0071643192.pdf

PLACEMENT OFTUBE(INTUBATION)

Postintubation Management

■ Sedation with benzodiazepines or propofol to minimize agitation

■ Pain control with narcotics to blunt sympathetic response to being intubated

■ Paralysis if needed for patient control during imaging or invasive procedures

RESUSCITATION

TABLE 1.3. Pretreatment Medications for Rapid Sequence Intubation

DRUG MECHANISM INDICATION

Lidocaine ↓Intracranial pressure (ICP) ↑ICP

↓Bronchospastic response ↑Intraocular pressure (IOP)

to intubation Reactive airway disease

Fentanyl ↓Sympathetic response to ↑ICP

intubation Intracranial bleed or

aneurysm

Heart disease

Aortic dissection

Atropine ↓Bradycardia due to < 10 years old

succinylcholine

↓Bronchorrhea due to

ketamine

Defasciculating ↓ICP response to ↑ICP/IOP

dose of: Vecuronium, succinylcholine

pancuronium,or

rocuronium

TABLE 1.4. Induction Medications for Rapid Sequence Intubation

DRUG CLASS BENEFIT SIDEEFFECT

Etomidate Imidazole derivative ↓ICP Brief myoclonus

Hemodynamically stable

Ketamine PCP derivative Bronchodilator ↑Secretions

Dissociative amnesia ↑ICP

Short acting Emergence phenomenon

Midazolam Benzodiazepine ↓ICP Negative inotropy →

hypotension.

Thiopental Barbiturate ↓ICP Negative inotropy and

vasodilation→

hypotension.