MedCom

  1. Preoxygenate
    • Variety of techniques...
    • at minimum NC @ 15 to 25 lpm and NRM
    • If this is inadequate or pt remains hypoxic NONINVASIVE POSITIVE PRESSURE VENTILATION (NIPPV) CPAP or BIPAP
  2. Push
    • Push an appropriate SEDATIVE
    • A. ETOMIDATE (0.3-0.4mg/kg IV/IO)
    • B. KETAMINE (1-2mg/kg IV/IO) - in place of or in addition to ETOMIDATE in bronchospastic patient OR substiture to ETOMIDATE where hypotension exists
  3. Paralyze
    • SUCCINYLCHOLINE 2mg/kg
    • VECURONIUM 0.1mg/kg
    • ROCURONIUM 1mg/kg
  4. Placement with proof
    • Place endotracheal tube and verify placement!
    • 1. Note passage through the vocal cords/glottic opening
    • 2. Absence of gastric sounds
    • 3. Presence of bilateral lung sounds and wave form capnography with 1st breath
    • - if an incomplete view of the glottis or no view then external laryngeal manipulation 
    • - bougi should be considered for patrial or minimal views (Cormack-Lehane grades 3/4)
  5. Protect and Position
    • * Sellick's maneuver may be applied to guard against aspiration
    • * Position into a "sniffing" position or align the auditory meatus with the sternum
  6. Post Intubation Managment
    • S E C U R E   T U B E
    • SEDATION
    • versed 0.05 to 0.1 mg/kg 5mg MAX Q5min
    • ativan 0.05 to 0.1 mg/kg 
    • PAIN MGT
    • fentanyl 0.5 to 1 mcg/kg 100 mcg MAX Q5min (300mcg/kg)
    • morphine 0.5 to 0.1 mg/kg 10 mg MAX Q10min (20mg MAX)
    • ketamine 0.5 mg/kg 50mg MAX Q 15min
    • PARALYSIS
    • vecuronium 0.1 mg/kg 10mg MAX
    • rocuronium 1 mg/kg 100mg MAX
    • PUSH DOSE PRESSORS
    • epi 5 to 20 mcg
    • phenylphrine 100mcg
  7. RSI EIGHT Ps
    • 1. PREPARE
    • 2. PREOXYGENATE
    • 3. PRETREATMENT
    • 4. PUSH
    • 5. PARALYZE
    • 6. PROTECT AND POSITION
    • 7. PLACEMENT WITH PROOF
    • 8. POST INTUBATION MANAGEMENT
  8. MOANS
    • (difficult to bag?)
    • MASK - seal difficult
    • OBESITY/OBSTRUCTION
    • AGE > 55
    • NO TEETH
    • STIFF LUNGS OR CHEST WALL
  9. RODS
    • (difficult extraglottic device)
    • RESTRICTED MOUTH OPENING
    • OBSTRUCTION (organic or foreign body)
    • DISRUPTED/DISTORTED AIRWAY
    • STIFF LUNGS OR SPINE
  10. SHORT
    • (difficult cricothyrotomy)
    • SURGERY IN PAST (SCAR)
    • HEMATOMA OR EXPANDING INFECTION
    • OBESITY
    • RADIATION THERAPY
    • TUMOR
  11. LEMONS
    • LOOK EXTERNALLY (beard, bullneck, large tongue)
    • EVALUATE 3-3-2
    • MALLANPATI
    • OBSTRUCTION (organic or foreign body)
    • NECK MOBILITY (c-collar, disease process, injury, ect)
    • SCENE, SPACE, SKILL
  12. PREPARE
    • 1. suction (hooked up and turned on)
    • 2. intubating equipment
    • 3. oxygen
    • 4. multiple sized tubes
    • 5. EGDs
    • 6. medications
    • 7. monitoring equipment
    • 8. confirmation equipment
    • (bvm w/ EtCO2 attached, commercial tube holder behind head)
  13. PRETREATMENT
    • You are NOT going to do this in MedCom exam!
    • A. defasiculating paralytic - to limit fasciculation - from sucs/post procedure discomfort - vec or roc @ 10% dose
    • B. lidocaine 1mg/kg 5 min prior to pre-intubation sedation
    • C. atropine for PEDs - 0.02 mg/kg (mind dose 0.1mg)
    • D. fentanyl - enhance sedative effect and possibly prevent increase in ICP during intubatioin
Author
thom.mccusker@gmail.com
ID
325781
Card Set
MedCom
Description
T3 Medical Command study cards.
Updated