CRITICAL CARE PARAMEDIC
QUESTIONS & ANSWERS
When should you perform the intubation during RSI? - ANSWER When the waveform
etco2 is flat- meaning the NMBA is working and the diaphragm has stopped.
Nitrogen washout - ANSWER Apply high flow 02 to prepare for intubation and washout
the N2.
Who gets atropine during RSI and why? - ANSWER 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 - ANSWER 0.02 mg/kg. Max dose: 0.5 mg
What can you do if pediatric patient has Low BP prior to RSI? - ANSWER administer
vasopresssors
Lidocaine RSI dose - ANSWER 1.0- 1.5 mg/kg IV
What is lidocaine used for in RSI? - ANSWER 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? - ANSWER Etomidate, Versed,
Ketamine, and propofol
Etomidate dose - ANSWER 0.2-0.3mg/kg
What is the preferred drug for sedation in RSI? - ANSWER 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? - ANSWER 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? - ANSWER Causes Adrenocortical
supression
Dose for Versed in RSI? - ANSWER 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? - ANSWER 1.5-4.0 mg/kg IV over 1 minute ( 5-10 mg/kg IM)
When is ketamine preferred? - ANSWER In pediatrics due to halluciations
What receptors does ketamine stimulate? - ANSWER Stimulates the opiod receptor
causing analgesia.
Will stimulate the catecholamine receptors and release cateccholamines leading to
increased HR, contractility, MAP, and BP.
Does ketamine increase ICP? - ANSWER 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 - ANSWER Continued sedation dose: 5-50 mcg/kg/min
Propofol contraindications - ANSWER OB and < 8 year old peds
What effects will propofol have on the body? - ANSWER Will lower the BP. Will reduce
airway resistance and can be useful inducting patients with bronchospasm.
Is propofol an analgesic? - ANSWER No it has sedation and amnesia properties
Is propfol good for patients with intracranial pathology? - ANSWER Yes, if they are
stable.
What side effects can all neuromuscular blocking agents cause? - ANSWER They all
can cause Low BP and Malignant hyperthermia.
How do you know when the gag reflex is gone during RSI? - ANSWER When the
diaphragm stops
NMBAS can lower BP? - ANSWER True
What should you give in conjuction when giving ketamine, and why? - ANSWER Give a
benzodiazepine and it is to prevent emergent reactions
Can propfol be a piggyback line? - ANSWER No must have own IV line
Why is bolusing propofol dangerous? - ANSWER It can cause major drop in blood
pressure
How much will propfol typically drop the MAP? - ANSWER 10mmHG
What RSI drug is most likely to cause anaphlaxysis? - ANSWER NMBA'S
What is myalgia? - ANSWER Muscle pain
QUESTIONS & ANSWERS
When should you perform the intubation during RSI? - ANSWER When the waveform
etco2 is flat- meaning the NMBA is working and the diaphragm has stopped.
Nitrogen washout - ANSWER Apply high flow 02 to prepare for intubation and washout
the N2.
Who gets atropine during RSI and why? - ANSWER 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 - ANSWER 0.02 mg/kg. Max dose: 0.5 mg
What can you do if pediatric patient has Low BP prior to RSI? - ANSWER administer
vasopresssors
Lidocaine RSI dose - ANSWER 1.0- 1.5 mg/kg IV
What is lidocaine used for in RSI? - ANSWER 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? - ANSWER Etomidate, Versed,
Ketamine, and propofol
Etomidate dose - ANSWER 0.2-0.3mg/kg
What is the preferred drug for sedation in RSI? - ANSWER 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? - ANSWER 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? - ANSWER Causes Adrenocortical
supression
Dose for Versed in RSI? - ANSWER 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? - ANSWER 1.5-4.0 mg/kg IV over 1 minute ( 5-10 mg/kg IM)
When is ketamine preferred? - ANSWER In pediatrics due to halluciations
What receptors does ketamine stimulate? - ANSWER Stimulates the opiod receptor
causing analgesia.
Will stimulate the catecholamine receptors and release cateccholamines leading to
increased HR, contractility, MAP, and BP.
Does ketamine increase ICP? - ANSWER 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 - ANSWER Continued sedation dose: 5-50 mcg/kg/min
Propofol contraindications - ANSWER OB and < 8 year old peds
What effects will propofol have on the body? - ANSWER Will lower the BP. Will reduce
airway resistance and can be useful inducting patients with bronchospasm.
Is propofol an analgesic? - ANSWER No it has sedation and amnesia properties
Is propfol good for patients with intracranial pathology? - ANSWER Yes, if they are
stable.
What side effects can all neuromuscular blocking agents cause? - ANSWER They all
can cause Low BP and Malignant hyperthermia.
How do you know when the gag reflex is gone during RSI? - ANSWER When the
diaphragm stops
NMBAS can lower BP? - ANSWER True
What should you give in conjuction when giving ketamine, and why? - ANSWER Give a
benzodiazepine and it is to prevent emergent reactions
Can propfol be a piggyback line? - ANSWER No must have own IV line
Why is bolusing propofol dangerous? - ANSWER It can cause major drop in blood
pressure
How much will propfol typically drop the MAP? - ANSWER 10mmHG
What RSI drug is most likely to cause anaphlaxysis? - ANSWER NMBA'S
What is myalgia? - ANSWER Muscle pain
