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18 Cards in this Set
- Front
- Back
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7 Ps of Rapid Sequence Intubation (RSI)
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Preparation,
Pre‐oxygenation, Pretreatment (100% O2 for 3 mins via NRBR Mask) Paralysis and induction, Position, Placement with proof, Postintubation management |
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Any contraindications to RSI?
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All are relative.
Only case would be if paralysis led to a "cant intubate can't ventilate" situation. |
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What are the adverse effects of laryngoscopy in adults and children?
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Adults: relfex sympathetic response = increase of BP + HR. (bad if pt has increase ICP, MI, aortic dissection)
Children: vagal bradycardic response. |
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What are the common pre-treatment agents with their respective doses?
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Fentanyl: 3 mg / kg IV push over 30-60 sec.
Lidocaine: 1.5 mg / kg IV Atropine: 0.02 mg / kg IV (children) 0.01 mg / kg IV (adults) |
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What are the indications and caveats for Lidocaine?
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I: equivocal evidence for raised ICP and bronchospasm/asthma
caveats: NO evidence of improved outcomes |
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What are the indications and caveats for Fentanyl?
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Ind: to blunt sympathetic response of laryngoscopy (where raised HR, BP, ICP would be harmful to the pt.)
Cav: can cause hypotension +/- resp. depression when not given in suggested dose or time frame. |
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What are the indications and caveats for Atropine?
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Ind: children < 5 yo WITH bradycardia
children < 10 yo. receving succ. WITH bradyC adults with bradyC after repeat doses of succs Cav: doesn't consistently prevent bradyC. |
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Three induction agents for RSI?
What are their doses of each? |
Propofol: 0,5-1.5 mg / kg IV. Induction in 30 sec.
(lasts ~10 mins) Ketamine: 1-2 mg / kg IV. induction in 1 min (lasts 10-20 mins) Etomidate: 0.3 mg / kg IV. induction in <1 min. (lasts 10-20 mins) |
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What is a simple way of remembering these doses?
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Think 2's
Prop: 2 mg / kg Ketamine 2 mg / kg Etomidate 0,2 mg / kg |
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When should you use etomidate?
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Ind: hemodynically stable (when ICP and Cardiac stability are needed).
Note: can cause severe myoclonic jerks (give ample benzo or narcotic); not analgesic Caveats: theoretical concerns of cortisol inhibition (esp. septic patients) |
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When is propofol used for induction?
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Ind: "quick on quick off". Use when you want to lower ICP. Has anticonvulsant and antiemetic properties.
Caveats: can cause hypotension, and apnea. NOT analgesic |
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What are indications and caveats for ketamine?
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Ind: Good for the head injured hypotensive patient
PRESERVES respiratory drive. Has antiemetic, amnesic, bronchodilator properties. Caveats: not recommended for the elderly or those with cardiac ischemia (due to refractory tachyC/HTN). |
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Two most common paralytics?
Doses? |
Succinylcholine. 1.5 mg / kg. (onset 45-60 sec).
5-10 min duration. Rocuronium. 1 mg / kg. (1-3 min onset). 30-45 min duration. |
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Why use paralytics in RSI?
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1. assist tracheal intubation
2. aid mechanical ventilation 3. control ICP (avoid intracranial HTN) |
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Why is succinylcholine the preferred agent for RSI?
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quick on quick off (<1 min on, <10 min off)
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What are the relative contraindications to using succinylcholine?
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1. hyperkalemic patients (succ. causes a ~0.5 mEq/L rise in serum K+)
> burns, crush, infections GREATER than 5 days old 2. pseuocholinesterase deficiencies ; myasthenia gravis. 3. cocaine or amphetamine abusers |
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What are the indications and caveats of rocuronium?
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Ind: when a contraindication to succinylcholine is anticipated,
Caveats: longer duration of action (30-45 mins). Can cause tachycardia. Longer onset of action (1-3 mins). |
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What induction agent is preferred for the head-injured patient?
For the major trauma patient? |
Ketamine is thought to be cerebroprotective and optimal for the head injured patient.
Etomidate's hemodynamic stability makes it ideal for major traumas. |
