RSI

Question 1

Indications

Answer 1

Need for immediate intubation assumed with failed intubation attempt

Question 2

Management- A

Answer 2

100% O2 assisted ventilations, BVM, hyperventilate patient prior to SUX if possible

1. Suction as needed
   * 2. IV secured. Surgical equipment available.
   * 3. Cardiac Monitor

Question 3

Management- B

Answer 3

Pretreatment medications

1. Lidocaine 1mg/kg: Only for pts with suspected increased ICP or with reactive airway disease
2. Atropine 0.5mg IV- Adu;ts with pulse

Question 4

Management- C

Answer 4

Apply NC at 4LPM for apneic oxygenation

Question 5

Management- D

Answer 5

Sux- 1.5 mg/kg IV max 200mg single dose

Question 6

Management- E

Answer 6

Cricoid pressure (Sellick maneuver) until intubation successful and cuff inflated

Question 7

Management- F (fasciculations)

Answer 7

After fasciculations stop, ventilate pt 4-5 times with BVM

1. Perform intubation
2. If Difficult intubation
   a) reposition, BURP technique, change rescuer
   b) Eschmann catheter
   c) NASCAR technique
   d) King Vision

Question 8

Management- F (fasciculations)

Answer 8

After fasciculations stop, ventilate pt 4-5 times with BVM

1. Perform intubation
2. If Difficult intubation
   a) reposition, BURP technique, change rescuer
   b) Eschmann catheter
   c) NASCAR technique
   d) King Vision

Question 9

Management- G

Answer 9

If relaxation inadequate after 60-120 seconds, repeat Sux, reattempt intubation

Question 10

Management- H

Answer 10

If intubation repeatedly unseccesful

1. Insert IGEL rescue airway
2. Perform cricoidthyrotomy if unable to ventilate (call OLMC)
   a) Needlejet in pts under 12

Question 11

Management I

Answer 11

Treat bradycardia with Atropine IV. Pre-treat with Atropine as above in hypoxic pt (low O2, high CO2). Halt intubation, hyperventilate w/ BVM and O2

Question 12

Management J

Answer 12

Upon successful intubation, confirm ET placement w/ EtCO2 and secure. Release cricoid pressure, ventilate with BVM, maintain EtCO2 35-45mm/Hg
1. If no EtCO2 reading or deteriorating waveform, pull and reattempt intubation

Question 13

Management K

Answer 13

Document GCS/neuro prior to Sux

Question 14

Management L

Answer 14

Once intubated, normal ventilation rates should be maintained. 12 breaths/min BVM (assist peds at normal ventialtion rates per age). For closed head injury pts maintain BP of 90 systolic and 30-35 mm/Hg EtCO2
1. Consider Versed 5-10mg IV/IO for post-intubation sedation, Child 0.1-0.2 mg/kg

Question 15

Need for long term paralytic- I

Answer 15

1. Identified need for long-term paralytic after successful intubation
   A. Need for long term paralytic defined
2. Pt successfully intubated (confirmed by EtCO2) and beginning to arouse or become combative
3. Risk of losing pt airway exists
4. Extended transport time

Question 16

Need for long term paralytic- II

Answer 16

Procedure
A. Vecuronium (Norcuron) 0.1 mg/kg IV bolus
B. Sedation with Versed 5-10mg prn
C. Follow above recommendations for ventilations. Notify receiving physician of long acting paralytic use.
D. Other considerations
1. Duration of action 25-40 minutes
2. Prolonged excretion in renal or hepatic failure pts
3. Like Sux has no effect on consciousness or pain threshold