Rapid Sequence Intubation Overview

To safely intubate the patient while minimizing the risk of aspiration.

It creates an oxygen reserve that allows for a period of apnea without desaturation.

It significantly increases the fraction of inspired oxygen (FiO2) and end-tidal oxygen level (ET02).

<p>It improves glottic exposure and first attempt success during intubation.</p> Signup and view all the answers

<p>Obese patients desaturate much faster than healthy adults during apnea.</p> Signup and view all the answers

<p>It is useful for difficult airways, such as those with distorted anatomy or morbid obesity.</p> Signup and view all the answers

<p>Preparation.</p> Signup and view all the answers

<p>Single-use and reusable versions.</p> Signup and view all the answers

<p>The initial success rate is about 50% and the ultimate success rate is about 75%.</p> Signup and view all the answers

<p>It involves monitoring and managing the patient after intubation.</p> Signup and view all the answers

<p>They have a higher risk of aspiration of gastric contents.</p> Signup and view all the answers

<p>Topical anesthesia is used to minimize discomfort during the procedure.</p> Signup and view all the answers

<p>Obesity, comorbidities, and recovery time from neuromuscular blockers.</p> Signup and view all the answers

<p>There is a reluctance among operators who feel inadequately trained.</p> Signup and view all the answers

<p>6-8 minutes.</p> Signup and view all the answers

<p>It can be a reasonable approach for patients not at high risk for aspiration.</p> Signup and view all the answers

<p>Conditions such as smoke inhalation or supraglottitis can be assessed.</p> Signup and view all the answers

<p>Succinylcholine can cause an increase in potassium levels, exacerbating hyperkalemia and potentially leading to serious cardiac complications.</p> Signup and view all the answers

<p>Masseter spasm may occur after succinylcholine administration, particularly in young patients, and could indicate a risk of malignant hyperthermia.</p> Signup and view all the answers

<p>Etomidate serves as an induction agent for anesthesia during rapid sequence intubation, providing sedation without significant cardiovascular effects.</p> Signup and view all the answers

<p>Preoxygenation increases the patient's oxygen reserve, which helps prevent desaturation during periods of apneic intubation.</p> Signup and view all the answers

<p>The main treatments include discontinuing the offending agent, administering dantrolene, and externally lowering body temperature.</p> Signup and view all the answers

<p>Rocuronium is preferred when succinylcholine is contraindicated, such as in patients with hyperkalemia or concerns for malignant hyperthermia.</p> Signup and view all the answers

<p>The Sellick maneuver applies cricoid pressure to help prevent regurgitation and aspiration during intubation.</p> Signup and view all the answers

<p>A dose of 1.2 mg/kg IV of rocuronium achieves comparable intubation conditions to succinylcholine within about 60 seconds.</p> Signup and view all the answers

<p>Delayed Sequence Intubation (DSI) optimizes preoxygenation and reduces peri-intubation desaturation rates in agitated or confused patients.</p> Signup and view all the answers

<p>Awake oral intubation involves sedation with airway reflex preservation, while sedation-only intubation does not utilize neuromuscular blockade and targets obtundance.</p> Signup and view all the answers

<p>Administering a sedative agent simultaneously enhances patient comfort and reduces anxiety during intubation while managing airway responses.</p> Signup and view all the answers

<p>Etomidate has minimal hemodynamic effects, making it safer for patients at risk for cardiovascular instability during intubation.</p> Signup and view all the answers

<p>Risks include potential ketamine-induced apnea and respiratory depression, particularly in patients with obstructive airway conditions.</p> Signup and view all the answers

<p>Succinylcholine competes with acetylcholine at the neuromuscular junction, causing temporary paralysis by inducing sustained depolarization.</p> Signup and view all the answers

<p>Induction agents can amplify the effects of NMBAs, leading to improved intubation conditions and better airway management.</p> Signup and view all the answers

<p>Vecuronium is preferred as it does not release histamine and avoids adverse cardiac effects while providing effective neuromuscular blockade.</p> Signup and view all the answers

<p>The two primary classes are depolarizing agents and nondepolarizing agents.</p> Signup and view all the answers

<p>The preferred dosing for ketamine is between 0.25 to 0.5 mg/kg IV every 10 minutes, titrated to the desired sedation level.</p> Signup and view all the answers

<p>Aminosteroid agents are chemically distinct and provide varying profiles for neuromuscular blockade and side effects.</p> Signup and view all the answers

<p>It confirms proper placement of the endotracheal tube within the trachea and indicates effective ventilation.</p> Signup and view all the answers

<p>To ensure adequate oxygen saturation and reduce the risk of hypoxemia during the intubation process.</p> Signup and view all the answers

<p>Fentanyl can reduce the reflex sympathetic response, stabilizing heart rate and blood pressure during intubation.</p> Signup and view all the answers

<p>To maintain adequate cerebral perfusion pressure (CPP) and prevent secondary brain injury.</p> Signup and view all the answers

<p>Etomidate and propofol.</p> Signup and view all the answers

<p>Hypoventilation and potential cardiovascular collapse.</p> Signup and view all the answers

<p>To facilitate patient comfort and prevent movement if adequate sedation is achieved.</p> Signup and view all the answers

<p>Due to exacerbation of hypotension or cardiovascular instability caused by the intubation process.</p> Signup and view all the answers

<p>Volume resuscitation, judicious agent selection, and pressor titration if necessary.</p> Signup and view all the answers

<p>In cases of bleeding or sepsis due to the risk of causing hypoventilation.</p> Signup and view all the answers

<p>To verify correct placement of the endotracheal tube in the trachea.</p> Signup and view all the answers

<p>A bedside gas analyzer is used to monitor ETO₂.</p> Signup and view all the answers

<p>ApOx maintains continuous oxygen flow, promoting the diffusion of alveolar oxygen into the pulmonary system.</p> Signup and view all the answers

<p>Lack of inhalation of 100% oxygen, intrapulmonary shunting, and dead space can shorten desaturation time.</p> Signup and view all the answers

<p>It aims to correct hemodynamically unstable conditions and improve impaired physiologies.</p> Signup and view all the answers

<p>The optimal position is head extension with cervical spine extension for direct laryngoscopy.</p> Signup and view all the answers

<p>Succinylcholine and rocuronium are commonly used NMBAs.</p> Signup and view all the answers

<p>The Sellick Maneuver is no longer recommended due to the risk of aspiration.</p> Signup and view all the answers

<p>Placement is confirmed by ETCO₂ monitoring.</p> Signup and view all the answers

<p>Laryngoscopy is performed about 45-60 seconds after administration.</p> Signup and view all the answers

<p>ApOx significantly reduces the risk of hypoxia during intubation.</p> Signup and view all the answers

<p>It provides a wide-angle view of the glottis and surrounding anatomy.</p> Signup and view all the answers

<p>A stylet helps maintain the shape of the tube and facilitates passage during intubation.</p> Signup and view all the answers

<p>Insert the scope, optimize the view, align the tube with the blade, and maneuver the tube through the vocal cords.</p> Signup and view all the answers

<p>They universally improve glottic visualization and reduce peri-intubation complications.</p> Signup and view all the answers

<p>It incorporates a CMOS video chip that enhances glottic views and allows for image saving.</p> Signup and view all the answers

<p>The Cobalt consists of a flexible video wand insert fitting inside a disposable, single-piece transparent blade.</p> Signup and view all the answers

<p>It creates a viewing field that negates the tongue's obstructive potential.</p> Signup and view all the answers

<p>They are made from lightweight titanium and have narrower side profiles.</p> Signup and view all the answers

<p>Ketamine is a phencyclidine derivative that produces a cataleptic state rather than true unconsciousness.</p> Signup and view all the answers

<p>Propofol can cause hypotension, necessitating reduced dosage or avoidance in such patients.</p> Signup and view all the answers

<p>Ketamine is preferred for patients with acute severe asthma or hemodynamic instability.</p> Signup and view all the answers

<p>Pain at the injection site is a common side effect of propofol administration.</p> Signup and view all the answers

<p>The recommended dose of midazolam is 0.2 to 0.3 mg/kg IV, but it is considered inferior to etomidate and propofol.</p> Signup and view all the answers

<p>Ketamine can provoke further hypotension or cardiovascular collapse in patients with profound shock or reduced myocardial contractility.</p> Signup and view all the answers

<p>Dexmedetomidine is typically administered at a dose of 1 mg/kg IV over 5 to 10 minutes.</p> Signup and view all the answers

<p>Etomidate generally has a more stable hemodynamic profile than ketamine, which may lead to higher rates of hypotension.</p> Signup and view all the answers

<p>Ketamine's bronchodilatory effect is crucial in managing patients with status asthmaticus.</p> Signup and view all the answers

<p>Propofol is delivered in a soybean oil and lecithin vehicle, posing allergy risks for those with sensitivities.</p> Signup and view all the answers

<p>6-10 minutes.</p> Signup and view all the answers

<p>It can prolong the succinylcholine block, but clinically this rarely exceeds 23 minutes.</p> Signup and view all the answers

<p>1.5 mg/kg IV.</p> Signup and view all the answers

<p>Children.</p> Signup and view all the answers

<p>Burns &gt;10% BSA, crush injuries, and neuromuscular diseases.</p> Signup and view all the answers

<p>Fine, chaotic muscle contractions.</p> Signup and view all the answers

<p>When their condition is stable for 6 months or more.</p> Signup and view all the answers

<p>To potentially reduce muscle pain from fasciculations.</p> Signup and view all the answers

<p>The primary role is to administer fentanyl to reduce pain and facilitate subsequent intubation.</p> Signup and view all the answers

<p>5 to 10 mcg/min IV.</p> Signup and view all the answers

<p>Atropine, though its benefit is unclear for those under 1 year old.</p> Signup and view all the answers

<p>Receptor upregulation due to lack of ACh stimulation.</p> Signup and view all the answers

<p>Videolaryngoscopy provides superior glottic visualization without needing a direct line of sight.</p> Signup and view all the answers

<p>The dose should be reduced by 50%.</p> Signup and view all the answers

<p>Ketamine or etomidate.</p> Signup and view all the answers

<p>Cervical spine immobilization is rarely indicated if there’s no associated blunt trauma or neurologic injury.</p> Signup and view all the answers

<p>It allows for superior glottic visualization compared to direct laryngoscopes.</p> Signup and view all the answers

<p>Excessive lifting force can lead to further cervical spine damage.</p> Signup and view all the answers

<p>End-tidal carbon dioxide confirmation.</p> Signup and view all the answers

<p>Inadequate glottic views and increased intubation failure.</p> Signup and view all the answers

<p>Sedation and analgesia using propofol.</p> Signup and view all the answers

<p>The use of specially angled blades designed for video systems.</p> Signup and view all the answers

<p>Improper technique can lead to inadequate views and possible complications.</p> Signup and view all the answers

<p>Utilize a non-rebreather mask at a high flush rate.</p> Signup and view all the answers

<p>Malignant hyperthermia is a life-threatening hypermetabolic disorder primarily triggered by certain anesthetic agents, notably succinylcholine.</p> Signup and view all the answers

<p>Muscle rigidity, tachycardia, tachypnea, and elevated body temperature are critical indicators for diagnosing malignant hyperthermia.</p> Signup and view all the answers

<p>Common laboratory results include elevated serum creatinine kinase (CK) levels, electrolyte imbalances like hyperkalemia, and ABGs typically showing respiratory acidosis.</p> Signup and view all the answers

<p>Immediate cessation of triggering agents, implementation of cooling measures, and administration of intravenous fluids are crucial for management.</p> Signup and view all the answers

<p>The recommended dosing for intravenous dantrolene is typically between 2.5 to 10 mg/kg.</p> Signup and view all the answers

<p>Muscle rigidity and elevated body temperature.</p> Signup and view all the answers

<p>Environmental triggers, such as specific anesthetic agents, can induce a malignant hyperthermia crisis.</p> Signup and view all the answers

<p>The presence of a triggering event, such as exposure to specific anesthetic agents.</p> Signup and view all the answers

<p>It provides information on previous anesthetic exposures and potential genetic predispositions.</p> Signup and view all the answers

<p>Tachycardia.</p> Signup and view all the answers

<p>A defect in the ryanodine receptor (RyR1) on skeletal muscle cells.</p> Signup and view all the answers

<p>Pain, swelling, and weakness in affected muscles, along with dark urine due to myoglobinuria.</p> Signup and view all the answers

<p>Administration of dantrolene, along with active cooling measures.</p> Signup and view all the answers

<p>Creatinine Kinase (CK) levels are elevated in both conditions.</p> Signup and view all the answers

<p>Specific anesthetic agents like succinylcholine and volatile anesthetics.</p> Signup and view all the answers

<p>It releases myoglobin into the bloodstream, which is toxic to the kidneys.</p> Signup and view all the answers

<p>Rapid onset of hyperthermia, often exceeding 40°C.</p> Signup and view all the answers

<p>Hydration to maintain renal function and monitoring of electrolytes.</p> Signup and view all the answers

<p>It involves uncontrolled calcium release from muscle ryanodine receptors, leading to heightened metabolic activity.</p> Signup and view all the answers

<p>Increased serum Creatine Kinase (CK) levels and the presence of dark urine are key indicators.</p> Signup and view all the answers

<p>Immediate administration of dantrolene is required for treatment.</p> Signup and view all the answers

<p>MH is associated with genetic susceptibility, which makes certain individuals more prone to the condition.</p> Signup and view all the answers

<p>Trauma, intense exercise, dehydration, and certain medications can trigger rhabdomyolysis.</p> Signup and view all the answers

<p>MH diagnosis relies on clinical findings during anesthesia and genetic testing, while rhabdomyolysis is diagnosed based on symptoms and CK levels.</p> Signup and view all the answers

<p>Hyperthermia is a common symptom in both conditions, indicating a serious metabolic disturbance.</p> Signup and view all the answers

<p>Supportive care is crucial to prevent kidney damage and maintain fluid balance in affected individuals.</p> Signup and view all the answers