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RCEMS Protocols 9/24 > RSI - Adult > Flashcards

RSI - Adult Flashcards

1
Q

How should the head be elevated before RSI?

A

20-40 degrees if able - ear to sternal notch

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2
Q

When is RSI indicated?

A

Failure to maintain airway
Failure to oxygenate
Failure to ventilate
Anticipated negative clinical course
Safety - for patient or crew

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3
Q

What piece of equipment should NOT be used to pre-oxygenate a patient prior to RSI?

A

ETCO2 NC

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4
Q

How long should a patient be pre-oxygenated before intubation attempt in RSI?

A

3 mins

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5
Q

How should a patient be pre-oxygenated prior to RSI?

A

O2 via NRB at or above 25lpm
or
PPV at 100% O2
or
O2 apneic oxygenation with NC

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6
Q

What acronym is used for RSI assessment?

A

HEAVEN

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7
Q

What does HEAVEN stand for?

A

Hypoxemia
Extremes of sizes
Anatomic abnormalities
Vomit/Blood/Fluids
Exsanguination
Neck mobility

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8
Q

What technique can be utilized for the presence of secretions in the airway?

A

SALAD technique

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9
Q

What does SALAD stand for?

A

Suction-Assisted Laryngoscopy Airway Decontamination

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10
Q

What medication can a critical care medic administer pre-RSI for hypotension?

A

Epinephrine 2-10mcg

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11
Q

What should be done with a c-collar prior to RSI?

A

It should be removed.

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12
Q

When should a patient be RSI’d?

A

If they are hemodynamically stable and cannot control or maintain their own airway secondary to ventilation and oxygenation issues.

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13
Q

When should a patient NOT be RSI’d?

A

Apnea, respiratory arrest, loss of landmarks, FBAO, uncorrected hypoxia, inability to ventilate with BVM, secretions in airway, MAP < 65 without resuscitation

CAUTION in significant facial or airway trauma, consider cricothyrotomy

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14
Q

What are the three components of hemodynamic stability?

A

MAP > 65
Adequate tissue perfusion
Absence of hypoxia

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15
Q

What are the three components of hemodynamic instability?

A

Map < 65
Inadequate tissue perfusion
Presence of hypoxia despite intervention

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16
Q

What should be considered for a hemodynamically unstable patient prior to RSI?

A

Fluid resuscitation

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17
Q

What is the dose for fluid resuscitation prior to RSI?

A

20ml/kg NS or Normo-sol IV bolus

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18
Q

If a patient presents as hemodynamically unstable, should they immediately be RSI’d?

A

No - fluid resuscitation should be performed first.

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19
Q

If MAP > 65, what sedatives can be used for RSI?

A

Ketamine: 1-2mg/kg rapid IVP
or
Versed: 5-10mg rapid IVP

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20
Q

What is another name for Versed?

A

Midazolam

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21
Q

What is the RSI dose of Ketamine?

A

1-2mg/kg rapid IVP

22
Q

What is the RSI dose for Versed?

A

5-10mg rapid IVP

23
Q

If MAP > 65, what paralytics can be used for RSI?

A

Rocuronium: 1mg/kg IVP
or
Etomidate: 20mg IVP (repeat ONLY once)

24
Q

What is the RSI dose of Rocuronium?

A

1mg/kg IVP

25
Q

What is the RSI dose of Etomidate?

A

20mg IVP (repeat ONLY once)

26
Q

What is another name for etomidate?

A

Amidate

27
Q

How many times may etomidate be repeat dosed?

A

Repeat ONLY once

28
Q

What are some methods to confirm successful airway capture?

A

Continuous waveform capnography, bilateral chest rise and fall, color improvement, bilateral breath sounds upon auscultation, condensation in tube

29
Q

In what order should RSI meds be given?

A

Sedation first, paralytic second

30
Q

If able, what should be done after successful intubation?

A

Insertion of NGT/OGT

31
Q

What type of medication should be routinely administered post-successful RSI?

A

Pain medication / analgesic

32
Q

What are the medications used for post-intubation pain management?

A

Fentanyl: 0.5-1mcg/kg IV, max dose of 100mcg. May repeat every 5min
or
Dilaudid: 0.5-1mg, max single dose 1mg. Max TOTAL dose 3mg
or
Ketamine: 0.5-1mg/kg IV, may repeat every 10min PRN
or
Versed: 2.5-5mg IV, may repeat in 3-5 min. Consider lower dose in age > 65yrs or chronically ill. Max TOTAL dose 20mg

33
Q

What is the post-intubation pain medication dose for Fentanyl?

A

0.5-1mcg/kg IV, max dose of 100mcg single dose. May repeat every 5min

34
Q

What is the post-intubation pain medication dose for Dilaudid?

A

0.5-1mg, max single dose 1mg. Max TOTAL dose 3mg

35
Q

What is the post-intubation pain medication dose for Ketamine?

A

0.5-1mg/kg IV, may repeat every 10min PRN

36
Q

What is the post-intubation pain medication dose for Versed?

A

2.5-5mg IV, may repeat in 3-5 min. Consider lower dose in age > 65yrs or chronically ill. Max TOTAL dose 20mg

37
Q

How often can the post-intubation pain management dose of Fentanyl be administered?

A

Every 5mins

38
Q

What is the max single dose of post-intubation pain management Fentanyl?

A

100mcg

39
Q

What is the max single dose of post-intubation pain management Dilaudid?

A

1mg

40
Q

What is the max TOTAL dose of post-intubation pain management Dilaudid?

A

3mg

41
Q

How often can the post-intubation pain management dose of Ketamine be administered?

A

May repeat every 10min PRN

42
Q

When can the post-intubation pain management dose of Versed be repeated?

A

May repeat in 3-5 min

43
Q

What should be considered when administering the post-intubation pain management dose of Versed be repeated?

A

Consider lower dose in age > 65yrs or chronically ill

44
Q

What is the total max dose of the post-intubation pain management dose of Versed?

A

Max TOTAL dose of 20mg

45
Q

If patient is refractory to fluid resuscitation, what should be considered?

A

IV push dose pressors and/or vasopressin infusion: Phenylephrine or epinephrine

46
Q

What medications can a critical care medic administer if a patient is refractory to fluid resuscitation?

A

///CRITICAL CARE ONLY///
Phenylephrine: 10mg mixed in 100ml (100cg/ml) 50-200mcg every 2-5min IVP
or
Epinephrine (1:1,000): 2mg mixed in 250ml. 5-10mcg every 2-5min IVP
or
Epinephrine (1:10,000 - CARDIAC EPI): 1mg into 9mL NS flush (10mcg/ml). 5-10mcg every 2-5 min IVP

47
Q

What can a non-critical care medic administer if a patient is refractory to fluid resuscitation?

A

Phenylephrine: 10mg mixed in 100ml NS (100mcg/ml). 50-200mcg/min
or
Epinephrine (1:1,000): 2mg mixed in 250ml (8mcg/ml). 2-10mcg/min, titrate at 1mcg/min at 2min intervals

48
Q

What is the critical care medic dosage of Phenylephrine for a patient refractory to fluid resuscitation?

A

///CRITICAL CARE ONLY///
Phenylephrine: 10mg mixed in 100ml (100cg/ml) 50-200mcg every 2-5min IVP

49
Q

What is the critical care medic dosage of Epinephrine 1:1,000 for a patient refractory to fluid resuscitation?

A

///CRITICAL CARE ONLY///
Epinephrine (1:1,000): 2mg mixed in 250ml. 5-10mcg every 2-5min IVP

50
Q

What is the critical care medic dosage of Epinephrine 1:10,000 (CARDIAC EPI) for a patient refractory to fluid resuscitation?

A

///CRITICAL CARE ONLY///
Epinephrine (1:10,000 - CARDIAC EPI): 1mg into 9mL NS flush (10mcg/ml). 5-10mcg every 2-5 min IVP

51
Q

What is the non-critical care medic dosage of Phenylephrine for a patient refractory to fluid resuscitation?

A

Phenylephrine: 10mg mixed in 100ml NS (100mcg/ml). 50-200mcg/min

52
Q

What is the non-critical care medic dosage of Epinephrine (1:1,000) for a patient refractory to fluid resuscitation?

A

Epinephrine (1:1,000): 2mg mixed in 250ml (8mcg/ml). 2-10mcg/min, titrate at 1mcg/min at 2min intervals

RCEMS Protocols 9/24 (17 decks)

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