RSI Flashcards
What are 3 induction drugs
Etomidate
Ketamine
Propofol
Which induction drug causes myoclonic jerking
Etomidate
Which induction drug stimulates catecholamine release and why is it good?
Ketamine it’s good in sepsis because the catecholamines can actually raise blood pressure
What is the dose for Etomidate
0.3 mg/kg
What is the dose for ketamine
1.5mg/kg
What is the dose for propofol induction?
1.5mg/kg
What are three paralytics
Sucks
rocks
vecuronium
What are the 3 pretreatment drugs?
Lidocaine
Fentanyl
Rocuronium
which pretreatment drug reduces the likelihood of bronchospasm
lidocaine
Which short-acting opioid is used to decrease the cardiovascular effects of sympathetic nervous system stimulation in patients for whom a rapid rise in blood pressure is undesirable (eg, patients with elevated intracranial pressure or significant cardiovascular disease).
fentanyl
what is defasciculation
The prevention of muscular twitches.
What is the onset time for lidocaine
<2 min
What is the onset time for fentanyl
immediate
What is the onset time for rocuronium
60 seconds
What is the commercial name for etomidate
amidate
what is the other name for propofol
diprivan
what is the other name for versed
midazolam
delete
cisastracurium
what is the other name for succinylcholine
suxmethonium
Why use fentanyl for sedation?
Fentanyl provides systemic analgesia and enhances the sedative effect of benzodiazepines. When midazolam-only sedation is ineffective, fentanyl can be considered as an adjunct
when is fentanyl used
Clinically, its most frequent use is as a sedative in intubated patients and in severe cases of pain in patients with renal failure due to its primarily hepatic elimination
what does RSI entail
Rapid sequence intubation (RSI) is an airway management technique that produces inducing immediate unresponsiveness (induction agent) and muscular relaxation (neuromuscular blocking agent) and is the fastest and most effective means of controlling the emergency airway
what are the 9 Ps of RSI
PROCESS OF RSI
Remembered as the 9Ps:
Plan
Preparation (drugs, equipment, people, place)
Protect the cervical spine
Positioning (some do this after paralysis and induction)
Preoxygenation
Pretreatment (optional; e.g. atropine, fentanyl and lignocaine)
Paralysis and Induction
Placement with proof
Postintubation management
what is SOAPME
SOAPME
Suction — at least one working suction, place it between mattress and bed
Oxygen — NRBM and BVM attached to 15 LPM of O2, preferably with nasal prongs for apneic oxygenation
Airways — 7.5 ET tube with stylet fits most adults, 7.0 for smaller females, 8.0 for larger males, test balloon by filling with 10 cc of air with a syringe — Stylet – placed inside ET tube for rigidity, bend it 30 degrees starting at proximal end of cuff (i.e. straight to cuff, then 30 degree bend) — Blade – Mac 3 or 4 for adults – curved blade — Miller 3 or 4 for adults – straight blade — Handle – attach blade and make sure light source works — Backups – ALWAYS have a surgical cric kit available! — have video laryngoscope, LMA and bougie at bedside
Pre-oxygenate – 15 LPM NRBM
Monitoring equipment/Medications — Cardiac monitor, pulse ox, BP cuff opposite arm with IV — Medications drawn up and ready to be given
End Tidal CO2
O2 MARBLES is an altern
drawbacks of propofol
Drawbacks: hypotension, myocardial depression, reduced cerebral perfusion, pain on injection, variable response, very short acting
What is the RSI combos that Dr. Oucha likes ?
Rox and Propofol or Sux and Etomodate
tell me about Versed
**Midazolam. Benzodiazepine
Popular Agent For RSI
Long Acting (2-4) Times More Potent Than Diazepam
Potent Amnestic Effects
Onset Of Action Is 1-2 Min
Duration Of Effect Is 30-60 Min
Typical Dose 0.1-0.3 Mg/Kg Iv.
Can Be Given IM When Immediate Administration Is Needed Without IV Access.
tell me about propofol
Diprivan. EXTREMELY SHORT ACTING INDUCTION SEDATIVE
HIGHLY LIPID SOLUBLE AND RAPIDLY PENETRATES THE BLOOD-BRAIN BARRIER.
CAUSES APNEA RAPIDLY, UNSUTABLE FOR RSI, INICATED FOR POST INTUBATION SEDATION.
ONSET OF ACTION 10-20 SEC
DURATION OF EFFECT 10-15 MIN
DOSE. 1-3 MG/KG IV
DISADVANTAGE: HYPOTENSION, APNEA
Tell me about Etomidate.
Amidate. NON BARBITUATE HYPNOTIC AGENT
EXCELLENT SAFETY PROFILE (PREHOSPITAL AND HOSPITAL)
ONSET OF ACTION IS 10-20 SEC:
DURATION OF EFFECT 3-5 MIN
DOSE: 0.2-0.3 MG/KG IV OVER 15-30
DISADVANTAGE: CORTISAL SUPPRESION
why do we use neuromuscular blocking agents
TO INDUCE MUSCLE RELAXATION, THUS FACILITATING ENDOTRACHEAL INTUBATION.
why do we use induction agents
FOR SEDATION ,PRIOR TO PARALYSIS, DURING RSI.
tell me about lidocaine
Antidysrhythmic, Cardiovascular Agent
Class 1b (Rapid Sodium Channel Blocker, Shortens Repolarization)
CNS Agent
Local Anesthetic
Action: Suppresses Automaticity of Ischemic Ectopic Foci Without Affecting Conduction. Thought To Raise the Ventricular Fibrillation Threshold.
Used In RSI As an Induction Agent to Blunt ICP.
Contraindications: Known Hypersensitivity, Ventricular Ectopy in Presence of Bradycardia. And Severe Conduction Abnormalities Without Pacemaker Availability.
Dose 1.0-1.5 Mg/Kg IVP 2-3 Min Prior To Rsi
Dose: Iv Bolus 1.0-1.5 Mg/Kg Over 3 Min, Repeat Dose Is Given In 5-15 Later at Half the Initial Dose. Max 3mg/Kg
Pediatric Dose: 0.5-1.0 Mg/Kg Per Bolus with maint Infusion Of 20-50 Mcg/Kg/Min Titrated To Effect.
tell me about atropine
AUTONOMIC cns AGENT, ANTICHOLINERGIC (PARASYMPATHOLYTIC) ANTIMUSCARINIC AGENT.
INHIBITS VAGAL TONE
PRIMARILY USED TO REMOVE EXCESS PARASYMPATHETIC TONE, AND TO BLUNT VAGAL TONE IN RSI.
USED IN HOSPICE TO DRY ORAL SECRETIONS ***
SIDE EFFECTS: PALPATATIONS, TACHYCARDIA, DRY MOUTH, DILATED PUPIS AND POSSIBLE ANXIETY.
DOSAGE: FOR SIGNIFICANT CARDOVASCULAR INSTABILITY 0.5-1.0 MG IVP q3-5 MIN (MAX DOSE 3 MG)
IF GIVEN ToO SLOW OR Too SMALL OF a DOSE CAN CAUSE PARADOXICAL SLOWING OF HEART RATE.**
Tell me about vecuronium
Autonomic nervous system agent, skeletal muscle relaxant- blocks acetylcholine, nondepolarizing Neuromuscular blocking agent.
Lasts 30 minutes
Reversed with sugammadex or neostigmine
minimizes fasciculations
Dosages 0.01 mg/kg (defasciculating dose), 0.08-0.10 mg/Kg IVP q 1-2 hours (paralyzing dose), 0.1 mg/kg IVP , can repeat q 1-2 hours (peds)
