOESN’T TRIGGER HISTAMINE RELEASE
DOSAGE 0.5-1.5MG/KG
ONSET - 20-40SEC
DURATION - 8-15 MIN
CAVEATS- APNEA, HYPOTENSION, NOT AN ANALGESIC
INDUCTION MEDICATION THAT IS CI IN TRAUMA WITH HYPOTENSION OR HYPOVOLEMIA
PROPOFOL
KETAMINE BENEFITS, CAVEATS, DOSAGE AND DURATION
BRONCHODILATOR, ANALGESIC, PRESERVES RESPIRATORY DRIVE
CAVEATS: INCREASE BP, INCREASE SECRETIONS, PRESERVES RESPIRATORY DRIVE AND EMERGENCE PHENOMENON, HAS CEREBROPROTECTIVE EFFECT,
DOSAGE 1-2 MG/KG
ONSET - 1 MIN
DURATION - 10-20 MIN
RSI MEDS FOR STATUS ASTHMATICUS WHICH IS REFRACTORY
KETAMINE
RSI MED FOR HEAD TRAUMA
KETAMINE
RSI MED NOT FOR ELDERLY OR WITH CARDIAC ISCHEMIA. WHY?
KETAMINE, BECAUSE OF THE ASSOCIATED TACHYCARDIA AND HYPERTENSION
3 benefits of neuromuscular blockade
Facilitate tracheal intubation, improve mechanical ventilation, help control intracranial hypertension
How does paralysing a patient improve intubation -2 and in what conditions does it benefit
Improves oxygenation and decreases peak airway pressures
For refractory pulmonary edema and respiratory distress syndrome
Downside of neuromuscular blockade
Limits neurological assessments,
Long term use - increases critical illness polyneuropathy and ptsd
Are neuromuscular blockers analgesic?
Nope, neither it is anxiolytic too
What are depolarizing agents?
High affinity for cholinergic receptors of motor end plate and resistant to acetylcholinesterase, not antagonized and enhanced by anticholinesterase agensts
What are nondepolarizing agents?
Compete with acetycholine for cholinergic receptors and can be antagonized by anticholinesterase agents
Preferred choice for intubation
Succinylcholine
Hydrolyzed succinylcholine
Plasma cholinesterase
Onset, duration and dosage of succinylcholine
45-60sec onset, duration of 5-9 min, dosage of 1.5mg/kg
In the event of failed intubation, BVM is required for how long, before the return of spontaneous ventilation
12 minutes
Transient rise of potassium in depolarizing neuromuscular blockade
Why the exaggerated hyperkalemic response
0.5 mEq/L
Due to ACh receptor upregulation at MNJ
3 clinical conditions that are contraindicated for admin of sux
Myopathies (MG), renal failure
Rare adverse effect of Sux, occuring in patients with genetic predisposition, and its antidote
Malignant Hyperthermia - dantrolene
Clinical findings in malignant hyperthermia
Unexplained rapid fever with muscle rigidity, acidosis or hyperkalemia
Drug that is metabolized by plasma choinesterase, which reduces amount of enzyme available for sux metabolism
Cocaine
If patient has know plasma cholinesterase deficiency, what NMJ drug should be used?
Rocuronium
Conditions at risk for hyperkalemia
What RSI drug should be contraindicated?
Succinylcholine CI: more than 5 days old of burns, denervation injury, crush injury, severe infection, preexisitng myopathies, preexisting hyperkalemia
Complications of succinylcholine
Fasciculations, transient increase in intragastric, intraocular, and icp, masseter spasm alone or with malignant hyperthermia, bradycardia, and prolonged apnea with pseudocholinesterase deficiency or MG
Excellent alternative for Sux
Rocuronium
Onset, duration and dosage of rocuronium
Onset of 1-3 min, duration of 30-45 min, dosage of 1mg/kg
Paralyzing agent that is biliary excreted
Dosage, onset and duration
Vecuronium
Dosage- 0.08 - 0.15 mg/kg, duration of 25-40 minutes, onset of 2-4 minutes
MOI of SUgammadex
Reversal agent that encapsulates the molecules of nondepolarizing agent that are circulating in plasma;
Reverses blockade from roc or vec
BVM adverse effect and when should it be deferred?
Gastric distention and deferred when oxygenation is optimal
