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RCEMS Protocols 9/24 > RSI - Adult > Flashcards

RSI - Adult Flashcards

(52 cards)

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1
Q

How should the head be elevated before RSI?

A

20-40 degrees if able - ear to sternal notch

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2
Q

When is RSI indicated?

A

Failure to maintain airway
Failure to oxygenate
Failure to ventilate
Anticipated negative clinical course
Safety - for patient or crew

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3
Q

What piece of equipment should NOT be used to pre-oxygenate a patient prior to RSI?

A

ETCO2 NC

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4
Q

How long should a patient be pre-oxygenated before intubation attempt in RSI?

A

3 mins

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5
Q

How should a patient be pre-oxygenated prior to RSI?

A

O2 via NRB at or above 25lpm
or
PPV at 100% O2
or
O2 apneic oxygenation with NC

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6
Q

What acronym is used for RSI assessment?

A

HEAVEN

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7
Q

What does HEAVEN stand for?

A

Hypoxemia
Extremes of sizes
Anatomic abnormalities
Vomit/Blood/Fluids
Exsanguination
Neck mobility

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8
Q

What technique can be utilized for the presence of secretions in the airway?

A

SALAD technique

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9
Q

What does SALAD stand for?

A

Suction-Assisted Laryngoscopy Airway Decontamination

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10
Q

What medication can a critical care medic administer pre-RSI for hypotension?

A

Epinephrine 2-10mcg

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11
Q

What should be done with a c-collar prior to RSI?

A

It should be removed.

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12
Q

When should a patient be RSI’d?

A

If they are hemodynamically stable and cannot control or maintain their own airway secondary to ventilation and oxygenation issues.

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13
Q

When should a patient NOT be RSI’d?

A

Apnea, respiratory arrest, loss of landmarks, FBAO, uncorrected hypoxia, inability to ventilate with BVM, secretions in airway, MAP < 65 without resuscitation

CAUTION in significant facial or airway trauma, consider cricothyrotomy

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14
Q

What are the three components of hemodynamic stability?

A

MAP > 65
Adequate tissue perfusion
Absence of hypoxia

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15
Q

What are the three components of hemodynamic instability?

A

Map < 65
Inadequate tissue perfusion
Presence of hypoxia despite intervention

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16
Q

What should be considered for a hemodynamically unstable patient prior to RSI?

A

Fluid resuscitation

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17
Q

What is the dose for fluid resuscitation prior to RSI?

A

20ml/kg NS or Normo-sol IV bolus

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18
Q

If a patient presents as hemodynamically unstable, should they immediately be RSI’d?

A

No - fluid resuscitation should be performed first.

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19
Q

If MAP > 65, what sedatives can be used for RSI?

A

Ketamine: 1-2mg/kg rapid IVP
or
Versed: 5-10mg rapid IVP

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20
Q

What is another name for Versed?

A

Midazolam

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21
Q

What is the RSI dose of Ketamine?

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A

1-2mg/kg rapid IVP

22
Q

What is the RSI dose for Versed?

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A

5-10mg rapid IVP

23
Q

If MAP > 65, what paralytics can be used for RSI?

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A

Rocuronium: 1mg/kg IVP
or
Etomidate: 20mg IVP (repeat ONLY once)

24
Q

What is the RSI dose of Rocuronium?

25
What is the RSI dose of Etomidate?
20mg IVP (repeat ONLY once)
26
What is another name for etomidate?
Amidate
27
How many times may etomidate be repeat dosed?
Repeat ONLY once
28
What are some methods to confirm successful airway capture?
Continuous waveform capnography, bilateral chest rise and fall, color improvement, bilateral breath sounds upon auscultation, condensation in tube
29
In what order should RSI meds be given?
Sedation first, paralytic second
30
If able, what should be done after successful intubation?
Insertion of NGT/OGT
31
What type of medication should be routinely administered post-successful RSI?
Pain medication / analgesic
32
What are the medications used for post-intubation pain management?
Fentanyl: 0.5-1mcg/kg IV, max dose of 100mcg. May repeat every 5min or Dilaudid: 0.5-1mg, max single dose 1mg. Max TOTAL dose 3mg or Ketamine: 0.5-1mg/kg IV, may repeat every 10min PRN or Versed: 2.5-5mg IV, may repeat in 3-5 min. Consider lower dose in age > 65yrs or chronically ill. Max TOTAL dose 20mg
33
What is the post-intubation pain medication dose for Fentanyl?
0.5-1mcg/kg IV, max dose of 100mcg single dose. May repeat every 5min
34
What is the post-intubation pain medication dose for Dilaudid?
0.5-1mg, max single dose 1mg. Max TOTAL dose 3mg
35
What is the post-intubation pain medication dose for Ketamine?
0.5-1mg/kg IV, may repeat every 10min PRN
36
What is the post-intubation pain medication dose for Versed?
2.5-5mg IV, may repeat in 3-5 min. Consider lower dose in age > 65yrs or chronically ill. Max TOTAL dose 20mg
37
How often can the post-intubation pain management dose of Fentanyl be administered?
Every 5mins
38
What is the max single dose of post-intubation pain management Fentanyl?
100mcg
39
What is the max single dose of post-intubation pain management Dilaudid?
1mg
40
What is the max TOTAL dose of post-intubation pain management Dilaudid?
3mg
41
How often can the post-intubation pain management dose of Ketamine be administered?
May repeat every 10min PRN
42
When can the post-intubation pain management dose of Versed be repeated?
May repeat in 3-5 min
43
What should be considered when administering the post-intubation pain management dose of Versed be repeated?
Consider lower dose in age > 65yrs or chronically ill
44
What is the total max dose of the post-intubation pain management dose of Versed?
Max TOTAL dose of 20mg
45
If patient is refractory to fluid resuscitation, what should be considered?
IV push dose pressors and/or vasopressin infusion: Phenylephrine or epinephrine
46
What medications can a critical care medic administer if a patient is refractory to fluid resuscitation?
///CRITICAL CARE ONLY/// Phenylephrine: 10mg mixed in 100ml (100cg/ml) 50-200mcg every 2-5min IVP or Epinephrine (1:1,000): 2mg mixed in 250ml. 5-10mcg every 2-5min IVP or Epinephrine (1:10,000 - CARDIAC EPI): 1mg into 9mL NS flush (10mcg/ml). 5-10mcg every 2-5 min IVP
47
What can a non-critical care medic administer if a patient is refractory to fluid resuscitation?
Phenylephrine: 10mg mixed in 100ml NS (100mcg/ml). 50-200mcg/min or Epinephrine (1:1,000): 2mg mixed in 250ml (8mcg/ml). 2-10mcg/min, titrate at 1mcg/min at 2min intervals
48
What is the critical care medic dosage of Phenylephrine for a patient refractory to fluid resuscitation?
///CRITICAL CARE ONLY/// Phenylephrine: 10mg mixed in 100ml (100cg/ml) 50-200mcg every 2-5min IVP
49
What is the critical care medic dosage of Epinephrine 1:1,000 for a patient refractory to fluid resuscitation?
///CRITICAL CARE ONLY/// Epinephrine (1:1,000): 2mg mixed in 250ml. 5-10mcg every 2-5min IVP
50
What is the critical care medic dosage of Epinephrine 1:10,000 (CARDIAC EPI) for a patient refractory to fluid resuscitation?
///CRITICAL CARE ONLY/// Epinephrine (1:10,000 - CARDIAC EPI): 1mg into 9mL NS flush (10mcg/ml). 5-10mcg every 2-5 min IVP
51
What is the non-critical care medic dosage of Phenylephrine for a patient refractory to fluid resuscitation?
Phenylephrine: 10mg mixed in 100ml NS (100mcg/ml). 50-200mcg/min
52
What is the non-critical care medic dosage of Epinephrine (1:1,000) for a patient refractory to fluid resuscitation?
Epinephrine (1:1,000): 2mg mixed in 250ml (8mcg/ml). 2-10mcg/min, titrate at 1mcg/min at 2min intervals

RCEMS Protocols 9/24 (17 decks)

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