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RSI

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transition5584's version from 2016-12-07 22:00

Premedication and Induction for RSI

Question Answer
Etomidate dose and administration0.3 mg/kg IV Push
The most hemodynamically neutral induction agent and one that increases BPEtomidate and Ketamine. Note that Etomidate does not have any analgesic effects (ketamine can also be used if hypotension is a concern)
Induction agents with analgesic effectsKetamine
Does etomidate adrenocortical suppression matter, how long does it last, what other implication is there?no evidence of sequalie, and does not even persist after 5 hours. Keep in mind this will effect ACTH stimulation test
Midazolam induction dose, dose related side effect?0.2 mg/kg, 0.1 mg/kg if worried about hypotension. Avg MAP drop is 10-25%
Best induction agent for those in shockEtomidate or Ketamine due to superior hemodynamic profiles
Do barbituates provide analgesia? Do Benzos?Neither benzos nor barbituates provide analgesia
Premedication with dose for intubation with concern for asthma, also contraindications. Does this med help with lowering increase in ICP with intubation?Lidocaine 1.5 mg/kg 3 minutes prior to intubation, avoid in 2nd or 3rd degree heart block w/o pacemaker. Lidocaine probably not helpful in reducing ICP with intubation.
Premedication for avoiding increased ICP or increased stress on the heart from increase in BP during intubation, what if you are worried about tenuous BP in patient with concern over head injury, ICH, meningitis, etc (do not want bump in ICP)Fentanyl 3 mcg/kg, use 1 mcg/kg in those with tenuous hemodynamic status.
Premedication for those with shock who need blood pressure support during RSI and dose, also tell when you should not use themEpinephrine 5-20 mcg, Phenylephrine 50- 200 mcg. Do not use in those with arrhythmogenic cause of shock, aortic dissection or suspected valvular failure.
Best induction agents for use in patient with asthma, why? and doseKetamine 1-2 mg/kg IV, Causes catecholamine release which may help with bronchodilation.
Best induction agent for awake intubation and why, plus dosing.Ketamine 1-2 mg/kg, preserved respiratory drive and analgesia.
Dosing of propofol for induction, concern for side effects1.5 - 3 mg/kg, hypotension, bradycardia.
Best induction agents for patients with head injury or stroke, Dose, why?You do not want something that drops BP. Etomidate 0.3 mg/kg IV, no blood pressure change. Ketamine 1-2 mg/kg, increases MAP. Decreased blood pressure can cause injury through hypo-perfusion, that is why other agents are troublesome.
Best induction agents to use and not to use in status epilepticus and whyMidazolam, Propofol decrease neuroexcitation, Etomidate may increase EEG seizure activity but is fine if used in those with hemodynamic compromise. Ketamine has stimulant effect and should be avoided.
Best agents for induction in asthma, why?Ketamine or Propofol, both have bronchodilatory action
Best agent in cardiovascular disease as cause for RSI, also consider this premedication, why?Etomidate, hemodynamic stability. Fentanyl 3 mcg/kg blunt catecholamine response from laryngoscopy and intubation.
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Paralytics for RSI

Question Answer
What is the only depolarizing NMBA in common use, dose, onset and Duration?Succinylcholine, 1.5 mg/kg, 45 seconds, 6-10 minutes.
Conditions where succinylcholine should not be used and why?Family history of Malignant hyperthermia, denervating neuromuscular disease, muscular dystrophy, stroke over 72 hours old, History of Rhabdomyolysis, burn over 72 hours old, and hyperkalemia, risk of hyperkalemia due to muscle activation all at once increasing blood levels of K as potassium shifts out of cells.
Why have atropine on hand when use succ?Bradycardia is a side effect of Succ.
Dosing of rocuronium and when to use it?Recuronium 1 mg/kg ideal body weight. When Succinylcholine is contraindicated.
How does one reverse NMBA, 2 agents? give dosesNeostigmine 0.06 to 0.08 mg/kg IV, Sugammadex 16 mg/kg IV
What must be considered when dosing NMBAs in myasthenia gravesIncreased dose of Succinylcholine and reduced dose of non-depolarizing NMBAs
Induction and Paralytic combo for IM administration, doses and onsetKetamine 4 mg/kg and Succinylcholine 4 mg/kg, note onset of effect is about 2 minutes.
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