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What are the 7 P’s of intubation?
- Paralysis with induction
- Post-intubation management
What is included in the Preparation phase of RSI?
- Monitor pulse ox, BP, cardiac rhythm
- BVM, Yankauer suction, CO2, Blade
- RSI medications
What is included in the Preoxygenation phase of RSI?
3 minutes of normal tidal volume breathing with 100% oxygen.
What is included in Pretreatment?
- Lidocaine 1.5mg/kg IV
- Fentanyl 3mcg/kg IV over 1 minute
- Vecuronium bromide 0.01mg/kg
- Atropine (in children under the age of 1)
What is included in Paralysis with induction?
- Use one of the following induction agents given rapid IV push prior to paralysis
- (Etomidate 0.3mg/kg IV, Midazolam 0.3 mg/kg IV, Ketamine hydrochloride 1.5 mg/kg IV, Propofol 1-2 mg/kg IV)
- And choose a paralytic of the following.
- Succinylcholine 1.5 mg/kg IV, Rocuronium 1mg/kg IV
What is included in the protection phase of RSI?
What is included in the Placement phase of RSI?
Intubate, inflate, capnography, ascultate, secure and release sellick maneuver
What is included in the Post-Intubation management of RSI?
- Chest X-ray to assess placement of endotracheal tube
- Long acting sedatives and possibly paralytics, (Lorazepam 0.05 mg/kg IV for sedation, or Vecuronium 0.1 mg/kg IV for paralysis)
- Mechanical ventilation
- Sedative: Propofol bolus/drip
What is the dose of Lidocaine in RSI?
What is the dose of fentanyl in RSI?
What is the dose of Vecuronium bromise for RSI?
What is the dose for Etomidate?
0.3 mg/kg IV
What is the dose for Midazolam?
0.3 mg/kg IV
What is the dose for Ketamine Hydrochloride?
1.5 mg/kg IV
What is the dose Propofol 1-2 mg/kg IV
What is the dose of Succinylcholine?
1.5 mg/kg IV
What is the dose of Rocuronium?
What is the pharmodynamics of Ketamine?
Ketamine is a rapid-acting general anesthetic producing an anesthetic state characterized by profound analgesia, normal pharyngeal-laryngeal reflexes, normal or slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and occasionally a transient and minimal respiratory depression. Ketamine is indicated as the sole anesthetic agent for diagnostic and surgical procedures that do not require skeletal muscle relaxation. The anesthetic state produced by Ketamine has been termed “dissociative anesthesia” in that it appears to selectively interrupt association pathways of the brain before producing somesthetic sensory blockade. It may selectively depress the thalamoneocortical system before significantly obtunding the more ancient cerebral centers and pathways (reticularactivating and limbic systems).
What are the adverse effects of Ketamine?
HTN, Tachycardia, Hallucinations, Bradycardia, diplopia, anaphylaxis, cardiac arrhythmia, death,
What is the pharmodynamics of Etomidate?
Etomidate is a non-barbiturate hypnotic that acts at the level of the reticular-activating system to produce anesthesia. Etomidate is an imidazole compound that appears to depress CNS function via GABA. Duration of action is intermediate between thiopental and methohexital, and recovery from a single dose is rapid with little residual depression. Like the barbiturates and propofol, etomidate is does not induce analgesia. Etomidate induces unconsciousness within one circulation time. Recovery is rapid as a result of extensive redistribution and rapid metabolism.
What are the adverse reactions of Etomidate?
Hiccups, Adrenal suppression, HTN, Arrhythmias, Laryngospasm, nausea/vomiting.