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General EMS stuff > RSI > Flashcards

RSI Flashcards

1
Q

Describe “trismus.”

A

Severe contraction of the muscles around the mouth, producing difficulty in intubation.

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2
Q

RSI decreases the risk of aspiration by __________.

A

paralyzing the musculature of the GI tract

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3
Q

List the 7 reasons RSI may/should be performed.

A
  • Combativeness
  • Trismus
  • Laryngospasam
  • Seizures
  • Head Trauma
  • Intact gag reflex
  • Pediatric upper airway emergencies
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4
Q

List the contraindications for RSI performance.

A
  • Anatomic abnormalities
  • Allergies to specific RSI medications
  • Airway edema in the face of adequate respirations
  • Facial injuries preventing use of bag valve mask
  • Tracheal transection
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5
Q

What three pieces of equipment must ALWAYS be present prior to performing RSI?

A
  • BIAD
  • BVM
  • Suction
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6
Q

Describe the “7 Ps” of RSI

A
  1. Preparation
  2. Pre-oxygenation
  3. Premedication / Pretreatment
  4. Paralysis with induction
  5. Protection / Positioning
  6. Placement / Proof
  7. Post-intubation management
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7
Q

Describe the Mallampati scores.

A

Class 1 = soft palate, uvula, anterior and posterior pillars visible

Class 2 = soft palate, uvula visible

Class 3 = soft palate, base of uvula visible

Class 4 = soft palate not visible

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8
Q

What is the “1 up/1 down” rule of RSI.

A

Have an ETT one size above and an ETT one size below what you expect to pass.

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9
Q

What is the purpose of pre-oxygenation?

A

Wash out the 79% of nitrogen that is present in the lungs.

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10
Q

What is the purpose of lidocaine in RSI?

A
  • Blunts the physiologic response of increased ICP in the head injured RSI patient
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11
Q

Contraindications of lidocaine in RSI

A

Known allergy
High degree heart block
Idioventricular rhythms

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12
Q

Laryngeal stimulation in peds patients may result in bradycardia. This is overcome by ____ admininstration.

A

atropine

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13
Q

The purpose of the sedative agent in RSI is to ____.

A

render the patient unaware of the intubation process and spare the psychological trauma and consequent physiologic response.

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14
Q

Common RSI induction agents.

A
  • Midazolam
  • Etomidate
  • Fentanyl
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15
Q

Less common RSI induction agents.

A
  • Propofol
  • Ketamine
  • Thiopental
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16
Q

What is a common side effect of Midazolam in RSI?

A
  • Hypotension
17
Q

Onset of Midazolam in RSI?

A

60-90 sec

18
Q

MOA of Etomidate

A

Sedative-hypnotic that works on the GABA receptors producing anesthesia.

19
Q

What is a side-effect of Etomidate that may be important in RSI of patients in septic shock?

A

Reduction of endogenous cortisol, reducing body’s ability to fight sepsis.

20
Q

What is a common side-effect of Fentanyl in RSI?

A

cause decreased respiration

21
Q

For RSI, Propofol may induce unconsciousness in as little as ____.

A

10-15 seconds

22
Q

For RSI, Propofol may cause what side effect?

A

hypotension

23
Q

Ketamine is an important induction agent in the hypotensive or asthmatic patient for RSI. Why?

A

Acts to release catecholamines from the adrenal medulla, causing (+) inotropy, chronotropy, dromotropy, and bronchodilation.

24
Q

What is the “LOAD” mnemonic for RSI?

A

L - Lidocaine for Suspected Increased ICP
O - Opioids for sedation
A - Atropine for peds
D - Defasciculating dose for Increased ICP, C-Spine Fracture

25
Q

Explain the MOA of depolarizing paralytics.

A

Substitutes for ACh and binds to receptors causing depolarization, and inability to reset resting membrane potential. (succinylcholine)

26
Q

Explain the MOA of non-depolarizing paralytics.

A

Block the uptake of ACh and bind to the receptor but do not stimulate depolarization. (Rocuronium/Vecuronium)

27
Q

What is the “order of paralysis” in RSI?

A
  1. Eyes, face, neck
  2. Extremities
  3. Abdomen
  4. Intercostals, glottis
  5. Diaphragm
28
Q

Cricoid pressure (“Sellick Maneuver”) is no longer indicated in patients with anterior airways. With what has it been replaced?

A

BURP

  • Backwards (posteriorly against the vertebrae)
  • Upwards (superiorly)
  • Rightwards (laterally to the patient”s right)
  • Pressure

General EMS stuff (93 decks)

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