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  • Airway-RSI Pocket Card

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    bellerevolte
    235 просмотров4 страницы
    This document outlines the "7 Ps of RSI" which refers to the steps for performing rapid sequence intubation (RSI). The steps include: 1) preparation of necessary equipment and medications, 2) preoxygenation of the patient, 3) pretreatment medications to reduce sympathetic response, 4) paralysis and induction, 5) protection of the airway with a Sellick maneuver, 6) placement of the endotracheal tube, and 7) post-intubation management and ventilation. Contraindications for succinylcholine and dosing guidelines for different patient types (standard, increased ICP, asthma/COPD, pediatric) are also provided.

    Исходное описание:

    RSI protocol for Emergency Medicine

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    This document outlines the "7 Ps of RSI" which refers to the steps for performing rapid sequence intubation (RSI). The steps include: 1) preparation of necessary equipment and medications, 2) preoxygenation of the patient, 3) pretreatment medications to reduce sympathetic response, 4) paralysis and induction, 5) protection of the airway with a Sellick maneuver, 6) placement of the endotracheal tube, and 7) post-intubation management and ventilation. Contraindications for succinylcholine and dosing guidelines for different patient types (standard, increased ICP, asthma/COPD, pediatric) are also provided.

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    © All Rights Reserved
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    Отметить как неприемлемый контент
    235 просмотров4 страницы

    Airway-RSI Pocket Card

    Загружено:

    bellerevolte
    This document outlines the "7 Ps of RSI" which refers to the steps for performing rapid sequence intubation (RSI). The steps include: 1) preparation of necessary equipment and medications, 2) preoxygenation of the patient, 3) pretreatment medications to reduce sympathetic response, 4) paralysis and induction, 5) protection of the airway with a Sellick maneuver, 6) placement of the endotracheal tube, and 7) post-intubation management and ventilation. Contraindications for succinylcholine and dosing guidelines for different patient types (standard, increased ICP, asthma/COPD, pediatric) are also provided.

    Авторское право:

    © All Rights Reserved
    Скачайте в формате PDF, TXT или читайте онлайн в Scribd
    Отметить как неприемлемый контент
    из 4

    AIRWAYMANAGEMENT:

    7PsofRSI
    1. Preparation:
    a. Monitorpulseoximetry,bloodpressure(BP),cardiacrhythm
    b. Atleastonefunctioning(IV)line(preferablytwo)
    c. BVM,Yankauersuction,endtidalcarbondioxide(CO)capnography
    d. Functioninglaryngoscopewithbladeofchoice
    e. Endotrachealtube[man:8.0mm,woman7.0mminternaldiameter
    (ID);pediatric:uselengthbased(Broselowtape)systemorrough
    guide[fourplusage(inyears)dividedby4],checkcuff,loadand
    shapestylet,10mLsyringe
    f. AllRSImedicationsreadytobeadministered
    g. Assessforpossibledifficultairway
    2. Preoxygenation:
    a. 3minutesofnormaltidalvolumebreathingoreightvitalcapacity
    breathswith100%oxygen(O)[usenonrebreathing(NRB)oxygen
    maskif100%Osourcenotavailable]:preventsdesaturationduring
    intubation
    3. Pretreatment:
    a. Lidocaine1.5mg/kgIVreducesintracranialandbronchospastic
    responsetolaryngoscopyinpatientswithelevatedintracranial
    pressure(ICP)orreactiveairwaydisease
    b. Fentanyl3g/kgIV(over1minute)reducessympatheticresponse
    [elevatedheartrate(HR)andbloodpressure(BP)]tointubationin
    patientswithelevatedICP,intracranialhemorrhage,cardiac
    ischemia,oraorticdissection
    c. Vecuroniumbromide0.01mg/kgIV(orpancuroniumbromide)
    bluntsICPelevationcausedbysuccinylcholineinpatientswith
    elevatedICP
    d. Atropine:Considerpretreatmentwithatropineinchildrenunderage
    one

    4. Paralysiswithinduction:
    a. Oneofthefollowinginductionagents(orequivalent)givenrapidIV
    pushpriortoparalysis:
    i. Etomidate0.3mg/kgIV
    ii. Midazolam0.3mg/kgIV
    iii. Ketaminehydrochloride1.5mg/kgIV
    iv. Propofol12mg/kgIV
    b. ParalyticagentbyIVpushimmediatelyafterinductionagent:
    i. Succinylcholine1.5mg/kgIV
    ii. Rocuronium1mg/kgIVifsuccinylcholinecontraindicated(see
    tablebelow)
    5. Protection:
    a. Sellickmaneuver(firmpressureoncricoidcartilagetopreventgastric
    regurgitation)shouldbeappliedassoonasconsciousnesslapsesandbe
    maintainedthroughoutintubationuntiltubeplacementconfirmed
    6. Placement:
    a. Insertendotrachealtubewithdirectvisualizationofthevocalcords
    b. Inflatecuff
    c. ConfirmendotrachealtubeisinthetracheausingendtidalCO
    capnography
    d. Auscultatelungsbilaterallytoensurerightmainstemintubationhasnot
    occurred
    e. Secureendotrachealtubewithtape
    f. ReleaseSellickmaneuver
    7. Postintubationmanagement:
    a. Chestxraytoassessplacementofendotrachealtube(tipshouldbeat
    midtrachea)
    b. Longactingsedativesand,ifnecessary,paralytics
    i. Lorazepam0.05mg/kgIVforsedation
    ii. Vecuronium0.1mg/kgIVforparalysis
    c. Initiatemechanicalventilation
    d. Sedative:Propofolbolus/drip

    Succinylcholinecontraindications
    Hyperkalemia
    Burn>10%bodysurfacebeyond72handlessthan6mo
    Paralysisbeyond3dandlessthan6mo
    Denervationsyndromeuntilinactivefor6mo
    Crushinjurybeyond3dandlessthan6mo
    Abdominalsepsisbeyond3d
    Increasedintraocularpressure(i.e.,penetratingglobeinjury)
    Historyofmalignanthyperthermia
    Musculardystrophy,multiplesclerosis,andamylotrophiclateralsclerosisalways
    contraindicated

    RISstandardpatient(70kg)
    100%oxygen(3minor8VCbreaths)
    Etomidate20mgIV
    Succinylcholine100mgIV
    WAIT45S
    Intubation
    RSI,rapidsequenceintubation;VC,vitalcapacity;IV,intravenous.

    RSIpatientwithincreasedICP(70kg)
    100%oxygen(3minor8VCbreaths
    Lidocaine100mgIV
    Vecuronium1mgIV
    Fentanyl200gIV
    WAIT3MIN
    Etomidate20mgIV
    Succinylcholine100mgIV
    WAIT45S
    Intubation
    RSI,rapidsequenceintubation;ICP,intracranialpressure;VC,vitalcapacity;IV,
    intravenous.

    RSIasthma/COPDpatient(70kg)
    100%oxygen(3minor8VCbreaths)
    Lidocaine100mgIV
    WAIT3MIN
    Ketamine100mgIV
    Succinylcholine100mgIV
    WAIT45S
    Intubation
    RSI,rapidsequenceintubation;VC,vitalcapacity;IV,intravenous;COPD,chronic
    obstructivepulmonarydisease.

    RSIpediatricpatient(<10yold)
    100%oxygen(3minor8VCbreaths)
    Atropine0.02mg/kgIV
    WAIT3MIN
    Etomidate0.3mg/kgIV
    Succinylcholine2mg/kgIV
    WAIT45S
    Intubation
    RSI,rapidsequenceintubation;VC,vitalcapacity;IV,intravenous;

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