BOOOOOOOOM

Question 1

What is airway management of a patient who is breathing fairly adequately?

Answer 1

Giving oxygen if needed

Positioning to maximize air exchange

Question 2

What is airway management of a patient who has labored breathing?

Answer 2

Continuous Positive Airway Pressure (CPAP)

Bilevel Positive Airway Pressure (BiPAP)

Question 3

A patient comes in with angioedema: what should be speculated as the causative agent?

Answer 3

ACE inhibitors

Question 4

What is airway protection?

Answer 4

Airway is fine…but there are other factors that might cause the patient to quit breathing (decreased LOC, absence of protective reflexes, apnea)

Question 5

What are three reasons NOT to intubate?

Answer 5

Airway is adequately protected
Oxygenation can be done less invasively
The patient is DNI

Question 6

If possible, what should be done prior to intubation?

Answer 6

Pre-oxygenating

Giving succinylcholine

Question 7

Why is succinylcholine given?

Answer 7

Ultra short-acting muscle relaxant

Paralysis lasts 8-12 minutes

Question 8

What are three back-up plans to intubation?

Answer 8

Combitube
King Airway
Laryngeal Mask Airway (LMA)

Question 9

When should intubation be given up on in favor of a back-up plan?

Answer 9

If intubating failed twice (even after repositioning after the first failure)

Question 10

What is a back-up to the back-up plans?

Answer 10

Cricothyroidotomy–between Adam’s apple and cricoid cartilage

Question 11

What are some side effects of succinylcholine?

Answer 11

Bradycardia (treated with atropine)
Increased pressures (intragastric, intracranial, intraocular)
Increased serum potassium
Increased temperature

Question 12

Who shouldn’t be given succinylcholine?

Answer 12

Burn patients (increases temp)
Renal failure patients (increased K+)

Question 13

How can succinylcholine affect a person’s appearance?

Answer 13

Eyes like a mole, moist as a slug, weak as a kitten

Muscarinic receptors –> salivation, lacrimation, urination, and defecation (SLUD)

Nicotinic effects –> fasciculation and weakness

Question 14

What are examples of non-depolarizing neuromuscular blockers?

Answer 14

Vecuronium

Rocuronium

Question 15

What is the MOA of vecuronium?

Answer 15

Competes at motor endplate for cholinergic receptor –> initiating flaccid paralysis

Question 16

How long after giving vecuronium should the patient be intubated?

Answer 16

2.5-3 minutes

Question 17

Where is vecuronium metabolized?

Answer 17

Liver and kidneys

Question 18

Does renal failure affect recovery time of vecuronium?

Answer 18

No

Question 19

Does liver failure affect recovery time of vecuronium?

Answer 19

Yes…may double recover time

Question 20

Does vecuronium cause hypotension or tachycardia?

Answer 20

No

Question 21

What is the rate of onset of rocuronium?

Answer 21

Close to succinylcholine

Question 22

Barbiturates, rapid acting sedatives, can be used prior to intubation: what is a possible side effect?

Answer 22

Hypotension

Question 23

What rapid-acting anesthetic that induces a disassociative state is used in kids, but is usually avoided in adults d/t a “bad trip”?

Answer 23

Ketamine

Question 24

Besides being anesthetic/disassociating, what are some other benefits of ketamine?

Answer 24

Useful in trauma and hypotensive states

Bronchodilatory

Question 25

Besides "bad trips", what are some other negative side effects of ketamine?

Answer 25

HTN | Increased upper airway secretions (treated with atropine)

Question 26

Benzodiazepines (midazolam) is a short acting CNS depressant that causes adequate sedation in 2-2.5 minutes: what is a possible side effect of this drug?

Answer 26

Slight drop in MAP

Question 27

What are examples of rapid acting sedative hypnotics?

Answer 27

Propofol | Etomidate

Question 28

What is the MOA of propofol?

Answer 28

Inserts into nerve membrane bilayer --> disrupts nerve conduction

Question 29

What are some side effects of propofol?

Answer 29

Apnea | CV depressant --> hypotension

Question 30

What sedative drug is ideal for hypovolemic/hemorrhagic shock patients?

Answer 30

Etomidate

Question 31

What are some possible side effects of etomidate?

Answer 31

Vomiting | Myoclonus

Question 32

What are the steps of intubation?

Answer 32

``` 1- Pre-oxygenate/prepare 2- Pre-treat/prime 3- Paralyze 4- Intubate 5- Confirm tube placement 6- Medicate for long-term management ```

Question 33

What is important to remember during step 2 (pre-treat/prime)?

Answer 33

Give drugs (lidocaine, fentanyl, vecuronium/rocuronium, atropine) enough time to work...2-3 minutes If there is not enough time to wait, skip step

Question 34

What is important to remember during step 6 (medicate for long-term management)?

Answer 34

Match long-acting paralytics to equally long-acting sedatives...make sure patient is not aware AND not in pain