RSI

Question 1

3 questions before RSI

Answer 1

Can the patient follow commands?
Can the patient control secretions?
What is the patient’s clinical course?

Question 2

8 P’s of RSI

Answer 2

1. Preparation
2. Positioning
3. Passive Oxygenation
4. Premedication/Pre-treatment
5. Paralytic for induction
6. Protection and Positioning
7. Perform Intubation, confirm placement with ET
8. Post-intubation Management - Long Acting paralysis? (last resort)

Question 3

Adjunct Tube Sizes

Answer 3

ETT tube x2 = NG, OG, suction catheter
ETT x 4 = chest tube size

Question 4

Shock Index

Answer 4

Pulse Rate / Systolic BP

Ex. 66/27
P = 120

120/66 = 1.8

> 0.9 high Mortality Potential

High shock states - Ketamine is the best induction agent. Reduce to 1mg/kg for high shock index due to potential for rebound hypotension.

Question 5

Depolarizing Agents

Answer 5

Succinlycholine - Acts on acetocholyne receptors to cause sustained depolarization in muscle cell.

Contraindications:

Hyperkalemia
Trauma
Stroke
Spinal Cord Injury
Burns/Chemical

Question 6

Pediatric ETT size

Answer 6

(Age + 16) /4 if >1 year
Weeks = 35 = 3.5 - 1? = 2.5 ETT

Question 7

Bronchial Tear

Answer 7

Desaturation and increase in subcutaneous air.

Advance the tube into the right bronchus, past the tear in order to partially ventilate.