In the hospital setting, what is the gold standard for ETT confirmation? -
ANSWER--Chest X-Ray
What should you expect to see on a chest X-Ray if your ETT is in the
right position? - ANSWER--Distal tip of ETT should be 2-3 cm from the
carina or 1" above the carina.
It should be at the level of the T2-T3 vertebrae.
What is the next most reliable confirmation method? - ANSWER-- Visual
confirmation of the tube passing through the vocal cords.
What is the gold standard of ETT placement in the prehospital setting? -
ANSWER--Waveform Capnograghy.
What should the pressure of the distal cuff be to prevent damage? -
ANSWER--25-30mmHg
What can lead to a false positive of capnography? - ANSWER--You can
get a false positive due to soda or beer belly for the colorimetric device.
What is a tube check? - ANSWER--It is placing a bulb over the ETT after
intubation to confirm placement. If the ETT is in the wrong place, the bulb
with not re-inflate.
End-tidal CO2 (ETCO2) - ANSWER--The measurement of CO2
concentration at the end of expiration
*Normal Range is 30-45 mmHg*
What is an EMMA Emergency Capnometer - ANSWER--A reusable
ETCO2 device that gives both CO2 and RR in the abscence of a cardiac
monitor.
,What is a normal expiratory plateau when measuring capnograpghy? -
ANSWER--35-45.
List the 7 P's of RSI. - ANSWER--1) Preparation
2) Preoxygenation
3) Pretreatment
4) Paralysis with induction
5) Protection and positioning
6) Placement with proof
7) Post intubation management
How long should you preoxygenate your patient prior to RSI and at what
oxygen concentration? - ANSWER--3-5 minutes, 10-15lpm if possible. `
Remember your gameplan using the A,B,C,D method. What does this
consist of? - ANSWER--A- Tube, B-Backup, C- Cric, D- Death.
If intubation is not working, how many things should you change? -
ANSWER--2.
What is the LOAD acronym? - ANSWER--L - Lidocaine (Head & Lung
Injury) Tight head, tight lung
O- Opiates (Blunts the pain response)
A- Atropine (Prevents reflexive bradycardia)
D- Diffisiculating Dose (small bumps of succs, roc, or vec)
is a depolarizing nueromuscular blocking agent. (NMBA) -
ANSWER--Succinycholine
, Succinylcholine usually causes ? - ANSWER--Muscle twitching or
fasiculations
What is the dose for Succinycholine? - ANSWER--1-2mg / kg.
What is the onset and duration for Succinycholine? - ANSWER--1-2
minute onset, 4-6 minute duration.
What are the contraindications for Succinycholine? - ANSWER--Crush
injuries, eye injuries, malignant hypothermia, burns.
Succinycholine can cause ? - ANSWER-- hyperkalemia
What are common signs of Maligant Hyperthermia? - ANSWER-- Spasm
or lock jaw (Trismus)
High fever (could be as high as 110.) Increased ETCO2
Tachycardia , Hypotension Sustained muscle contractions
How medication is used to treat Malignant Hyperthermia? - ANSWER--
Dantolene Sodium (Dantrium)
is a non depolarizing nueromuscular blocker with a duration of 30-
45 minutes. - ANSWER--Vecuronium.
What is the onset of Vecuronium? - ANSWER--4-6 minutes.
What can you do while administering Veccuronium to reduce ICP during
intubation? - ANSWER--Give a smaller defisiculating dose
is a non depolarizing nueromuscular agent with an onset of 1-2
minutes. - ANSWER--Rocuronium (Zemeron)
You must keep refrigerated, and the medication is good for up to 14
days. - ANSWER--Rocuronium
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