RSI Drugs Flashcards
(15 cards)
Propofol dose/ onset/ duration
Neat- 1000mg/100ml-> 10mg/ml
Induction 1-2mg/kg
Maintenance- 1.5-3mg/kg/hr
Bolus- 10-50 mg or 1-5 ml
Onset IV 40 seconds
Duration- 3-5 mins
Propofol adverse effects
Respiratory depression
Aponeas
Hypotension
Hypertonicity
Myoclonus tics
What is propofol infusion syndrome
Cause by high dose or high cumulative dose
- bradycardia
- RAGMA
- Rhabdomyolysis
- raised LFTs/ fatty liver
- hyperlipidemia
Ketamine - dose/ onset/ duration and bolus
Neat- 200mg/2ml—> dilute 200mg in 20ml saline for 10mg/ml
Induction 1-2mg/ ml (10-20ml)
Adult 100-200mg
Maintence- 50-100mg/hr run at 4mg/ml/min
Bolus 8-20mg (2-5ml)
IV onset 30-60 secs IM 3-8 mins
IV duration 5-15 mins IM 10-30 mins
Fentanyl- induction/ maintenance/Bolus onset and durations
Comes as 100mcg in 2ml or 500mcg in 10ml
Dilute 100mcg in 10ml saline= 10mcg/ml
Dose
Premed- 0.5-1mcg/kg (25-100mcg)
Induction- 2-3mcg/kg (150-300mcg)
Maintenance- 10mcg/ ml at 10-200mcg/hr or 1-20ml per hour
Bolus- 25-50mg
IV onset 1-2 mins
Duration- 30-40 mins
Midazolam dose/ induction/ infusion/ Bolus/ onset and duration
Found at 1mg/ml—> dilute 50mg in 50ml saline so 1mg/ml
Sedation 1-2mg/kg IV
Bolus 2.5-5mg IV (2.5-5ml)
Maintenance- 1-20mg/hr
Onset IV- 2 mins
IM/PR/PO- 15 mins
Dose IV/ IM 0.15mg/kg PR 0.3mg/kg
Remifentanyl drug use and dose
Dose- 0.5 mcg/kg
Rapid offset and onset
Premed 1-3 mcg/kg
Infusion 0.3mcg/kg/min
Onset 1 min
Duration t1/2 4 mins
Can use without muscle relaxants
What is RSI
Rapid sequence induction- airway technique employed in emergency situations in immediate delivery of induction and relaxant agents
Pre O2 pt- may apply cricoid pressure- induction- muscle relaxant
Emergent intubation
Risks- intact gag/ fill stomach
Modified RSI has pre O2 steps or may give NIV first ins more delayed fashion
Checklist for RSI- 9Ps
S- suction x2
O- oxygen
A- airway adjuncts
Pre O2 pharm agents
Monitoring and meds
End title CO2 and IV access x2
9Ps
1-plan
2- prep- drugs/equipment/roles/place
3- protect c spine
4- positioning and pre O2
5- pre txt- I.e IVF/ analgesia/ antiemetics
6- pressure- cricoid
7- paralysis and induction
8- place ETT and proof
9- post intubation mc
RSI in head injury
Pre intubation- c spine precautions?
A- protect airway aim place tube approx 10mins
B- check SaO2 >90 %
C- hypotension
D- GCS posturing and pupils
E- signs BOS # boggy haematoma/ cSF leak battle sign raccoon
RSI- 2X suction prepare for soiled airway.
Induction- aim MAP>80
Ketamine 1-2mg/kg
Roc 1-1.2mg/kg
Rescue metaraminol
Inline c spine immobilisation or BURP
Vent vol- c.SIMV- TV 6/8mg/kg
Aim SaO2 >90%
RR 12-20
peep 5
ie ratio 1:1.5
Pmsx 40
Normocaponea
Normotraemia
Normoglycaemia
Head up 30degrees
mAP>80
RSI obesity
Pre intubation- ramping/ tragus- sternum and variation bed
A- anticipate anatomically difficult- 2 handed BVM/ PEEP >5cm
Sit up till RSI
IVF- 0.9% Nacl 20ml/kg
Map>65 HR<100
RSI- video cmac
Stump or short handle
D blade
Have adjunct ready
Drugs at ideal BW- ketamine 1.5mg/kg and roc 1.2mg/kg
Vent at - low TV and high RR
TV6mg/kg RR18-20 saO2 >90 PEEP>5 I:e ratio- 1:2 pmsx <40
NGT: TEDs baristas bed
Paediatric RSI
Pre intubation- ETt and drugs age and weight adjusted
Position- shoulder padded due to large occipital
A- difficult- large head/ loose teeth/ short upper airway/ floppy glottis
B- pre O2- reduced FRC/ and high BMR = early hypoxia during aponea
C- IV access or IO/ 10-20ml/kg bolus
ETT size= age/4 + 4
Depth ETTX3- to teeth
Straight blade and stylet
Drugs- atropine 20mcg/kg
Ketamine 2-4mg/kg
Roc 1.2mg/kg sux 1.5mg/kg
Vent- RR age adjusted
tv - neonate 4ml/kg
Other 6ml/kg
PEEP=3-5cmH2O
Inotropes- metaraminol 0.01mg/kg
Adrenaline 10mcg/kg
RSI sepsis
Prior to intubation- optimise haemodynamics.
Early IV abx
Pre O2- NIV or BVm
Dose reduce drugs- 1/2 dose induction or just paralysis
Vent- increased RR
Lung protective vent settings
