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Day 4 |
Assignment white, chapter 20 page 418 to 422Egan, chapter 36 page 758 to 764Egan workbookChapter 36 page 253 to 255Intubation Drugs, sedativeMidazolam(generic name):Versed(trademark name), :used most often:Slower onset (3 to 5) minutes than barbituates/hyonotic agents1mg/ml = 0.1% solutionIntubation Drugs- SedativeShort acting (30 to 60 min)Does not increase ICPCauses respiratory and cardiovasuclar depressionIntubation Drugs- sedativeLorazapam(generic name):ativan:is used in the treatment of anxiety disorders and for short term (up to 4 months) of relief of the symptoms of anxiety:most common sedative used for ventilator and ICU patients:classified as a benzodiazepineSuccinylcholine : Paralytic:stimulates nicotinic: muscarinic cholinergic receptors:GOLD STANDARDS FOR 50 YEARS:fast onset 45 seconds, short duration 8 to 10 minutes100mg/ml = 10% solution Intubation Drugs: Paralytic:pancuronium::Pavulon::Slow onset 1 to 5 minutes::long duration agent 45 to 90 minutes::renal excretion::Vagolytic, tachyarrythmias commonStimulating a vagus nerve causes bradycardia, so by blocking the vagus nerve with this drug, tachyarrythmias are common10mg/10ml = 0.1%Intubation Drugs: sedativeEtomidate:etomidate (amidate), a non barbiturate hypnotic:decrease ICP/IOP:Rapid onset, short duration:minimal hemodynamic effectsIntubation Drugs: sedative:Diprivan::(propofol)::general anesthesia,::Intravenous anesthetic::Ventilator Management::ICU sedation:::Sedation vacationConscious sedation, minimally depressed is VS every 15 minutesDeep sedation, is vital signs every 5 minutesGeneral anesthesia is VS q5minutesOrotracheal intubation:Ventilate the patient with bag valve mask:Intubation attempt should take no longer than 30 secs:If unsuccessful, then ventilate again with bag and mask for 3 to 5 minutes:Insert laryngoscope::hold in left hand::inset in right side of mouth::displace tongue toward centerOrotracheal intubation:Visualize glottis and displace epiglottis:insert the ETT Tube::Do not use the laryngoscope blade to guide tube::Once you see the tube pass the glottis, advance the cuff past the cords by 2 to 3 cms:Hold tube with right hand:Remove laryngoscope then stylet:inflate cuff with approximately 10 cc of air:Manually ventilate the patient with a manual resuscitator (BVM)Orotracheal intubation:Assess tube position::Auscultation(stethoscope) of chest and epigastic::cm mark at teeth, usually 22 or 23 cm for adults::Capnometry/colorimetry (all intubation):stabalize tube/confirm placement::fiberoptic laryngoscope gives bedside confirmation::Chest x ray:Request ABC 20 to 30 minutes after ventilator initiation |
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