0071643192.pdf

COMPLICATIONS

■ Broken teeth
■ Laryngospasm
■ Mainstem intubation

A patient who was unable to escape a burning building that collapsed on

him 3 days ago is decompensating and developing respiratory failure.

What paralytic would you use for intubation?

A nondepolorizing agent (eg, vecuronium, rocuronium) should be used.

Upregulation of acetylcholine receptors in the setting of recent (3 days to 6 months)

burns or crush injury may lead to exaggerated K+release and hyperkalemia with the

use of succinylcholine.

RAPIDSEQUENCEINTUBATION

PREPARATION

■ Monitors, IV, equipment
■ Positioning of patient

PREOXYGENATION

■ Three minutesof 100% O 2 or six vital capacity breaths.

PRETREATMENT

■ Pretreatment medications include lidocaine, opioid, atropine and defascic-
ulating agent (LOAD).
■ Indications for pretreatment medications include (see Table 1.3):
■ ↑Intracranial or intraocular pressure (lidocaine, opioid, defasciculating
agent)
■ Mitigate tachycardic response to intubation in dissection, CAD (opioid).
■ Mitigate bronchospasm with laryngoscopy (lidocaine).
■ Prevent reflex bradycardia in the pediatric age group (atropine).
■ Administer approximately 3 minutes before induction medications.

Paralysis with induction:

■ Administer induction medication (see Table 1.4), then paralytic (see
Table 1.5).
■ Avoid succinylcholine in patients who may have preexisting hyperkalemia
(eg, patient with ESRD).
■ Also avoid succinylcholine in patients at risk for succinylcholine-induced
hyperkalemia.
■ Neuromuscular diseases (eg, ALS, muscular dystrophy)
■ Skeletal muscle denervation (stroke, spinal cord injury): Of <6 months
■ Multiple trauma: From day 3 to 6 months
■ Major burns: From day 2 to 6 months
■ Prolonged abdominal sepsis >3 days

RESUSCITATION

6 P’s of RSI:

Preparation

Preoxygenation

Pretreatment

Paralysis with induction

Placement of tube

Postintubation

management

Pretreatment

medications—

LOAD

Lidocaine

Opioid

Atropine

Defasciculator

Risk of hyperkalemia with

succinylcholine if:

Neuromuscular disease

Denervation disease

Crush injury

Major burn

Prolonged abdominal sepsis