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10 Cards in this Set
- Front
- Back
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What are the indications for intubation?
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1. depressed level of consciousness (GCS<8) 2. hypoxemia 3. airway obstruction |
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List down the equipments needed for intubation
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1. Laryngoscope Mac 3/4, or Miller blade for children and obese 2. ETT tube (uncuffed for children) 3. Stylet for ETT 4. 10 mL syringe for ETT balloon 5. Lubricant 6. Bag valve mask assembled 7. Suction by the bed 8. Donut |
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Pre-flight checklist for RSI
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- pre-oxygenation with NRM at 100% O2 for 3-5 mins or 4 vital capacity breaths - assess if LEMON for difficult airway - Check equipments (ETT correct size, laryngoscope lights checked, suction prepared, donut under neck) - Check that all monitors are on. - Ensure that blood pressure is adequate, give vasopressors if needed - check ventilator, O2 connected - appropriate drugs drawn up |
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During the take-off for RSI
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- vital signs on 2 min cycle - pretreatment given (lignocaine/fentanyl) - give sedative - give paralytic - remove dentures - patient is in morning sniffing position/ head tilt chin lift - take note of comark lehane grade, and use external laryngeal manipulation if needed - Using the laryngoscope, visualize the vocal cords and insert ETT to be at midpoint of trachea 2cm above carina (i.e. 2cm below vocal cords) à 20-23cm mark (M) or 19-21cm (F) - clinical confirmation of ETT - string tie ETT at lip area - set ventilator |
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How do we clinically and non-clinically confirm the position of the ETT?
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clinically: - check chest rise - ascultate 5 points - check end-tidal CO2, and its waveform - pressure cuff non-clinically: - ABG - CXR |
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Post-take off for RSI
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- top up analgesia and sedation infusion if needed (fentanyl, propofol etc) - insert NG tube - put patient at 30 degree head up - one on one nursing - DVT prophylaxis - stress ulcer treatment if needed |
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what are the common induction agents for RSI?
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1. midazolam (0.2-0.3mg/kg) 2. etomidate (0.3mg/kg) 3. propofol 4. ketamine (2mg/kg) |
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what is usually used for paralysis in RSI?
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succinylcholine |
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what are the pretreatment drugs for RSI ? what are the indications?
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Fentanyl (2 ug/kg over 1 min) ABC Asthma = give lignocaine Brain(raised ICP) = give fentanyl +lignocaine CVS = give fentanyl |
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list the rough timeline for a RSI
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- 5 mins = preparation, preoxygenation - 3 mins = pretreatment 0 mins = paralysis with induction + 30 s = protection (sellick's maneurvre) + 45 s = placement and proof + 1 min = post intubation management (secure ETT, mechanical ventilation, give analgesia/sedation) + 10 mins = CXR to check ETT depth |
