Dosages
The patient's GCS deteriorates en-route. The GCS is now 5 and you decide to RSI. The patient weighs approximately 165 lbs. Calculate the appropriate dosage of Succinylcholine.
113-150 mg
A 220 lb. construction worker has fallen approximately 75 feet. He has sustained multiple long bone fx, chest trauma and has a 6" nail protruding from his left eye. The pt is alert, but complaining of severe difficulty breathing and has paradoxical chest wall movement and absent lung sounds on the left side. Your most appropriate action would be to:
Perform a needle Thoracostomy *Bonus* if you can describe the procedure per guidelines.
Based on the history and mechanism of injury, your patient probably has a head injury. What is the best medication for induction?
Etomidate
A 35 y/o construction worker is pinned under a partially collapsed building. His torso is free however he appears to have a crush injury to the right lower leg. He becomes altered requiring RSI. What is an appropriate sedative and paralytic regimen?
Only avoid succinylcholine given crush injury. Otherwise all other medications are appropriate.
What are 3 indications for RSI?
Failure of airway patency
Failure of airway protection
Failure of ventilation or oxygenation
Anticipated clinical course
To facilitate safety
Your 13 year old trauma patient becomes markedly bradycardic during an intubation attempt. The most appropriate action would be to:
A. Temporarily discontinue the attempt and ventilate via BVM and 100% FiO2
B. Continue the attempt and administer Atropine 0.5mg
C. Start CPR
D. Administer Lidocaine 1.5 mg/kg for ICP control
A.
Immediately upon intubation, you patient becomes markedly bradycardic and hypoxic. What will be your most likely finding?
The tube is in the esophagus.
You arrive at a facility for an OD patient. The sending P.A. reports that he has administered a total of 6mg of Narcan and there is a questionable history of trauma. The patient is becoming increasingly uncooperative and agitated. Your best approach to the safe transport of this patient would be:
Sedation with benzodiazepines and consider RSI
After transferring an intubated patient from the bed in their home to the stretcher, what is your first priority?
Re-verify ETT placement by at least three methods.
List the IV dosages for these RSI medications Etomidate Ketamine Succinylcholine Rocuronium
Etomidate: 0.3 mg/kg Ketamine: 1-2 mg/kg Succinylcholine: 1.5-2.0 mg/kg Rocuronium: 1 mg/kg
You are transporting a 90kg head injured patient who was intubated, sedated and paralyzed 30 minutes ago. He received 9 mg of Vecuronium and 4 mg of Versed following ETT confirmation. The patient now has increasing systolic BP and tachycardia. What is the most likely cause the the vital signs change?
Inadequate sedation.
Post RSI, the patient begins moving. Of the following, which is the most appropriate course of action?
A. Nothing, as this is expected
B. Resedate and give analgesia. Only consider re-paralyzing if ventilator dysynchrony.
C. Re-paralyze only as the sedation and analgesia are still working
D. Give analgesia only.
B
Succinylcholine is appropriate in all the following scenarios EXCEPT:
A. A 2 year old with respiratory failure and a platelet count of 120
B. A 54 year old post arrest patient with a blood sugar of 310
C. A 22 year old trauma patient with a hemoglobin of 5.2
D. A 60 year old acute renal failure patient with a potassuim of 6.2
A and D
For the elective intubation of a 320 lb, 45 year old female with sepsis, the correct dose of Vecuronium is:
10 mg (0.1 mg/kg; Max dose 10 mg)
You are preparing to intubate a patient who has sustained burns over approx. 50% of his total BSA, including possible airway burns. Prior to administering succinylcholine, it is important to establish the time of injury because use of this agent in patients with burns more than 24 hours old can cause serious_____________
Hyperkalemia
An adult male was intubated with an 8.0 oral ETT. What is the correct tube depth placement?
24 cm
What are the 7 P's of RSI
Prepare
Preoxygenate
Pretreatment
Paralysis with induction
Positioning
Placement with proof
Post intubation management
Name one depolarizing paralytic and one non-depolarazing paralytic that is in our PCG's
Depolarazing: Succinylcholine
Non-depolarizing: Rocuronium, Vecuronium
You intubate a 70 kg 50 year old male presumed to be in septic shock. What is the correct dose of ketamine for sedation following RSI?
70 mg
You are dispatched to the scene of an MVC. In addition to EMS, 2 physicians have responded from the local ER. Upon your arrival, one is attempting to intubate an unresponsive male patient. After multiple attempts, the physician is unable to intubate. Your parter is on his second attempt and is having difficulty. The next appropriate action would be to:
Prepare for an alternative airway adjuct.
In the event that paralytics must be reversed, which medication can be given by the EMS crew to counter the effects?
An antidote to paralytics is not in our medication box. However in a perfect would Sugammadex for Roc.
Hypotension
The proper BSI for RSI is:
Gloves, Eye protection, Mask (N-95)