Rapid Sequence Intubation (RSI) Flashcards

Vocabulary flashcards covering key terms, mnemonics, dosages, and concepts from the Rapid Sequence Intubation (RSI) lecture.

Rapid Sequence Intubation (RSI)

An advanced airway management procedure involving the administration of an induction agent to induce unconsciousness followed by a neuromuscular blocking agent (paralytic) to facilitate endotracheal intubation.

Induction Agent

A pharmaceutical agent administered during RSI to provide rapid sedation and unconsciousness prior to paralysis.

Neuromuscular Blocking Agent (NMBA)

A paralytic pharmaceutical agent administered during RSI to produce complete body-wide muscle paralysis.

Facilitated Intubation

An intubation procedure that uses sedation alone without the co-administration of a paralytic agent.

MOANS Criteria

A mnemonic used to evaluate potential difficulty with bag-valve-mask ventilation: Mask seal, Obesity/obstruction, Age (> $55$\,years), No teeth, and Stiff lung/snoring history.

LEMON Criteria

A mnemonic used to assess the potential difficulty of direct laryngoscopy and intubation: Look externally, Evaluate ($3\text{-}3\text{-}2$ Rule), Mallampati score, Obstruction, and Neck mobility.

3-3-2 Rule

An airway evaluation method where $3$ parallel fingers fit in the patient's mouth opening, $3$ parallel fingers fit under the chin, and $2$ fingers fit between the thyroid notch and hyoid bone.

Mallampati Score

An assessment that scores the visual space within the oral cavity based on the ability to view the soft palate, uvula, and oropharynx relative to tongue size.

Upper Lip Bite Test (ULBT)

An alternative airway assessment graded Class I, Class II, or Class III based on how far the lower incisors can cover or touch the mucosa of the upper lip.

SHORT Criteria

A mnemonic used to evaluate potential difficulty when performing a surgical airway: Surgery, Hematoma, Obesity, Radiation, and Tumor.

Nitrogen Washout

A pre-oxygenation process replacing nitrogen gas in the lung's functional residual volume with oxygen, increasing the patient's $PaO_2$ and delaying desaturation.

LOAD Mnemonic

A mnemonic representing pre-treatment drugs administered prior to RSI: Lidocaine, Opioid analgesic, Atropine, and Defasiculating agent.

Lidocaine

A pre-treatment drug administered at $1.5\,mg/kg$ IV to suppress cough and gag reflexes, decrease ICP spikes, decrease MAP spikes, and attenuate bronchospasm.

Rigid Chest Syndrome

A potential complication caused by rapid or high-dose administration of opioid analgesics like fentanyl, causing severe chest wall rigidity.

Atropine

A pre-treatment drug given at $0.02\,mg/kg$ IV, primarily in pediatric patients, to counter laryngoscopy-induced bradycardia and decrease airway secretions.

Defasiculating Agent

A small dose ($10\%$ of full dose) of a non-depolarizing NMBA given to prime the body, accelerate full paralysis, and minimize succinylcholine-induced fasciculations.

Midazolam (Versed)

A benzodiazepine induction agent administered at $0.2\text{--}0.3\,mg/kg$ IV with an onset of $30\text{--}90\,seconds$ that provides amnesia, sedation, hypnosis, and anticonvulsant effects.

Lorazepam (Ativan)

A benzodiazepine induction agent administered at $0.03\text{--}0.06\,mg/kg$ IV with an onset of $1\text{--}2\,minutes$ and duration of $1\text{--}2\,hours$.

Etomidate (Amidate/Hypnomidate)

A hemodynamically stable anesthetic induction agent given at $0.2\text{--}0.6\,mg/kg$ IV (induction dose $0.3\,mg/kg$) with an onset of $15\text{--}45\,seconds$ and duration of $3\text{--}12\,minutes$.

Ketamine (Ketalar/Ketaset)

An anesthetic induction agent given at $1\text{--}2\,mg/kg$ IV providing bronchodilation, analgesia, and amnesia, but capable of raising already elevated ICP, IOP, or MAP.

Propofol (Diprivan)

A fast-acting anesthetic induction agent given at $1\text{--}2\,mg/kg$ IV with an onset of $15\text{--}45\,seconds$ that decreases ICP and cerebral oxygen demand, but can induce vasodilation and hypotension.

Succinylcholine (Anectine)

A depolarizing neuromuscular blocking agent given at $1\text{--}2\,mg/kg$ IV with an onset of $< 60\,seconds$ and duration of $5\,minutes$ that rapidly depolarizes the motor endplate.

Malignant Hyperthermia

A life-threatening hypermetabolic reaction to succinylcholine presenting with rapidly increasing end-tidal $CO_2$, masseter muscle spasm, hyperkalemia, cardiac arrest, and high fever.

Dantrolene Sodium (Dantrium)

The specific antidote medication for malignant hyperthermia, administered at an initial dose of $2.5\,mg/kg$ and repeated up to $10\,mg/kg$.

Rocuronium (Zemuron)

A non-depolarizing neuromuscular blocking agent given at $0.6\text{--}1.2\,mg/kg$ IV for intubation, featuring an onset of $< 2\,minutes$ and duration of $30\text{--}60\,minutes$.

Pancuronium (Pavulon)

A non-depolarizing neuromuscular blocking agent given at $0.1\,mg/kg$ IV for intubation with an onset of $1\text{--}2\,minutes$ and duration of $45\text{--}60\,minutes$.

Vecuronium (Norcuron)

A non-depolarizing neuromuscular blocking agent given at $0.15\,mg/kg$ IV for intubation with an onset of $90\text{--}120\,seconds$ and duration of $60\text{--}75\,minutes$.

Sniffing Position

An anatomical posture aligning the oral, pharyngeal, and laryngeal axes achieved by elevating the head $5\text{--}10\,cm$ ($2\text{--}4\,inches$) and extending the neck.

BURP Maneuver

An external laryngeal manipulation technique involving Backward, Upward, Rightward, Pressure applied to improve vocal cord visualization during laryngoscopy.

Primary Confirmation (Intubation)

Subjective post-intubation verification methods including seeing the tube pass the vocal cords, hearing bilateral lung sounds, absence of epigastric sounds, and equal chest rise and fall.

Secondary Confirmation (Intubation)

Objective post-intubation verification methods including continuous positive end-tidal carbon dioxide ($ETCO_2$) readings, pulse oximetry, and esophageal bulb syringe devices.