CCT RSI

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Author:
wdzracer
ID:
8439
Filename:
CCT RSI
Updated:
2010-02-28 15:45:54
Tags:
RSI Drugs
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Description:
RSI Drugs
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  1. 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
  2. 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
  3. RSI dosage for Atropine
    • – Dosage for pediatric patients
    • • 0.02 mg/kg or .2 ml/kg IV
    • – Minimum dose is 0.1 mg
  4. Contraindications for Versed in RSI
    • • Shock
    • • Coma
    • • Depressed vital signs
  5. Side effects of Versed in RSI
    • • Drowsiness-GREAT!!!!
    • • Amnesia-FABULOUS!!!!
    • • Respiratory depression and apnea-OK (We’ll fix)
    • • Hypotension-BAD!!!!
  6. 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
  7. 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
  8. 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
  9. 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
  10. Onset and duration of Succinylcholine (Anectine)
    • • Rapid onset of action (within 45 seconds)
    • • Short duration (4-5 minutes)
  11. 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
  12. Dosage for Succinylcholine (Anectine)
    • • Dosage
    • – Adult and pediatric
    • • 1 to 1.5 mg/kg over 10-30 seconds IV
  13. 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

  14. Dosage for Norcuron (Vecuronium)
    • – Adult and pediatric:
    • – .01 mg/kg for defasciculating dose
    • • 0.1 mg/kg IVP for paralytic dose
  15. Considerations for Norcuron (Vecuronium)
    • – Paralysis occurs within 1 minute and last for approximately 30-45minutes
    • – Consider a Norcuron drip for transport
  16. Dosage of Fentanyl for RSI
    1-2 micrograms/kg, given 1-3 minutes prior to intubation

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