Untitled Deck Flashcards
What is the primary medication for managing combative patient?
Ketamine, preferred over older agents like Haldol or Versed due to its unique dissociative properties.
Discuss low-dose ketamine.
Analgesia with minimal effects on perception or emotions (10 mg or 0.1-0.3 mg/kg).
Discuss sub-dissociative ketamine.
30 mg or 0.2-0.5 mg/kg, causing analgesia and possible hallucinations.
Discuss dissociative dose of ketamine.
Complete dissociation (100 mg or >0.7 mg/kg), with patients unaware and lacking memory of this period.
What side effect can occur with a rapid bolus of dissociative-dose IV ketamine?
Transient laryngospasm, often managed with a tight BVM seal and gentle pressure.
Why keep patients dissociated with ketamine in an urgent or emergent situation?
Once dissociated, always dissociated unless used procedurally; consider redosing ketamine to keep patients dissociated and avoid issues with emergence reaction.
Why should small doses of ketamine be avoided in anxious BiPAP patients?
Small doses may cause recreational or partial dissociation, worsening mask discomfort and claustrophobia. Use bronchodilators and anxiolytics instead.
What tool can predict post-intubation hypotension?
The Shock Index (HR/SBP); a value ≥1 suggests risk for hypotension after intubation.
How should you approach managing inspiration loss and positive pressure in intubated hypotensive patients?
Consider awake intubation with ketamine, use FiO₂ instead of high PEEP, and keep respiratory rates slow to minimize inspiratory time.
What are the primary goals when managing induction in shock?
1) Maintain vital signs, 2) Control pain, and 3) Prevent awareness if possible.
What is the primary role of fentanyl in pretreatment for intubation?
To blunt reflex sympathetic response to laryngoscopy, preventing dangerous catecholamine surges.
Why should lidocaine be used cautiously as a pretreatment agent?
Evidence for its benefit is limited, and it can decrease MAP in haemodynamically compromised patients.
Which induction agent requires a significant dose reduction in shock due to its profound hypotensive effects?
Propofol, requiring a 90% dose reduction in shock.
What are the recommended induction doses for shock?
Ketamine: 0.5-0.75 mg/kg, Etomidate: 0.15-0.2 mg/kg, Propofol: 0.1-0.4 mg/kg
Why is it important to use ideal body weight for sedatives and actual body weight for paralytics?
Sedatives target CNS receptors which don’t increase with body mass, while paralytics need to distribute throughout skeletal muscle.
