RSI
So we think we are big shots now that we can intubate, right!?!?! Well, think again.... Look at me here on my first day of the job as a paramedic, I knew my drug doses, I knew patients get 0.30 mg of etomidate per kilogram, and 2 mg/kg of succinylcholine for me to do my RSI/intubation, but apparently my supervisor was a little mad at me trying to intubate this patient:
I was just told in paramedic school that laughter is not always the key to healthy patients:
Drug's used in intubation:
Fentanyl- this can be use as a pretreatment for a pressure with ICP or pain
Lidocane- tight head, tight lungs, don't hesitate to use lidocane!
Etomidate- 0.3 mg/kg, this drug will take effect in 30-60 seconds and will only last 5-8 minutes, this is used to help sedate the patient.
Ketamine- Ketamine is another drug that can be used to sedate the patient. 1.5-2mg/kg.
Succinylcholine- 2 mg/kg, this drug is a paralytic and is depolarzing, don't be fooled, it will not work with bipolar patients like I once thought. Apparently the "doctors" and "pharmacists" meant it will depolarize the muscles. Don't use this in a burn patient post 24 hours of burn or on a crush patient greater then 4 hours of entrapment!
Vecuronium- 0.10-0.25 mg/kg, this is a nondepolarizing agent but will paralyse the patient for 30-60 minutes.
P^9
P to the power! Don't forget your p's before you intubate. I found out this had nothing to do with urination but rather a way to not screw up an intubation:
Pre-plan in your stations
Prepare- your drugs, personnel, placement, back up airways'
Protect c-spine
Preoxygentae
Position
Pretreat
Placement- Auscultation, ETC02
Proof
Post-intubation management.
 |
| If the patient is A&Ox4, GCS15, no signs of decompensating, we are not suppose to intubate. Thankfully I only got reprimanded a little for trying to intubate this one! |
I was just told in paramedic school that laughter is not always the key to healthy patients:
Why intubate:
- inability to control the airway
- GCS < 8
- risk of aspiration
- cardiac arrest
- swelling of the upper airway
- prolonged respiratory effort that results in failure or fatigue
- Pulmonary Edema (try CPAP first) or Pulmonary Embolism
- Facial trauma
This is just a little list, there could be other reasons to intubate as well, use your best judgement, if you think the patient will not maintain their own airway, or they will stop breathing, do not hesitate to do an RSI. But one must remember, the excuse that all patients eventually will stop breathing is not a reason to intubate, I learned the hard way on that one.
Drug's used in intubation:
Fentanyl- this can be use as a pretreatment for a pressure with ICP or pain
Lidocane- tight head, tight lungs, don't hesitate to use lidocane!
Etomidate- 0.3 mg/kg, this drug will take effect in 30-60 seconds and will only last 5-8 minutes, this is used to help sedate the patient.
Ketamine- Ketamine is another drug that can be used to sedate the patient. 1.5-2mg/kg.
Succinylcholine- 2 mg/kg, this drug is a paralytic and is depolarzing, don't be fooled, it will not work with bipolar patients like I once thought. Apparently the "doctors" and "pharmacists" meant it will depolarize the muscles. Don't use this in a burn patient post 24 hours of burn or on a crush patient greater then 4 hours of entrapment!
Vecuronium- 0.10-0.25 mg/kg, this is a nondepolarizing agent but will paralyse the patient for 30-60 minutes.
P^9
P to the power! Don't forget your p's before you intubate. I found out this had nothing to do with urination but rather a way to not screw up an intubation:
Pre-plan in your stations
Prepare- your drugs, personnel, placement, back up airways'
Protect c-spine
Preoxygentae
Position
Pretreat
Placement- Auscultation, ETC02
Proof
Post-intubation management.
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