RSI Flashcards
Describe “trismus.”
Severe contraction of the muscles around the mouth, producing difficulty in intubation.
RSI decreases the risk of aspiration by __________.
paralyzing the musculature of the GI tract
List the 7 reasons RSI may/should be performed.
- Combativeness
- Trismus
- Laryngospasam
- Seizures
- Head Trauma
- Intact gag reflex
- Pediatric upper airway emergencies
List the contraindications for RSI performance.
- Anatomic abnormalities
- Allergies to specific RSI medications
- Airway edema in the face of adequate respirations
- Facial injuries preventing use of bag valve mask
- Tracheal transection
What three pieces of equipment must ALWAYS be present prior to performing RSI?
- BIAD
- BVM
- Suction
Describe the “7 Ps” of RSI
- Preparation
- Pre-oxygenation
- Premedication / Pretreatment
- Paralysis with induction
- Protection / Positioning
- Placement / Proof
- Post-intubation management
Describe the Mallampati scores.
Class 1 = soft palate, uvula, anterior and posterior pillars visible
Class 2 = soft palate, uvula visible
Class 3 = soft palate, base of uvula visible
Class 4 = soft palate not visible
What is the “1 up/1 down” rule of RSI.
Have an ETT one size above and an ETT one size below what you expect to pass.
What is the purpose of pre-oxygenation?
Wash out the 79% of nitrogen that is present in the lungs.
What is the purpose of lidocaine in RSI?
- Blunts the physiologic response of increased ICP in the head injured RSI patient
Contraindications of lidocaine in RSI
Known allergy
High degree heart block
Idioventricular rhythms
Laryngeal stimulation in peds patients may result in bradycardia. This is overcome by ____ admininstration.
atropine
The purpose of the sedative agent in RSI is to ____.
render the patient unaware of the intubation process and spare the psychological trauma and consequent physiologic response.
Common RSI induction agents.
- Midazolam
- Etomidate
- Fentanyl
Less common RSI induction agents.
- Propofol
- Ketamine
- Thiopental
What is a common side effect of Midazolam in RSI?
- Hypotension
Onset of Midazolam in RSI?
60-90 sec
MOA of Etomidate
Sedative-hypnotic that works on the GABA receptors producing anesthesia.
What is a side-effect of Etomidate that may be important in RSI of patients in septic shock?
Reduction of endogenous cortisol, reducing body’s ability to fight sepsis.
What is a common side-effect of Fentanyl in RSI?
cause decreased respiration
For RSI, Propofol may induce unconsciousness in as little as ____.
10-15 seconds
For RSI, Propofol may cause what side effect?
hypotension
Ketamine is an important induction agent in the hypotensive or asthmatic patient for RSI. Why?
Acts to release catecholamines from the adrenal medulla, causing (+) inotropy, chronotropy, dromotropy, and bronchodilation.
What is the “LOAD” mnemonic for RSI?
L - Lidocaine for Suspected Increased ICP
O - Opioids for sedation
A - Atropine for peds
D - Defasciculating dose for Increased ICP, C-Spine Fracture
