Adult RSI Questions - Sites@Duke | sites.duke.edu



Adult RSI QuestionsAll of the following can induce unconsciousness EXCEPT for:a.A benzodiazepine such as midazolam or ativanb.A narcotic such as fentanylc.Etomidated.Succinylcholinee.PropfolWhile it may not be the perfect maneuver, the goal of cricoid pressure during RSI is to:a.Prevent aspiration of gastric contentsb.Improve the larygnscopic view for the intubating providerc.Cause constriction of the lower esophageal sphincterd.Improve the chances of intubatione.Prevent ventilation of the stomachA patient with hypercarbic respiratory failure and end stage renal disease requires intubation. His airway appears normal. Hb is 8.5 g/dL. Creatinine is 6.7 and the patient had hemodialysis this morning. Potassium is 6.0. Oxygen saturation is 95% with assisted ventilation via an Ambu bag. BP is 90/40, HR 100. Which of the following drug combinations is most appropriate for RSI in this patient? a.Etomidate/rocuroniumb.Propofol/rocuroniumc.Midazolam/succinylcholined.Etomidate/succinylcholinee.None needed, this is an emergencyWhich of the following is a contraindication to LMA placement?a.Inability to secure an airway with an endotracheal tubeb.A patient that is vomitingc.Difficulty with ventilation after giving a neuromuscular blockerd.A patient with severe gastroesophageal reflux diseaseCorrectly identify the pictured item: a.Glidescopeb.Bougiec.Mac laryngoscoped.Miller laryngoscopee.McGrath bladeYou proceed with intubation and upon direct laryngoscopy you see the epiglottis and the posterior tips of the vocal cords. This would be classified as which grade view: a.1b.2c.3d.4e.5If an RSI dose of rocuronium is used to facilitate intubation, you would expect this drug to begin wearing off after approximately:a.10 – 15 minutesb.20 – 40 minutec.45 – 70 minutesd.70 – 100 minutesAfter inducing and paralyzing a patient with head trauma, you note emesis in the posterior oropharynx but can see the vocal cords. You suction the mouth. Oxygen saturation is 97%. Other vital signs are stable. The most appropriate next step is to: a.Remove the laryngoscope blade and mask ventilateb.Intubate the patient and ventilate with 100% oxygen c.Intubate the patient, suction the airway, then ventilate with 100% oxygend.Awaken the patient and perform an awake fiberoptic intubatione.Awaken the patient, place a naso-gastric tube, then attempt RSI againCorrectly identify the pictured item: a.Laryngeal Mask Airwayb.Bougiec.Mac laryngoscoped.Miller laryngoscopee.McGrath bladeAll of the following patients would be considered a “full stomach” and require an rapid sequence induction EXCEPT:a.60% BSA burns 6 weeks agob.Ate at a fast food restaurant 6 hours agoc.28-weeks pregnantd.NPO for 48 hours due to small bowel obstructione.Hiatal hernia requiring treatment with both proton pump inhibitors and histamine receptor blockersFollowing an MVC, a patient with a sub-arachnoid hemorrhage, unequal pupils, and who is non-responsive, requires intubation for surgical decompression. His airway looks normal and he has no facial trauma. An ABG on room air shows pH 7.32, pCO2 30, pO2 82, Hb 9.5, lactate 3.5, Na+ 138, K+ 6.0. Creatinine is 2.0. In order to establish muscle relaxation, the most appropriate neuromuscular blocking agent for this patient is: a.Succinylcholineb.Pancuroniumc.Rocuroniumd.Vecuroniume.CisatracuriumAll of the following are essential components to a typical, uncomplicated rapid sequence intubation EXCEPT: a.Patient preparationb.Preoxygenationc.Induction of unconsciousnessd.Muscle relaxatione.Mask ventilation when apneicf.SuctionCorrectly identify the pictured item: a.Glidescopeb.Bougiec.Mac laryngoscoped.Miller laryngoscopee.McGrath bladeYou are providing sedation for an ICU procedure. Five minutes after starting, the patient begins to snore, soon after which you note the lack of air movement from the patient and his oxygen saturation falls to 88%. The FIRST thing you should do is:a.Intubateb.Place an LMAc.Mask ventilation with 100% oxygend.Nothing, 88% is not too abnormale.Tap the patient on the shoulder and call his nameWhat is the typical intubating dose for rocuronium in adults if used for RSI? a.0.3 mg/kgb.2 mg/kgc.8mgd.1.2 mg/kgYou place an endotracheal tube following an RSI. Which of the following is the MOST accurate for confirmation of proper endotracheal tube placement?a.Fiberoptic bronchoscopyb.End-tidal CO2 monitorc.Auscultationd.Direct visualization of endotracheal tube through the cordse.Esophageal detection deviceWhich of the following is NOT an acceptable method for confirmation of endotracheal tube position:a.CXRb.ETCO2 detectionc.Bilateral breath sounds on auscultationd.Suction catheter easily passed through ETT?When preparing for endotracheal intubation, the ‘sniffing position’ aligns all of the following axes except:a.Pharyngealb.Oralc.Tracheal?d.LaryngealCorrectly identify the pictured item: a.Glidescopeb.Bougiec.Mac laryngoscoped.Miller laryngoscopee.McGrath bladeYou are assessing a patient’s airway before proceeding with an intubation. The patient opens his mouth, protrudes the tongue, you can only see the soft palate and maybe a bit of the uvula. This patient’s Mallampati class is:a.Ib.IIc.IIId.IVe.VAn induction drug and neuromuscular blocker are given for an RSI and you notice muscle fasciculations approximately 30 seconds later. The drug MOST likely to cause this finding is: a.Rocuroniumb.Etomidatec.Fentanyld.Succinylcholinee.PropofolA 51-year-old man is brought to the ED after a stab wound to the right upper quadrant. He is confused and incoherent. He appears pale, diaphoretic, and his abdomen is enlarged and tense. His vital signs are: HR 140, BP 85/55, RR 30, oxygen saturations 91% on 4 liters nasal cannula. Which of the following drugs would NOT be appropriate for intubating this patient?a.Ketamineb.Succinylcholinec.Etomidated.Rocuroniume.Propofolf.MidazolamCorrectly identify the pictured item: a.Glidescopeb.Laryngeal Mask Airwayc.Bougied.Oral airwaye.Nasal airwayAll of the following are predictors of difficult mask ventilation EXCEPT:a.Age < 40 yearsb.Presence of a beardc.BMI ≥ 30d.Edentulouse.History of obstructive sleep apneaWhat is the standard intubating dose of?etomidate? a.0.3 mg/kgb.2 mg/kgc.8mgd.1.2 mg/kge.2 mg/kgA patient with renal failure presents to the ED with respiratory distress likely due to a severe pneumonia and requires intubation. He is on an ACE-inhibitor has a creatinine of 5.8. He is intubated with etomidate and succinylcholine. The patient develops ventricular fibrillation after intubation and CPR is immediately started. Following defibrillation and drugs appropriate for cardiac arrest, which of the following would be the best option for the immediate treatment of the likely cause of ventricular tachycardia? a.Dialysisb.Beta-blockers and aspirinsc.Coronary artery stent placementd.Intravenous calciume.PeriocardiocentesisIn patients that have suffered trauma and are placed in cervical collars, the essential components of your primary plan for intubation include all of the following EXCEPT: a.Suctionb.Sniffing positionc.Position patient at head of the bedd.Supplemental oxygen with mask and ambu-bage.An assistantWhich of the following induction agents most reliably maintains hemodynamic stability during an RSI? a.Propofolb.Etomidatec.Lorezepamd.Thiopentale.MidazolamThe typical adult dose of succinylcholine for RSI is: a.0.5 mg/kgb.1 mg/kgc.2 mg/kgd.2.5 mg/kge.3 mg/kg Which of the following sedatives dose not provide any analgesia:a.Ketamineb.Demedetomidinec.Fentanyld.PropofolA 62-year-old patient is admitted for suspected sepsis due to a urinary track infection. On morning rounds, she is found to be lethargic, minimally responsive to questioning, and diaphoretic. His vital signs are HR 114, BP 76/45, RR 25, oxygen saturation 92% on 4 L nasal cannula O2.Which induction agent may be considered the LEAST desirable for this patient with regards to his hemodynamic status? a.Etomidateb.Propofolc.Midazolamd.Ketaminee.FentanylCorrectly identify the pictured item: a.Glidescopeb.Laryngeal Mask Airwayc.Bougied.Oral airwaye.Nasal airway Succinylcholine is contraindicated for which of the following patients?a.A patient who requires an RSI after a motor vehicle accidentb.A patient who presents 2 hours after a burn injuryc.A patient with a small bowel obstructiond.A patient with a history of malignant hyperthermiae.A patient who develops hypoxemic respiratory failure and ate a meal 3 hours agoFollowing intubation with propofol and rocuronium, a patient in the medical ICU is hypotensive to 76/56 with a heart rate of 98. Phenylephrine 100mcg is given but this does not improve the blood pressure, and now his BP is 50/20, heart rate is 40 and irregular, and oxygen saturation is now 84% by pulse oximetry. You are hand ventilating with 100% oxygen and his lungs feel less compliant and it appears his skin is developing a rash on the chest. The most appropriate next drug to administer is:a.Ketamine 2 mg/kgb.Ephedrine 1 mgc.Epinephrine 0.5 mgd.Atropine 0.5 mge.Phenylephrine200 mcgf.Vasopressin 1 unitA 32 you man sustained a spinal cord injury 10 years ago and is now a quadriplegic. He was admitted to the medicine service due to fatigue, malaise, fever, and foul smelling, dark-colored urine. He needs to be intubated due to respiratory failure. Approximately 45 seconds after the induction drug and paralytic are given, you note muscle fasciculations. Seconds after successfully confirming endotracheal tube placement, the patient develops ventricular tachycardia and no pulse is appreciated. CPR is initiated. The MOST LIKELY cause of this arrhythmia is: a.Hyperkalemiab.Myocardial ischemiac.Hypoxia d.Cardiac tamponadee.Ketamine overdoseCorrectly identify the pictured item: a.Glidescopeb.Laryngeal Mask Airwayc.Bougied.Oral airwaye.Nasal airwayYou perform an RSI, induce and paralyze a patient with appropriate drugs, your assistant holds cricoid pressure, and you attempt to intubate. However, you can only see the epiglottis. You reposition the head and increase the size of the laryngoscope blade but on the second attempt you still cannot see the vocal cords. Now the oxygen saturation has fallen to 83%. At this point you should: a.Give epinephrine 10 mcg bolus, repeat if neededb.Mask ventilate the patientc.Emergency cricothyroidotomyd.Start jet ventilation e.Place an LMAFull preoxygenation will provide how many minutes of oxygen saturation above 90% after a healthy patient is rendered apneic? a.1 minb.2 minc.4 mind.8 mine.16 minWhat is the proper order of events for a rapid sequence intubation?a.Preoxygenation, Positioning, Inducation agent, Paralytic, Intubate, Cricoid Pressure, Confirm intubationb.Positioning, Preoxygenation, Cricoid pressure, Induction agent, Paralytic, Intubate, Confirm intubationc.Positioning, Preoxygenation, Induction agent, Cricoid pressure, Paralytic, Intubate, Confirm intubationd.Positioning, Preoxygenation, Paralytic, Induction agent, Cricoid pressure, Intubate, Confirm intubatione.Positioning, Preoxygenation, Induction agent, Paralytic, Intubate, Cricoid pressure, Confirm intubationAfter performing an RSI for an otherwise healthy 32 year old patient who is experiencing severe influenza pneumonia, you note the blood pressure to be 68/45 and the heart rate is still 100 bpm. Which drug would be most appropriate to give next?a.Ketamine2 mg/kgb.Ephedrine 1 mgc.Epinephrine 0.5 mgd.Atropine0.5 mge.Phenylephrine100 mcgf.Vasopressin 1 unit ................
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