Airway & Intubation Flashcards
(30 cards)
9Ps of RSI
1.Plan
2. Preparation - drugs & equipment (STOP IC BARS)
3. Protect C spine
4. Preoxygenated
5. Pretreatment - resuscitation & blunt intubation response
6. Paralysis
7. Position
8. Placement & confirmation of placement - ETCO2/Steth/CXR
9. Post intubation management
Difficult airway Ax
LEMON and 4Ds
LEMON
L - Look / 4D’s
E - Evaluate 332 rule
M - Mallampati
O - Obstruction
N - Neck mobility
4D’s
Distortion
Dentition
Disproportion
Dysmobility
ET size?
Adult
Child
Male 7.5-8.5
Female 7-8
Cuffed ET = (age/4)+ 3.5
Induction agent dosages
Etomidate 0.2-0.3 mg/kg
Midazolam 0.2-0.4 mg/kg
Propofol 1-2.5 mg/kg
Ketamine 1-2 mg/kg
Septic shock patient
Half dose of ketamine 0.25-0.5mg/kg (actually analgesia or sedation dosages)
Muscle relaxant in higher dose due to low flow state sux 2mg/kg or ROC 1.6mg/kg
Pros and cons
Etomidate
👍🏼Cardiovascular stable
👎🏼Myoclonus therefore not epilepsy
👎🏼Adrenal suppression therefore not great in septic shock
Pros and cons
Propofol
👍🏼 30 seconds
👍🏼 good anticonvulsant effects - status epilepticus
👎🏼 decrease BP
👎🏼pain on injection
👎🏼 egg or soybean allergy
Pros and cons
Ketamine
👍🏼Increase BP and HR
👍🏼Bronchodilator effects
👎🏼Increase IOP
👎🏼Increase ICP
👎🏼Hallucinogenic
Paralytic agent dosages
Sux 1-2mg
- onset 30 sec - 1min
- duration 10 mins
- NB S/E bradycardia & hypotension/ hyperkalaemia increase by 0.5/ malignant hyperthermia/ Scoline Apnoea
Roc 0.6-1.12mg (1.6mg in shocked or unstable)
- onset 1-2mins
- duration 30-90mins
Antidote for Rocuronium or vecuronium?
Sugammadex
NB effects of suxamethonium
- Hyperkalaemia by 0.5mmol/L
- burns >72hrs
- crush
- denervation neuromuscular disorders >72hrs - Malignant hyperthermia
- dantrolene Rx - Scoline apnoea
ETCo2 graphs
Extubation criteria
Indication for intubation resolved
Peep <6
Fi02 < 40%
Sats >92 %
GCS- Lift head off bed and follow commands
RSBI - <105
Then Spontaneous breathing trial 30-90mins
-RR <30
-TV >325
If no distress then extubate
Complications of extubation?
Stridor
Laryngospasm
Awake intubation?
- Head up
- Atropine/glycopyrulate - antisialogue
- Antiemetic
- Lignocaine gel & spray
- Ketamine
- Laryngoscope and bougie
- Then only fully sedate and paralyze
Lignocaine toxicity
With epi 7mg/kg
Without epi 5mg/kg
Sx: perioral numbness , neuro, cardio
Mx: intralipid 20%
Cormack-Lehane classification
Grade 1
Grade 2 - arytenoids
Grade 3 - tip of epiglottis
Grade 4 - soft palate
Indications for RSI
“ABCDE”
Airway issue - low tone / trauma/ swelling/ secretions
Breathing issue - respiratory failure
Circulatory issue - shock
Disability issue - low GCS/ SCI or Neuro disease with respiratory failure
Expectant issue - inhalational burns
Who is at risk for rapid desaturation?
- Children
- Pregnant
- Obese
- Chest injuries or lung diseases e.g. pneumonia
- High fever or hyper dynamic circulation
Post Intubation sedation?
Morphine & Midazolam 45/45mg
Push dose epinephrine?
1mg (1000mcg)/ml vial with 9mls of NaCL= 100mcg/ml
Then take 1ml of that and add an additional 9mls of NaCl = 10mcg/ml
Push dose = 0.5-2ml of this as needed
Atropine dose as pretreatment?
E.g. bradycardia in Paediatrics
0.02mg/kg
Delayed Sequence Intubation vs rapid Sequence Intubation vs Awake intubation
Bougie in what ET size?
Size 6 and upwards
How to hold a bougie ?
