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13 Cards in this Set

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What conditions may cause a difficult intubation?
* Immobilized trauma pt.
* Children
* Short neck.
* Limited jaw opening.
* Limited cervial mobility.
* upper airway conditions (burns, neck injury, epiglottitis)
* Facial trauma
* Laryngeal trauma
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.
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.
Explain Paralysis.
* 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.
Explain Postintubation Management.
* Sucure the tube.
* Initiate mechanical ventilations.
* Monitor pt.
Explain Pretreatment.
* 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.
How can pt. be sedated before paralysis?
* 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.
Explain Placement
* Perform orotracheal intubation and confirm placement.
Explain Preoxygenation.
* Done simultaneously with preparation
* 100% O2 for 5 min.
* Consider Pulse oximetry
Vecuronium (Norcuron)
Class?
MOA?
Dose?
Class:
MOA:
Dose:
List the Mallampati Signs.
* 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
What are the 5 "P's" of RSI
1) Preparation
2) Preoxygenation
3) Pretreatment
4) Paralysis (with induction)
5) Placement of the tube
6) Postintubation management
Explain Preparation.
* Assess pt. for difficulty of intubation.
* Prepare all drug and equip.
* Ensure one or more patent IV lines.
* Explain procedure to pt.