RSI

Dosages

100

The patient's GCS deteriorates in flight. The GCS is now 5 and you decide to RSI. The patient weighs approximately165 lbs. Calculate the appropriate dosage of Succinylcholine.

113-150 mg

200

For the elective intubation of an 80kg, 25 year old male with head trauma, the correct dose of Etomidate is:

24 mg

300

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: 0.6-1.2 mg/kg 

400

For the elective intubation of a 70 kg, 45 year old female with sepsis, the correct dose of Rocuronium is:

70 mg

500

For the elective intubation of a 70 kg 45 year old female with sepsis, the correct dose of ketamine is:

70 mg

Scenario

100

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 

200

Your 12 year old trauma patient becomes markedly bradycardic during an intubation attempt. You 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.

300

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.

400

You are preparing to intubate a patient who has sustained burns over approx. 50% of his total BSA, including possigle 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

500

You are dispatched to the scene of an MVC. In addition to EMS, 2 doctors have responded from the local ER. Upon your arrival, one is attempting to intubate an unresponsive male patient. Alfter multiple attempts, the doctor 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.

Patient Condition

100

Based on the history and mechanism of injury, your patient probably has a head injury. What is the best medication for induction?

Etomidate

200

Immediately upon intubation, you patient becomes markedly bradycardic and hypoxic. What will be your most likely finding?

The tube is in the esophagus.

300

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

400

An adult male was intubated with an 8.0 oral ETT. What is the correct tube depth placement?

24 cm

500

In the event that paralytics must be reversed, which medication can be given to counter the effects?

An antidote to paralytics is not in our medication box.

Tricky

100

What is the correct dose of Succinylcholine for a patient weighing less than 13kg?

1.5 to 2.0 mg/kg

200

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

300

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

D

400

What is the minimum means of verifying tube placement? 

A minimum of continuous waveform capnography as well as two additional verification methods must be documented. 

500

What are the components of a LEMON assessment?

Look; Evaluate (3-3-2); Mallampati; Obstruction; Neck mobility

Random

100

When performing RSI on the pediatric patient <5 years old, what drug should be considered in the absence of any absolute contraindications? A. Morphine B. Fentanyl C. Rocuronium D. Atropine

Atropine

200

After transferring an intubated patient from the house to the back of the ambulance, what is your first priority?

Re-verify ETT placement by at least two methods.

300

What is the onset time and duration of action for Rocuronium?

30 to 60 seconds and 30 to 60 minutes.

400

Name one depolarizing paralytic and one non-depolarazing paralytic that is in our protocol?

Depolarazing: Succs; Non-depolarizing: Roc

500

The proper BSI for RSI is:

Gloves, Goggles, Facemask.