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20 Cards in this Set
- Front
- Back
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Etomidate |
Sedative 0.3 mg/kg 15-45 second onset, 3-12 min duration Use with caution in hypotension pts CI: pts with adrenal suppression, avoid in shock pts or Addison disease, avoid in COPD or asthmatic pts or sepsis Will decrease adrenal response within 20 minutes of administration |
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Ketamine |
Sedative 2mg/kg push too fast may result in apnea 0.1-0.2mg/kg for pain 4mg/kg-5 IM for combative
40-60 second onset, 10-20 minute duration 4-6 min onset IM
Stops pain impulses Potent bronchodilator Potential for increased secretions May cause laryngospasm Suction and if unresolved 0.01mg/kg 0.4mg IV scopolamine (slowly)
May hallucinate upon awakening
Maintenance 0.5-1mg/kg IV q15min Post intubation infusion 1-2mg/kg/hr 500mg/250mL 2mg/mL |
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Rocuronium |
Non depolarizing neuromuscular blocker 1mg/kg >2min onset (4-6 min) duration of action (30-60 minutes) 0.6-1.2mg/kg Maintenance 0.1-0.2 mg/kg IV q20-30 minutes Sugammadex (bridion) 16mg/kg used for reversal of roc |
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Midazolam |
On going sedation 0.05-0.1mg/kg/hr
Anterograde amnesia Helps you forget event ever happened 2.5 to 5mg IV dependent on use Use lowest dose possible Do not combine with other benzodiazepine meds Flumazenil (romazicon) 0.2mg is reversal agent Flumazenil will effect blood pressure |
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Fentanyl |
Analgesia and sedation 1mcg/kg q 20 minutes
Onset within 3-5 minutes, 30-60 minutes duration
Often requires anti emetic 4mg Zofran or 25mg promethazine(Phenergan)
Maintenance 0.5-1.5mcg/kg may repeat q 5 min
Post intubation infusion Fentanyl 1-3 mcg/kg/min 500mcgin100ml 5mcg a mL 25-75mcg an hour |
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Vecuronium |
Non depolarizing paralytic 0.1mg/kg or 0.15mg/kg which ever protocol calls for Maintenance 0.01m-0.1mg/kg Duration of action (60-75 min) May be supplied as powder that needs reconstituted |
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LOAD |
Lidocaine-blunts cough reflex preventing ICP increase Opiates-blunts pain response Atropine for infants-prevents reflexive bradycardia in infants <1y/o Defasiculating dose- 1/10 dose of Rocuronium or Vecuronium prior to Succinylcholine admin |
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Propofol (diprivan) |
Milk of amnesia
1-2 mg/kg IV 5-50 mcg/kg/min (maintenance) 15-45 second onset, 5-10 minute duration Bolus dose usually 10 or 20mg Decreases CPP and MAP not a good choice for shock pts Lipid soluble |
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Succinylcholine (Anectine) |
Depolarizing NBA Causes fasciculations 1-2mg/kg Less than a minute onset 4-6 min duration Can cause hyperkalemia CI: crush injuries, eye injuries, narrow angle glaucoma, history of malignant hyperthermia, burns >24hrs old, hyperkalemia, or any nervous system disorder(guillain-barre, myasthenia Gravis, I guess seizures?) |
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Dantrolene sodium( dantrium) |
Treatment of malignant hyperthermia Can be seen after succs admin and gas anesthesia Cause by defect in skeletal muscle sarcoplasmic reticulum MH is due to a problem with Ca+ removal from cell. Dose 2.5mg/kg rapid IV bolus DO NOT GiVE Calcium channel blockers( verapamil, diltiazem,amlodipine,etc |
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Hemodynamically unstable pts |
Likely catecholamine depleted and have lower cardiac output May need to use 1/2 the induction dose due to depleted catecholamine stores And double paralytic dose Low cardiac output slows the onset of action |
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Et tube size for peds pt |
Age in years+16/4 for uncuffed tube Age in years+16/3.5 for cuffed et tube |
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Lemon |
Look externally Evaluate 3-3-2 Mallampati i-iv Obstructions Neck Mobility |
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Heaven |
Hypoxemia:o2 sat <93 Extremes of size:pt under 8 or clinical obesity Anatomic challenges Vomit/Blood/fluid Exsanguination/anemia:potential accelerated desaturations Neck mobility issues: kyphosis, fusions, injuries etc |
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Sellick's maneuver |
Posterior pressure on cricoid cartilage Occludes esophagus does not work all that well |
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BURP maneuver |
Backwards,Upwards, Rightward pressure Designed to bring cords into view Does not work as well as ELM |
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External laryngeal manipulation(ELM) |
Larangoscopist brings cords into view then assist maintains, gently manipulate the cricoid until the person performing intubation can see the cords then maintain that position |
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Chest xray gold standard depth confirmation |
Distal tip of ett should be 5cm +/- 2cm above the carina in adults Peds 1.5cm
Murphys eye @ Level of t2-t4 vertebrae where the clavicles come together Carina is usually seen at t5-t7 |
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Sugamadex |
Reversal for Rocuronium |
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7 ps of rsi |
Preparation: pulse ox >93% Bp >100mmhg systolic
Cardiac monitor Consider early use of epi push dose pressorCardiac monitorAt least 1 functional large bore IVBVM, Yankaur, Suction tubingEtco2Positioning At least 1 functional large bore IV BVM, Yankaur, Suction tubing Etco2 Positioning- ramp the pt up with ear to sternal notch. DL or VL devices Tubes main size and next size up and down, syringes RSI medications ready Back up airway
Preoxygenate: 3 minutes of 100% o2 normal volume breathing Consider NC set to 10-15 l/m Consider NRB Consider Peep valve Goal nitrogen washout replace nitrogen with o2 in the blood to allow more time for intubation
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