Critical care paramedic
When need to you carry out the intubation throughout RSI?
When the waveform etco2 is flat- that means the NMBA is running and the diaphragm has
stopped.
NG tube at some point of RSI?
No clamp, continuous suction
Nitrogen washout
Apply high drift 02 to put together for intubation and washout the N2.
Who receives atropine for the duration of RSI and why?
Pediatric sufferers <2-3 y/o previous to RSI. Pediatric sufferers cardiac output is rate
established. Pediatric patients aren't able to increase inotropy. Atropine will assist save you
with bradycardia.
Atropine dose
zero.02 mg/kg. Max dose: zero.5 mg
What are you able to do if pediatric affected person has Low BP prior to RSI?
Push presssors
Lidocaine RSI dose
1.Zero- 1.5 mg/kg IV
What is lidocaine used for in RSI?
For sufferers with suspected increased ICP. Lidocaine will lower vagal nerve stimulation. It
will reason blunting of the airway reflexes and prevent coughing, gagging, so one can
improve ICP.
What are the drug alternatives for sedation in RSI?
Etomidate, Versed, Ketamine, and propofol
Etomidate dose
,zero.2-0.3mg/kg
What is the favored drug for sedation in RSI?
Etomidate. Has speedy onset of 10-20 seconds, short duration of 4-10 mins, can be used in
peds, has no histamine release.
What are the downsides to giving etomidate for RSI?
Causes a slight boom in airway resistance, Myoclonus can be visible, and you should keep
away from in septic sufferers.
Why can you no longer provide etomidate for septic patients?
Causes Adrenocortical supression
Dose for Versed in RSI?
2.5-five.0 Mg Iv or .1-.3 mg/kg.
Has a speedy onset of .5- 2 minutes, and a short length of 20-30 minutes.
Pediatric infusion dose: zero.05-0.4mg/kg in keeping with hour
Ketamine dose for RSI?
1.5-4.Zero mg/kg IV over 1 minute ( 5-10 mg/kg IM)
When is ketamine preferred?
In pediatrics due to halluciations
What receptors does ketamine stimulate?
Stimulates the opiod receptor causing analgesia.
Will stimulate the catecholamine receptors and launch cateccholamines main to accelerated
HR, contractility, MAP, and BP.
Does ketamine increase ICP?
No proof indicates that ketamine will increase ICP in hypotensive or normotensive patients.
Best now not to provide ketamine in patients who have suspected IC with excessive blood
pressure.
Propofol dose
Continued sedation dose: five-50 mcg/kg/min
Propofol contraindications
,OB and < 8 year old peds
What effects will propofol have on the body?
Will lower the BP. Will reduce airway resistance and can be useful inducting patients with
bronchospasm.
Is propofol an analgesic?
No it has sedation and amnesia properties
Is propfol good for patients with intracranial pathology?
Yes, if they are stable.
What do all neuromuscular blocking agents cause?
They all can cause Low BP and Malignant hyperthermia.
What type of NMBA is more common with MH?
Depolarizing NMBA's
What is the reversal agent for Non-depolarizing NMBA's?
Neostigmine
Succinylcholine dose
1-1.5 mg/kg
Higher doses may reduce occurance of myalgia.
Only FDA approved depolarizing NMBA?
Succinylcholine
Pediatric dose for succs?
2.0mg/kg
Contraindications for succs?
Hyperkalemia, burns >seventy two hours, < 1 yr eye injuries, glaucoma, MH, paraplegia, MD
Will succs purpose an icrease in ICP?
No it will not
, Onset and length of succs?
Rapid onset - 3-five mins
Duration- 25-30 minutes
How much can succs increase your serum potassium levels?
3.Zero-5 meq/L
What can cause potassium to be released whilst giving succs?
Fasiculations
Early signal for Mh?
Increased etco2 with out cause, and reduced spo2
What will Mh do?
Increase frame temp and metabolism
NMBA reversal agents
Sugammadex
What is the order of paralysis?
1. Eyes , face, neck. 2. Extremties. Three. Abdomen. 4. Intercostals. Glottis. Five.
Diaphragm
How do you already know while the gag reflex is gone in the course of RSI?
When the diaphragm stops
How to prevent myalgia while giving succs?
Give better dose
NMBAS can decrease BP?
True
What must you give in conjuction when giving ketamine, and why?
Give a benzodiazepine and it's far to prevent emergent reactions
Can propfol be a piggyback line?
When need to you carry out the intubation throughout RSI?
When the waveform etco2 is flat- that means the NMBA is running and the diaphragm has
stopped.
NG tube at some point of RSI?
No clamp, continuous suction
Nitrogen washout
Apply high drift 02 to put together for intubation and washout the N2.
Who receives atropine for the duration of RSI and why?
Pediatric sufferers <2-3 y/o previous to RSI. Pediatric sufferers cardiac output is rate
established. Pediatric patients aren't able to increase inotropy. Atropine will assist save you
with bradycardia.
Atropine dose
zero.02 mg/kg. Max dose: zero.5 mg
What are you able to do if pediatric affected person has Low BP prior to RSI?
Push presssors
Lidocaine RSI dose
1.Zero- 1.5 mg/kg IV
What is lidocaine used for in RSI?
For sufferers with suspected increased ICP. Lidocaine will lower vagal nerve stimulation. It
will reason blunting of the airway reflexes and prevent coughing, gagging, so one can
improve ICP.
What are the drug alternatives for sedation in RSI?
Etomidate, Versed, Ketamine, and propofol
Etomidate dose
,zero.2-0.3mg/kg
What is the favored drug for sedation in RSI?
Etomidate. Has speedy onset of 10-20 seconds, short duration of 4-10 mins, can be used in
peds, has no histamine release.
What are the downsides to giving etomidate for RSI?
Causes a slight boom in airway resistance, Myoclonus can be visible, and you should keep
away from in septic sufferers.
Why can you no longer provide etomidate for septic patients?
Causes Adrenocortical supression
Dose for Versed in RSI?
2.5-five.0 Mg Iv or .1-.3 mg/kg.
Has a speedy onset of .5- 2 minutes, and a short length of 20-30 minutes.
Pediatric infusion dose: zero.05-0.4mg/kg in keeping with hour
Ketamine dose for RSI?
1.5-4.Zero mg/kg IV over 1 minute ( 5-10 mg/kg IM)
When is ketamine preferred?
In pediatrics due to halluciations
What receptors does ketamine stimulate?
Stimulates the opiod receptor causing analgesia.
Will stimulate the catecholamine receptors and launch cateccholamines main to accelerated
HR, contractility, MAP, and BP.
Does ketamine increase ICP?
No proof indicates that ketamine will increase ICP in hypotensive or normotensive patients.
Best now not to provide ketamine in patients who have suspected IC with excessive blood
pressure.
Propofol dose
Continued sedation dose: five-50 mcg/kg/min
Propofol contraindications
,OB and < 8 year old peds
What effects will propofol have on the body?
Will lower the BP. Will reduce airway resistance and can be useful inducting patients with
bronchospasm.
Is propofol an analgesic?
No it has sedation and amnesia properties
Is propfol good for patients with intracranial pathology?
Yes, if they are stable.
What do all neuromuscular blocking agents cause?
They all can cause Low BP and Malignant hyperthermia.
What type of NMBA is more common with MH?
Depolarizing NMBA's
What is the reversal agent for Non-depolarizing NMBA's?
Neostigmine
Succinylcholine dose
1-1.5 mg/kg
Higher doses may reduce occurance of myalgia.
Only FDA approved depolarizing NMBA?
Succinylcholine
Pediatric dose for succs?
2.0mg/kg
Contraindications for succs?
Hyperkalemia, burns >seventy two hours, < 1 yr eye injuries, glaucoma, MH, paraplegia, MD
Will succs purpose an icrease in ICP?
No it will not
, Onset and length of succs?
Rapid onset - 3-five mins
Duration- 25-30 minutes
How much can succs increase your serum potassium levels?
3.Zero-5 meq/L
What can cause potassium to be released whilst giving succs?
Fasiculations
Early signal for Mh?
Increased etco2 with out cause, and reduced spo2
What will Mh do?
Increase frame temp and metabolism
NMBA reversal agents
Sugammadex
What is the order of paralysis?
1. Eyes , face, neck. 2. Extremties. Three. Abdomen. 4. Intercostals. Glottis. Five.
Diaphragm
How do you already know while the gag reflex is gone in the course of RSI?
When the diaphragm stops
How to prevent myalgia while giving succs?
Give better dose
NMBAS can decrease BP?
True
What must you give in conjuction when giving ketamine, and why?
Give a benzodiazepine and it's far to prevent emergent reactions
Can propfol be a piggyback line?
