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13 Cards in this Set
- Front
- Back
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What conditions may cause a difficult intubation?
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* Immobilized trauma pt.
* Children * Short neck. * Limited jaw opening. * Limited cervial mobility. * upper airway conditions (burns, neck injury, epiglottitis) * Facial trauma * Laryngeal trauma |
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Succinylcholine (Anectine):
Class? MOA? Dose? |
* Class: Depolarizing Neuromuscular Blocker
* MOA: Binds to the nicotinic receptor for ACh at the neuromuscular junction and cause depolarization of the muscle fiber. * Dose: Adult: 0.6-1.5 mg/kg IV over 10-30 sec. Max 150mg. Peds: 1-2 mg/kg rapid IV. Onset .5-1 min. IV. Duration 5-10 min. |
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Pancuronium (Pavulon)
Class? MOA? Dose? |
* Class: nondepolarizing neuromuscular blocker
* MOA: binds to the ACh receptor site. As concentration ACh build it displaces the blocker and muscle tone returns. * Dose: Adult: 0.04-0.1 mg/kg slow IV, repeat Q 30-60min. PRN. Peds: 0.04-0.1 mg/kg slow IV Onset in 3-5 min. Duration of 45-60 min. |
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Explain Paralysis.
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* Administer sedative to produce unconsciousness, immediately followed by rapid push of neuromuscular blocker.
* Sellick's maneuver as pt. loses consciousness to prevent regurgitation. * Do not ventilate unless pt.'s SaO2 falls below 90%. * Within 45 sec. of Succinylcholine, pt. will be relaxed enough to intubate. |
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Explain Postintubation Management.
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* Sucure the tube.
* Initiate mechanical ventilations. * Monitor pt. |
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Explain Pretreatment.
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* Done 3 min. before induction.
* Consider lidocaine to help prevent laryngospasm and rise in ICP. * Consider beta blockers or opioids to reduce sympathoadrenal response to intubation. * Consider atropine in peds to prevent bradycardia due to vagal stimulation. |
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How can pt. be sedated before paralysis?
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* Diazepam (Valium) 5-10 mg IV Q 10-15 min. PRN. Max 30mg.
Peds <5yrs 0.2-0.5 mg slow IV Q 2-5 min. Max 5 mg. >5yrs 1 mg Q 2-5 min. Max 10 mg. * midazolam (Versed) 1-2.5 mg slow IV. Max 0.1 mg/kg. Elderly dose 0.5 mg slow IV. Max 1.5 mg in 2 min. period. Peds loading dose 0.05-0.2 mg/kg then infusion 1-2 mcg/kg/min. |
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Explain Placement
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* Perform orotracheal intubation and confirm placement.
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Explain Preoxygenation.
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* Done simultaneously with preparation
* 100% O2 for 5 min. * Consider Pulse oximetry |
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Vecuronium (Norcuron)
Class? MOA? Dose? |
Class:
MOA: Dose: |
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List the Mallampati Signs.
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* Class I: soft palate, uvula, fauces, pillars visible
NO DIFFICULTY * Class II: soft palate, uvula, fauces visible. NO DIFFICULTY * Class III: soft palate, base of uvula visible. MODERATE DIFFICULTY * Class IV: only hard palate visible. SEVERE DIFFICULTY |
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What are the 5 "P's" of RSI
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1) Preparation
2) Preoxygenation 3) Pretreatment 4) Paralysis (with induction) 5) Placement of the tube 6) Postintubation management |
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Explain Preparation.
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* Assess pt. for difficulty of intubation.
* Prepare all drug and equip. * Ensure one or more patent IV lines. * Explain procedure to pt. |
