RSI Flashcards
How many steps
7
If you oxygenate a healthy individual for 5 mins @ 100% O2 …
they can be apenic for 7 minutes without permanent brain damage
Ideally you wouldn’t bag b4 intubation due to …
Baging - abdominal distention = higher risk for aspiration
Sedative/Analgesic take about how many minutes to work
3 minutes
Sedative for intubation
Midazolam (Versed)
0.1 to 0.3 mg/kg IV
Analgesic for intubation
Fetanyl
2-3 mcg/kg IV
Protective Agents (4) prior to intubation
- Lidocaine
- Opioids
- Atropine
- Defascicultaing Agent
What does lidocaine do as a protective agent + dose
1.5 mg/kg
Suppresses gag/cough from laryngoscope blade during intubation
Reduce sudden ICP with the blade
What do opioids do as a protective agent + dose
Fetanyl 1-3 mcg/kg
Dec sympathetic surge and bradycardia from laryngoscope stimulation
What does atropine do as a protective agent + dose
- 01 - 0.02 mg/kg (ped)
- 5 - 0.1 mg (adult)
Dec parasympathetic surge and bradycardia from laryngoscope stimulation - pulling back on the vagal stimulation
Succ can cause
a shuttering of the muscles (fasciculations) around 40 seconds after it is given - making intubation difficult
Examples of defasciculating agents
Vancuronium (norcuron)
Defasciculating Agent dose + protective gaent
1/10th of loading dose of neuromuscular blocker
Prevents fasciculations from Succ
4 Anesthesisa for RSI
- Etomidate
- Ketamine
- Thiopental
- Propofol
Etomidate dose and precaution
0.2 - 0.4 mg/kg
May cause myoclonic activity
Ketamine dose and precaution
1 - 2 mg/kg
Be careful w/ asthma
May cause hypotension
May cause laryngospasm
Thiopental dose and preaution
2mg/kg
Contraidicated w/ Burns Hyperkalemia Neuromusuclar disorders Eye Injuries
Propofol dose and precaution
0.5 - 2 mg/kg
Contraindicated w/ egg allergies
7 Ps
- Prep
- Pre-oxygenate
- Pre-tx (Sedate)
- Paralysis (short acting neuromuscular agent)
- Placement
- Placement verification
- Post-Intubation
Adults ET tubing size is usually
6.5 to 8.0
Pediatric ET tube equation
Uncuffed: (Age/4) + 4
Cuffed: (Age/4) + 3
UP TO 12
Easy as 1-2-3-4
ETT X 1 = ETT Size
ETT X 2 = NG/OG or Folely
ETT x 3 = ETT insertion depth
ETT x 4 = Chest tube
4 Paralytic Medications
- Succ
- Pancuronium
- Rocuronium
- Vecuronium
Continuous capnography
Rounded waveform
Top between 35-45
Kussmaul’s Sign
Elevation of JVD during inspiration
Succinylcholine
1 -2 mg/kg
Contraindicated in head/eye injuries / cardiovascular disease
Pancuronium
0.01 mg/kg (defasciculating dose)
Rocuronium
0.6 - 1 mg/kg
Contraindicated in head/eye injuries/ cardiovascular disease
Vecuronium
- 01 mg/kg (defasciculating dose)
0. 1 mg (paralyzing dose)
