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10 Cards in this Set
- Front
- Back
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What are the indications for tracheal intubation?
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Correction of hypoxemia
Correction of hypercarbia Ensuring maintenance of patent airway Prevention of impending hypoventilation en vue d'une procédure qui demandera une intubation Provision of a route for resus medication administration |
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What is RSI?
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Simultaneous administration of an induction agent + neuromuscular blockage
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7 P intubation
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Préparation
Matériel Personnel Préoxygénation (100% O2 x 3min, non-rebreather mask w 15L/min of O2) Prémédication T - 3 Paralysie et sédation Positionnement (Sniffing : flexion lower neck, extersion of atlanto occipital joint +/- BURP) Placement du tube et preuve Post-intubation |
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What is the proper equipment needed for Airway Management?
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Oxygen source and tubing
Suction catheter Suction source Pulse oximetry CO2 detector Bag-valve mask Orophagyngeal Airways Nasopharyngeal Airways Endotracheal tubes - 8.0-8.5 inner diameter for adult male, 7.5-8.0 mm for adult female Laryngoscope blades and handles - Curved Macintosh blade # 3 most popular, # 4 for large patients; straight miller #2 or #3 for same purposes (more often use in peds) Syringes Magill forceps Stylets Water-soluble lubricant Alternative or rescue devie : LMA, glidescope Surgical rescue equipement ; surgical crico kit Medications to topical airway anesthesia, sedation, or RSI |
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What are the steps to intubation?
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1. Hold laryngoscope in L hand
2. Use R hand to : Insert ETT, operate suction catheter, BURP 3. Insert blade into the R corner of the patient's mouth 4. Visualize arytenoids 5. Lift epiglottis 6. Expose larynx 7. Advance blade incrementally 8. Advance ETT (Correct tube placement : approx 23 cm in men, 21 cm in women) 9. Check ETT placement (bilateral BS, absence epigastric sounds, Capnography, RX) 10. Inflate baloon 11. SEcure ETT |
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Name pretreatments Agents considered in RSI
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Lidocaine 1.5mg/Iv/topically
Indications : Elevated ICP, Bronchospasm, Asthma CI : BAV 2/3e Fentanyl 3mcg/kg IV (210mcg 70kg) Indcations : Elevated ICP, Cardiac ischemia, Aortic dissection Atrope 0.02 mg/kv I Indications : ped < 5a w brady / < 10 a succ w brady (minimal dose 0.1 mg) |
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Name induction agents
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Etomidate 0.3 mg/kg IV (20 mg)
Induction < 1 min Duration 10-20m Benefits ↓ ICP, ↓ Intraocular pressure, Neutral BP Caveats : myoclonic jerking or sz and V, no analgesia, ↓ cortisol Versed 0.2mg/kg ( 15 mg) Ind : 60-90 sec Dur.: 15-30 min Benefits : Status epilepticus Caveats : hypotension, long duration CI: Instabilité HD, grossesse Propofol 1.5 mg/kg Ind: 20-40 sec Duration 8-15min Benefits : antiemetic, anticonvulsant, ↓ICP Caveats: Apnea, ↓ BP, No analgeisa, Trismus, dystonia Ketamine 1.5 mg/kg Ind: 1 min Duration 10-20 min Benefits : bronchodilator, dissociative amnesia, analgesia Cavets: ↑Secretions, ↑BP, Emergence |
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Paralytic agent
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Depolarizing agents : high affinity for cholinergic - R of the motor end plate and are resistant to acetylcholinesterase
Non depolarizing : compte w acetylcholine for the cholinergic - R and usually and be antogonized by anticholinesterase agents Succ 1.5mg/kg (75 mg- 50 kg ; 120 mg - 80 kg) Onset : 45-60 sec Dur. : 5-10 min Roc : 1mg/kg Onset : 1-3 min Dur : 30-45 min |
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C-I to succ use?
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Absolue :
Hyperthermie maligne Risques d'hyperK+ importantes : myopathies Myasthenic Grave Relative : R Risques d'HyperK + : brûlés, crush injury, immobilisation prolongé, troubles génétiques de cholinestérase |
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Acronym for preparation RSI
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SOAPME
Suction — at least one working suction, place it between mattress and bed Oxygen — NRBM and BVM attached to 15 LPM of O2, preferably with nasal prongs for apneic oxygenation Airways — 7.5 ET tube with stylet fits most adults, 7.0 for smaller females, 8.0 for larger males, test balloon by filling with 10 cc of air with a syringe — Stylet – placed inside ET tube for rigidity, bend it 30 degrees starting at proximal end of cuff (i.e. straight to cuff, then 30 degree bend) — Blade – Mac 3 or 4 for adults – curved blade — Miller 3 or 4 for adults – straight blade — Handle – attach blade and make sure light source works — Backups – ALWAYS have a surgical cric kit available! — have video laryngoscope, LMA and bougie at bedside Pre-oxygenate – 15 LPM NRBM Monitoring equipment/Medications — Cardiac monitor, pulse ox, BP cuff opposite arm with IV — Medications drawn up and ready to be given End Tidal CO2 |
