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What are 3 situations that would exclude RSI for a patient?
- • Inability to ventilate
- – Large amount of facial hair
- – Shape of face
- – Deformities
- • Known hyperkalemia
- • History of malignant hyperthermia
What is Atropine used for in RSI?
- – Pediatric Patients
- • These patients tend to vagal
- – With introduction of laryngoscope
- – Hypoxia
- – Succinylcholine administration
- • Also used to decrease oral secretions for better visualization
- – If the patient is 1 year of age or less always premedicate!!
- – If the child is 1-8 years of age draw up the medication and have it readily accessible.
- – Attempt the intubation and if the patient develops bradycardia administer the drug.
- • Remember, increasing the heart rate increases oxygen demand
RSI dosage for Atropine
- – Dosage for pediatric patients
- • 0.02 mg/kg or .2 ml/kg IV
- – Minimum dose is 0.1 mg
Contraindications for Versed in RSI
- • Shock
- • Coma
- • Depressed vital signs
Side effects of Versed in RSI
- • Drowsiness-GREAT!!!!
- • Amnesia-FABULOUS!!!!
- • Respiratory depression and apnea-OK (We’ll fix)
- • Hypotension-BAD!!!!
Dosage of Versed in RSI
- • Adult:
- – 1 to 5 mg slow IV (.05 to .1 mg/kg)
- – May be repeated if necessary in small increments
- (total max dose not to exceed 0.1 mg/kg)
- • Elderly
- – Consider cutting dose in half
- • Pediatric:
- – Loading dose 0.05 to 0.2 mg/kg
- • Consider continuous infusion at 1-2 mcg/kg/min after the patient is intubated
Positive actions of Etomidate
- •Drug of choice for the unstable patient with or without head trauma
- • Etomidate has minimal hemodynamic effects
- • It causes less cardiovascular depression
- • Etomidate has been shown to decrease
- – Intracranial pressure
- – Cerebral blood flow
- – Cerebral oxygen metabolism
- • The person appears conscious but will not recall anything
- • Short acting
- – Will generally awaken in 5-10 minutes
Contraindications and side effects of Etomidate
- • Contraindication – Known sensitivity to the agent
- • Side effects
- – Nausea and Vomiting
- – Dysrhythmias
- – Breathing difficulties
- – Involuntary muscle movement » This is not seizure activity
Dosage of Etomodate
- • Adult and Pediatric
- – Standard dose for both
- is 0.3 mg/kg
- • Range can be 0.2 to 0.6 mg/kg
Onset and duration of Succinylcholine (Anectine)
- • Rapid onset of action (within 45 seconds)
- • Short duration (4-5 minutes)
Contraindications for Succinylcholine
- – Hyperkalemia (What is the normal range for K+)?
- • Renal disease, impairment
- • Crush injuries
- • Massive blood transfusions
- • Burn patients > 24 hours post injury
- – Family history of malignant hyperthermia
- •Patients with Myasthenia Gravis
- –The relative lack of ACh receptors makes these patients relatively resistant to Succinylcholine
- – Therefore, higher doses must be used to induce paralysis
- – Once paralysis is achieved, it may be prolonged
Dosage for Succinylcholine (Anectine)
- • Dosage
- – Adult and pediatric
- • 1 to 1.5 mg/kg over 10-30 seconds IV
Considerations of Succinylcholine (Anectine)
- – Do not use for maintenance of paralysis!!!
- – Patients must be adequately sedated during paralysis
- • Succinylcholine has NO effect on consciousness or pain!!
- – Will not stop neuronal seizure activity
- • Initial muscle fasciculation’s
Dosage for Norcuron (Vecuronium)
- – Adult and pediatric:
- – .01 mg/kg for defasciculating dose
- • 0.1 mg/kg IVP for paralytic dose
Considerations for Norcuron (Vecuronium)
- – Paralysis occurs within 1 minute and last for approximately 30-45minutes
- – Consider a Norcuron drip for transport
Dosage of Fentanyl for RSI
1-2 micrograms/kg, given 1-3 minutes prior to intubation
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