Rapid Sequence Intubation: Medications, dosages, and ...
[Pages:4]Rapid Sequence Intubation: Medications, dosages, and recommendations
Timeline
of
Rapid
Sequence
Intubation
S
Zero
Minus
10
Minutes
Zero
Minus
5
Minutes
Zero
Minus
3
Minutes
Zero
Zero
plus
20-- 30
seconds
Zero
plus
45
seconds
1.
Preparation
7.
Post-- intubation
management
2.
Preoxygenation
3.
Pretreatment
4.
Paralysis/
Induction
5.
Positioning
6.
Placement
with
proof
1. Preparation
?
Assemble
all
necessary
equipment,
drug,
etc.
2. Preoxygenation
?
Replace
the
nitrogen
in
the
patient's
functional
reserve
with
oxygen
?
"nitrogen
wash
out
?
oxygen
wash
in"
3. Pretreatment
?
Ancillary
medications
are
administered
to
mitigate
the
adverse
physiologic
consequences
of
intubation
4. Paralysis
with
induction
?
Administer
sedative
induction
agent
via
IV
push,
followed
immediately
by
administration
of
paralytic
via
IV
push
5. Positioning
?
Position
patient
for
optimal
laryngoscopy;
Sellick's
maneuver,
if
desired,
is
applied
now
6. Placement
with
proof
?
Assess
mandible
for
flaccidity;
perform
intubation,
confirm
placement
7. Post--intubation
management
?
Long--term
sedation/analgesia/paralysis
as
indicated
Pre--treatment
?
agents
should
be
given
3
minutes
prior
to
intubation
(can
be
given
in
any
order)
Drug
Dose
Indication
Other
notes
Lidocaine
100
mg
Head
injury,
traumatic
Lidocaine
will
help
brain
injury,
unknown
protect
the
patient
mechanism
of
injury,
from
increases
in
elevated
ICP
intracranial
pressure
caused
by
intubation
Fentanyl
2--3
mcg/kg
Elevated
ICP,
Fentanyl
helps
decrease
cardiovascular
disease
catecholamine
(ischemic
coronary
discharge
secondary
to
disease,
aneurismal
intubation,
thus
disease,
great
vessel
decreasing
the
risks
rupture
or
dissection,
associated
from
BP
intracranial
increases
in
pts
with
CV
hemorrhage)
disease,
aortic
dissections,
etc.
Be
careful
if
the
patient
is
already
hypotensive
Rocuronium
0.1
mg/kg
Head
injury,
traumatic
Defasciculation
no
(defasciculation)
(e.g.,
7
mg
in
a
70
kg
pt)
brain
injury,
unknown
longer
routinely
mechanism
of
injury,
recommended.
May
elevated
ICP
consider
if
pt.
w/head
injury
to
be
paralyzed
with
succinylcholine
(SCh).
SCh
causes
transient
muscle
fasciculation
(twitch)
which
theoretically
may
increase
intracranial
pressure.
Summary
of
Induction
Agents
Agent
Usual
Onset
Duration
Emergency
(sec)
of
Action
Induction
(min)
Dose
Thiopental
3
mg/kg
IV
5d
after
burn,
crush,
denervation,
severe
infection
Adverse
Effects
Hyperkalemia
Muscle
fasciculations
Elevated
IOP
Comments
Bradycardia
may
occur
after
repeated
doses,
have
atropine
ready
in
the
event
it
occurs
Paralytic
Summary
?
Nondepolarizing
Agent
Usual
Onset
Duration
Indications
Emergency
(sec)
(min)
Induction
Dose
Rocuronium
1
mg/kg
60--75
40--60
RSI
when
succinylcholine
contraindicated
Vecuronium
0.01
mg/kg
120-- priming
dose
180
followed
3
minutes
later
with
0.15
mg/kg
45--65
Not
recommended
for
RSI
unless
a
nondepolarizing
agent
is
indicated
and
rocuronium
is
not
available
Adverse
Effects
Comments
No,
clinically
significant
ADEs
No
clinically
significant
ADEs
Ensure
contingency
plan
in
place
in
the
event
of
failed
airway
Ensure
contingency
plan
in
place
in
the
event
of
failed
airway
................
................
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