RSI Flashcards
Which NMB is used in RSI?
Why?
- Suxamthenonium(succinylcholine)
2. because it is rapid acting, the onset of action is between 30-60 seconds
How does cricoid pressure work?
It is when we push on the cricoid ring and compress the oesophagus posteriorly and the patient cannot regurgitate(C6)
What can we use instead of Sux if contraindicated(burns/MH)
-We can give rocuronium
Why do we do RSI?
To induce anaesthesia to prevent aspiration
What is the contra-indication to RSI?
-difficult airway(you need to refer the pt)
What are the risk factors for aspiration/regurgitation?
- laryngeal reflexes
- decreased lower oesophageal tone
- increased abdominal pressure
- delayed gastric emptying
What blunts the laryngeal reflexes?
- GCS<8/15-trauma, head injury, CVA
- anatomical abnormalities
- mypathies
- bulbar and pseudo bulbar palsies- Parkinsons, cerebral pasly
What decreases the lower oesophageal tone?
- hiatus hernia with the hx of GERD
- pregnancy
- drugs-caffeine, B2 stimulation, alcohol
- obesity
- achalasia, oesophageal strictures
What causes an increase in intra-gastric pressure?
- when patient had something to eat
- pregnancy
- morbid obesity
- intestinal haemorrhage
What causes delays in gastric emptying?
- opiates, anticholinergics, pain, fear, active labour, renal failure
Why do we need to pre-oxygenate the patient before the RSI?
To buy us more time to intubate
- use oxygen mask
- Make sure the ET02 is more than 90% or wait 3-5 minutes to finally see the results
What is another name for applying cricoid pressure?
- Applying sellick maneovre
- provide pressure of 10N and 30-40N when patient has a GCS of<8
Which induction agents are ideal?
- propofol
- thiopentone
- etomidate
- ketamine
What do we do after extubation?
- left lateral, head down/head up position
If the patient aspirates what do you do?
- suction
2. Give supplemental oxygen, PEEP and maybe even IPPV
What is the pre-treatment procedure in these patients?
- maxalon 10 mg
2.Increase ph: sodium citrate 30 ml for 30 minutes
PPI- continue if patient on it already
H2 receptors_ranitidine,cimetidine at least 2 hours prior
3.
What is the sequence for non-Rapid Sequence induction in a patient in theatre?
- Start off by giving supplemental oxygen with oxygen mask via the breathing circuit
- You can give extra meds to make sure the intubation process is ubtunded-benzodiazepine, fentanyl, ketamine
- Then titrate the intravenous induction agent until the patient loses the eyelid reflex(they are asleep)
- Either LMA or ETT
- When using them you attach the ventilator and start the IAA
- Secure the airway with tape
- close the patients eyes
- Make sure the fresh gas flow is Fi02 of 30% and more than 1L/min of wash in and <1L/min for maintenance
How do you wake the patient up?
- Stop the IAA
- Give > 5L of fresh gas flow
- Gie 80-100% of oxygen
- suck up the pharyngeal secretions
- Make sure full muscle strength has come back(give reversal if it hasnt)
- confirm spontaneous ventilation(3-5 Tidal volume)
- Confirm whether they are able to protect their airway: with a GCS>8
Why do we apply cricoid pressure?
-to ensure that the oesophagus is compressed between the verterbral column and the cricoid
Why do we use the cricoid specifically?
The cricoid is the only part that has a complete ring of cartilage because the trachea does not have cartilage posteriorly
