RSI

Question 1

What are 3 induction drugs

Answer 1

Etomidate
Ketamine
Propofol

Question 2

Which induction drug causes myoclonic jerking

Answer 2

Etomidate

Question 3

Which induction drug stimulates catecholamine release and why is it good?

Answer 3

Ketamine it’s good in sepsis because the catecholamines can actually raise blood pressure

Question 4

What is the dose for Etomidate

Answer 4

0.3 mg/kg

Question 5

What is the dose for ketamine

Answer 5

1.5mg/kg

Question 6

What is the dose for propofol induction?

Answer 6

1.5mg/kg

Question 7

What are three paralytics

Answer 7

Sucks
rocks
vecuronium

Question 8

What are the 3 pretreatment drugs?

Answer 8

Lidocaine
Fentanyl
Rocuronium

Question 9

which pretreatment drug reduces the likelihood of bronchospasm

Answer 9

lidocaine

Question 10

Which short-acting opioid is used to decrease the cardiovascular effects of sympathetic nervous system stimulation in patients for whom a rapid rise in blood pressure is undesirable (eg, patients with elevated intracranial pressure or significant cardiovascular disease).

Answer 10

fentanyl

Question 11

what is defasciculation

Answer 11

The prevention of muscular twitches.

Question 12

What is the onset time for lidocaine

Answer 12

<2 min

Question 13

What is the onset time for fentanyl

Answer 13

immediate

Question 14

What is the onset time for rocuronium

Answer 14

60 seconds

Question 15

What is the commercial name for etomidate

Answer 15

amidate

Question 16

what is the other name for propofol

Answer 16

diprivan

Question 17

what is the other name for versed

Answer 17

midazolam

Question 18

delete

Answer 18

cisastracurium

Question 19

what is the other name for succinylcholine

Answer 19

suxmethonium

Question 20

Why use fentanyl for sedation?

Answer 20

Fentanyl provides systemic analgesia and enhances the sedative effect of benzodiazepines. When midazolam-only sedation is ineffective, fentanyl can be considered as an adjunct

Question 21

when is fentanyl used

Answer 21

Clinically, its most frequent use is as a sedative in intubated patients and in severe cases of pain in patients with renal failure due to its primarily hepatic elimination

Question 22

what does RSI entail

Answer 22

Rapid sequence intubation (RSI) is an airway management technique that produces inducing immediate unresponsiveness (induction agent) and muscular relaxation (neuromuscular blocking agent) and is the fastest and most effective means of controlling the emergency airway

Question 23

what are the 9 Ps of RSI

Answer 23

PROCESS OF RSI

Remembered as the 9Ps:

Plan
Preparation (drugs, equipment, people, place)
Protect the cervical spine
Positioning (some do this after paralysis and induction)
Preoxygenation
Pretreatment (optional; e.g. atropine, fentanyl and lignocaine)
Paralysis and Induction
Placement with proof
Postintubation management

Question 24

what is SOAPME

Answer 24

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
O2 MARBLES is an altern

Question 25

drawbacks of propofol

Answer 25

Drawbacks: hypotension, myocardial depression, reduced cerebral perfusion, pain on injection, variable response, very short acting

Question 26

What is the RSI combos that Dr. Oucha likes ?

Answer 26

Rox and Propofol or Sux and Etomodate

Question 27

tell me about Versed

Answer 27

****Midazolam. Benzodiazepine Popular Agent For RSI Long Acting (2-4) Times More Potent Than Diazepam Potent Amnestic Effects Onset Of Action Is 1-2 Min Duration Of Effect Is 30-60 Min Typical Dose 0.1-0.3 Mg/Kg Iv. Can Be Given IM When Immediate Administration Is Needed Without IV Access.

Question 28

tell me about propofol

Answer 28

Diprivan. EXTREMELY SHORT ACTING INDUCTION SEDATIVE HIGHLY LIPID SOLUBLE AND RAPIDLY PENETRATES THE BLOOD-BRAIN BARRIER. CAUSES APNEA RAPIDLY, UNSUTABLE FOR RSI, INICATED FOR POST INTUBATION SEDATION. ONSET OF ACTION 10-20 SEC DURATION OF EFFECT 10-15 MIN DOSE. 1-3 MG/KG IV DISADVANTAGE: HYPOTENSION, APNEA

Question 29

Tell me about Etomidate.

Answer 29

Amidate. NON BARBITUATE HYPNOTIC AGENT EXCELLENT SAFETY PROFILE (PREHOSPITAL AND HOSPITAL) ONSET OF ACTION IS 10-20 SEC: DURATION OF EFFECT 3-5 MIN DOSE: 0.2-0.3 MG/KG IV OVER 15-30 DISADVANTAGE: CORTISAL SUPPRESION

Question 30

why do we use neuromuscular blocking agents

Answer 30

TO INDUCE MUSCLE RELAXATION, THUS FACILITATING ENDOTRACHEAL INTUBATION.

Question 31

why do we use induction agents

Answer 31

FOR SEDATION ,PRIOR TO PARALYSIS, DURING RSI.

Question 32

tell me about lidocaine

Answer 32

Antidysrhythmic, Cardiovascular Agent Class 1b (Rapid Sodium Channel Blocker, Shortens Repolarization) CNS Agent Local Anesthetic Action: Suppresses Automaticity of Ischemic Ectopic Foci Without Affecting Conduction. Thought To Raise the Ventricular Fibrillation Threshold. Used In RSI As an Induction Agent to Blunt ICP. Contraindications: Known Hypersensitivity, Ventricular Ectopy in Presence of Bradycardia. And Severe Conduction Abnormalities Without Pacemaker Availability. Dose 1.0-1.5 Mg/Kg IVP 2-3 Min Prior To Rsi Dose: Iv Bolus 1.0-1.5 Mg/Kg Over 3 Min, Repeat Dose Is Given In 5-15 Later at Half the Initial Dose. Max 3mg/Kg Pediatric Dose: 0.5-1.0 Mg/Kg Per Bolus with maint Infusion Of 20-50 Mcg/Kg/Min Titrated To Effect.

Question 33

tell me about atropine

Answer 33

AUTONOMIC cns AGENT, ANTICHOLINERGIC (PARASYMPATHOLYTIC) ANTIMUSCARINIC AGENT. INHIBITS VAGAL TONE PRIMARILY USED TO REMOVE EXCESS PARASYMPATHETIC TONE, AND TO BLUNT VAGAL TONE IN RSI. USED IN HOSPICE TO DRY ORAL SECRETIONS *** SIDE EFFECTS: PALPATATIONS, TACHYCARDIA, DRY MOUTH, DILATED PUPIS AND POSSIBLE ANXIETY. DOSAGE: FOR SIGNIFICANT CARDOVASCULAR INSTABILITY 0.5-1.0 MG IVP q3-5 MIN (MAX DOSE 3 MG) IF GIVEN ToO SLOW OR Too SMALL OF a DOSE CAN CAUSE PARADOXICAL SLOWING OF HEART RATE.****

Question 34

Tell me about vecuronium

Answer 34

Autonomic nervous system agent, skeletal muscle relaxant- blocks acetylcholine, nondepolarizing Neuromuscular blocking agent. Lasts 30 minutes Reversed with sugammadex or neostigmine minimizes fasciculations Dosages 0.01 mg/kg (defasciculating dose), 0.08-0.10 mg/Kg IVP q 1-2 hours (paralyzing dose), 0.1 mg/kg IVP , can repeat q 1-2 hours (peds)