Critical Care Paramedic Exam - Complete Solutions (Answered)

Critical Care Paramedic Exam - Complete Solutions (Answered) When should you perform the intubation during RSI? When the waveform etco2 is flat- meaning the NMBA is working and the diaphragm has stopped. NG tube during RSI? No clamp, continuous suction Nitrogen washout Apply high flow 02 to prepare for intubation and washout the N2. Who gets atropine during RSI and why? Pediatric patients 2-3 y/o prior to RSI. Pediatric patients cardiac output is rate dependent. Pediatric patients are not able to raise inotropy. Atropine will help prevent with bradycardia. Atropine dose 0.02 mg/kg. Max dose: 0.5 mg What can you do if pediatric patient has Low BP prior to RSI? Push pressors Lidocaine RSI dose 1.0- 1.5 mg/kg IV What is lidocaine used for in RSI? For patients with suspected increased ICP. Lidocaine will decrease vagal nerve stimulation. It will cause blunting of the airway reflexes and prevent coughing, gagging, which will raise ICP. What are the drug options for sedation in RSI? Etomidate, Versed, Ketamine, and propofol Etomidate dose 0.2-0.3mg/kg What is the preferred drug for sedation in RSI? Etomidate. Has rapid 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 mild increase in airway resistance, Myoclonus may be seen, and you must avoid in septic patients. Why can you not give etomidate for septic patients? Causes Adrenocortical suppression Dose for Versed in RSI? 2.5-5.0 Mg Iv or .1-.3 mg/kg. Has a rapid onset of .5- 2 mins, and a short duration of 20-30 mins. Pediatric infusion dose: 0.05-0.4mg/kg per hour Ketamine dose for RSI? 1.5-4.0 mg/kg IV over 1 minute ( 5-10 mg/kg IM) When is ketamine preferred? In pediatrics due to hallucinations What receptors does ketamine stimulate? Stimulates the opioid receptor causing analgesia. Will stimulate the catecholamine receptors and release cateccholamines leading to increased HR, contractility, MAP, and BP. Does ketamine increase ICP? No evidence shows that ketamine increases ICP in hypotensive or normotensive patients. Best not to give ketamine in patients who have suspected IC with high blood pressure. Propofol dose Continued sedation dose: 5-50 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 occurrence of myalgia. Only FDA approved depolarizing NMBA? Succinylcholine Pediatric dose for succs? 2.0mg/kg Contraindications for succs? Hyperkalemia, burns 72 hours, 1 year eye injuries, glaucoma, MH, paraplegia, MD Will succs cause an icrease in ICP? No it will not Onset and duration of succs? Rapid onset - 3-5 mins Duration- 25-30 mins How much can succs raise your serum potassium levels? 3.0-5 meq/L What can cause potassium to be released when giving succs? Fasiculations Early sign for Mh? Increased etco2 without reason, and decreased spo2 What will Mh do? Increase body temp and metabolism NMBA reversal agents Sugammadex What is the order of paralysis? 1. Eyes, face, neck 2. Extremties 3. Abdomen 4. Intercostals glottis. 5. Diaphragm How do you know when the gag reflex is gone during RSI? When the diaphragm stops How to prevent myalgia when giving succs? Give higher dose NMBAS can lower BP? True What should you give in conjunction when giving ketamine, and why? Give a benzodiazepine and it is to prevent emergent reactions Can propfol be a piggyback line? No must have own IV line Why is bolusing propofol dangerous? It can cause major drop in blood pressure How much will propfol typically drop the MAP? 10mmHG What RSI drug is most likely to cause anaphlaxysis? NMBA'S What is myalgia? Muscle pain True or false flying with propofol can cause you to have to titrate your dose to get desired effect? True What should be your dose titration for propofol at the bedside of the patient? 5 mcg/kg/min Why can moving the patient have effects when giving particular drugs such as propofol? Movement can have effects on the dose given-metabolism of dose When a skull fracture is suspected or known what type of tube do you put in place? OG tube If no skull fracture of major head injury is suspected what kind of tube do you place in your RSI patient? NG tube Why do you place OG or NG tube in RSI patient? To decompress the stomach due to ventilation