Podcasts about rapid sequence intubation

On this special PodSwap Episode, you will be hearing from Nurse Mo from the Straight A Nursing Podcast! She does an amazing job breaking down all the pharmacology of medications we use for Rapid Sequence Intubation or RSI.Rapid sequence intubation, a procedure performed to emergently intubate a patient with an intact gag reflex in cases of acute respiratory failure and/or cardiovascular collapse. As a nurse working in the emergency department or ICU, you will be obtaining and may be administering the medications used to perform a rapid sequence intubation. Please be aware of your scope of practice and facility protocol regarding the administration of these medications. In some cases, the medications can only be administered by a physician.Which combination of medications the physician chooses will vary depending on a variety of factors including the patient's condition and physician preference. A common combination is a sedative with a short-acting paralytic, though analgesics may also be utilized. This episode provides an overview of the medications commonly utilized for RSI:PropofolSuccinylcholineRocuroniumVecuroniumEtomidateKetamineFentanylMidazolam___________________You can check out the following from Nurse Mo:Full Transcript – Read the article and view referencesFREE CLASS – If all you've heard are nursing school horror stories, then you need this class! Join me in this on-demand session where I dispel all those nursing school myths and show you that YES…you can thrive in nursing school without it taking over your life!Study Sesh – Change the way you study with this private podcast that includes dynamic audio formats that help you review and test your recall of important nursing concepts on-the-go. Free yourself from your desk with Study Sesh!Fast Pharmacology – Learn pharmacology concepts in 5 minutes or less in this audio based program. Perfect for on-the-go review!Pharmacology Success Pack – Want to get a head start on pharmacology? Download the FREE Pharmacology Success Pack

This is the next episode of our Push Dose Pearls miniseries with ED Clinical Pharmacist, Chris Adams. In this ongoing series we'll dig into some of the questions we all have about medications we commonly see and use in the ED. This episode focuses on RSI (rapid sequence intubation) meds - stuff every ED doc needs to know! What has changed and what are the latest recommendations? We'll answer these questions and more!  Did this episode change your practice? Let us know on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guests: Christopher Adams, PharmD, Emergency Department Senior Clinical Pharmacist and Assistant Professor at UC Davis Resources: Acquisto NM, Mosier JM, Bittner EA, Patanwala AE, Hirsch KG, Hargwood P, Oropello JM, Bodkin RP, Groth CM, Kaucher KA, Slampak-Cindric AA, Manno EM, Mayer SA, Peterson LN, Fulmer J, Galton C, Bleck TP, Chase K, Heffner AC, Gunnerson KJ, Boling B, Murray MJ. Society of Critical Care Medicine Clinical Practice Guidelines for Rapid Sequence Intubation in the Critically Ill Adult Patient. Crit Care Med. 2023 Oct 1;51(10):1411-1430. doi: 10.1097/CCM.0000000000006000. Epub 2023 Sep 14. PMID: 37707379. Engstrom K, Brown CS, Mattson AE, Lyons N, Rech MA. Pharmacotherapy optimization for rapid sequence intubation in the emergency department. Am J Emerg Med. 2023 Aug;70:19-29. doi: 10.1016/j.ajem.2023.05.004. Epub 2023 May 10. PMID: 37196592. Bennett BL, Scherzer D, Gold D, Buckingham D, McClain A, Hill E, Andoh A, Christman J, Shonk A, Spencer SP. Optimizing Rapid Sequence Intubation for Medical and Trauma Patients in the Pediatric Emergency Department. Pediatr Qual Saf. 2020 Sep 25;5(5):e353. doi: 10.1097/pq9.0000000000000353. PMID: 33062904; PMCID: PMC7523837.. *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

RSI is rapid sequence intubation, a procedure performed to emergently intubate a patient with an intact gag reflex in cases of acute respiratory failure and/or cardiovascular collapse. As a nurse working in the emergency department or ICU, you will be obtaining and may be administering the medications used to perform a rapid sequence intubation. Please be aware of your scope of practice and facility protocol regarding the administration of these medications. In some cases, the medications can only be administered by a physician.  Which combination of medications the physician chooses will vary depending on a variety of factors including the patient's condition and physician preference. A common combination is a sedative with a short-acting paralytic, though analgesics may also be utilized. This episode provides an overview of the medications commonly utilized for RSI: Propofol Succinylcholine Rocuronium Vecuronium Etomidate Ketamine Fentanyl Midazolam ___________________ Full Transcript - Read the article and view references FREE CLASS - If all you've heard are nursing school horror stories, then you need this class! Join me in this on-demand session where I dispel all those nursing school myths and show you that YES...you can thrive in nursing school without it taking over your life! Study Sesh - Change the way you study with this private podcast that includes dynamic audio formats that help you review and test your recall of important nursing concepts on-the-go. Free yourself from your desk with Study Sesh! Fast Pharmacology - Learn pharmacology concepts in 5 minutes or less in this audio based program. Perfect for on-the-go review! Pharmacology Success Pack - Want to get a head start on pharmacology? Download the FREE Pharmacology Success Pack

This podcast reviews RSI research related to paramedics with nurse anesthetist Penny Chiasson. She is also a hypnotherapist with Genesis Hypnosis. Article discussed: Alzaatreh, M. Y., Alsadi, M. R., Alkhsealat, Y., Alhemedi, M., & Alrabab'a, M. H. (2022). Pre-hospital rapid sequence induction by paramedics: A scoping review. Journal of Emergency Medicine, Trauma & Acute Care (5) 40. Connections: If you want to connect with Penny Chiasson you can reach her at penny@pennychiasson.com and to connect with the show, reach out through www.ProfessorBram.com.

Show notes at pharmacyjoe.com/episode859. In this episode, I’ll discuss the SCCM Rapid Sequence Intubation Guidelines. The post 859: SCCM Rapid Sequence Intubation Guidelines appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode859. In this episode, I’ll discuss the SCCM Rapid Sequence Intubation Guidelines. The post 859: SCCM Rapid Sequence Intubation Guidelines appeared first on Pharmacy Joe.

Have you heard that you're supposed to decrease the dose of your sedative when performing RSI on hypotensive patients? First, avoid the question about why you haven't addressed the hypotension before intubating.. maybe there's a reason. Maybe. But, regardless of why, intubate you will. What about those doses? I've been hearing for years that I should be dropping the dose of sedation prior to RSI. But what evidence are these recommendations based on? We review a paper today that is aimed at providing some evidence on this question. Oh, and I offer a gratuitous plug for the ESO/PCRF Research Forum nerdvanna. Here's the URL for more information: https://www.eso.com/events/research-forum-pcrf/ Citation:Driver BE, Trent SA, Prekker ME, Reardon RF, Brown CA: Sedative Dose for Rapid Sequence Intubation and Postintubation Hypotension: Is There an Association? Annals of Emergency Medicine. June 2023 (Epub Ahead of Print) Also discussed:Pappal RD, Roberts BW, Mohr NM, Ablordeppey E, Wessman BT, Drewry AM, Winkler W, Yan Y, Kollef MH, Avidan MS, et al.: The ED-AWARENESS Study: A Prospective, Observational Cohort Study of Awareness With Paralysis in Mechanically Ventilated Patients Admitted From the Emergency Department. Ann Emerg Med. 2021;77(5):532–44.

Background: Getting a definitive airway in a critically ill trauma patient can be a stressful situation.  The potential for soiled airways, cervical spine injuries, maxillofacial injuries and head injuries combined with agitation/delirium, altered mental status and hypoxemia can make securing a definitive airway both an anatomic and physiologic challenge. Traditional RSI entails preoxygenation followed by ... Read more The post REBEL Cast Ep122 – Delayed vs Rapid Sequence Intubation in Agitated Trauma Patients appeared first on REBEL EM - Emergency Medicine Blog.

Merhaba Bu yazımızda 1 ay önce yayınlanmış bir çalışmadan bahsedeceğiz. Aslında bu çalışma, kendi içinde kısıtlılıkları olsa da, günlük pratikte çok sık düşündüğümüz bir endişeyle ilgili olması sebebiyle bence önemli. Sorumuz; RSI'da verdiğimiz sedatif ilaçların dozu ile postentübasyon hipotansiyon ilişkili mi? Kendi pratiğimde ben de ketamin kullanırken bile, sınırda hipotansif hastalarda veya hemodinamik olarak “kaldıramayacağını” düşündüğüm hastalarda bazen bilinçli olarak bazen de farkında bile olmadan doz azaltıyorum. Fakat bununla ilgili aslında yeterli çalışma yok. Özellikle zaten altta yatan hastalığı sebebiyle hemodinamik instabil hastalarda tercih ettiğimiz ketamin ve etomidat gibi kan basıncı üzerine etkisi olmadığını düşündüğümüz ajanlarda, doz azaltmak gerçekten de mantıklı mı? Yoksa hemodinamiyi korumaya çalışırken uyanık paraliziye mi sebep oluyoruz?  “Sedative Dose for Rapid Sequence Intubation and Postintubation Hypotension: Is There an Association?” ​1​ Çalışmada temel olarak acil serviste entübe edilen yetişkinlerde, etomidat veya ketaminin mg/kg olarak dozu ile entübasyon sonrası ilk 15 dk içindeki hipotansiyonun ilişkili olup olmadığı araştırılmış. Hipotezleri yüksek doz etomidat ve ketaminin daha yüksek oranda postentübasyon hipotansiyona yol açtığı.  Çalışma kapsamında hastaların preentübasyon hemodinamik durumları hipertansif, normotansif, tedavi almayan hipotansif, iv sıvı tedavisi alan hipotansif ve sıvı ile birlikte vazopressör alan hipotansif olarak kaydedilmiş. Postentübasyon hipotansiyon, entübasyon sonrası ilk 15 dk içinde sistolik kan basıncının

2023 SAEM PharmD Research  02:10 – Emergency Medicine Resident Perceptions of the Educational Impact of Emergency Medicine Clinical Pharmacists with Francisco Ibarra, PharmD, BCCCP 12:10 – Impact of Emergency Medicine Pharmacists on Anticoagulation Reversal with Jaclyn Scalgione, PharmD, BCPS 24:25 – Incidence of Postintubation Hypotension after Rapid Sequence Intubation in Full vs. Reduced Dose Induction Agent with Alicia Mattson, PharmD, BCCCP 35:12 – Phenobarbital as an Adjunct to Benzodiazepines in the Setting of Alcohol Withdrawal with Amelia Slane, PharmD, BCPS 48:19 – Single Dose Aminoglycosides for Complicated Urinary Tract Infections in the Emergency Department with Jordan Jenrette, PharmD 61:53 – Effect of Intravenous vs. Oral First Dose Antibiotics in the Emergency Department on Hospital Admission with Jessica Pham, PharmD PharmacyToDose.Com  @PharmacyToDose  PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Date: June3, 2023 Reference: Kotani et al. Etomidate as an induction agent for endotracheal intubation in critically ill patients: A meta-analysis of randomized trials. Journal of Critical Care April 2023 Guest Skeptic: Dr. Amber Gombash is an emergency physician in Concord, NC. Case: You have a critically ill patient that you are preparing to intubate and wonder […] The post SGEM#405: We're Off To Never-Never Land – But Should We Use Etomidate for the Rapid Sequence Intubation? first appeared on The Skeptics Guide to Emergency Medicine.

Editor's Summary by Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor in Chief of JAMA, the Journal of the American Medical Association, for the January 3, 2023, issue. Related Content: Audio Highlights

In Part Two of this "Mini Grand Rounds" series, let's look at the 1 mg/kg dosing of roc. Could it be optimized? Click HERE to leave a review of the podcast!Follow HERE!References:All references for Episode 85 are found on my Read by QxMD collectionDisclaimer: The information contained within the  ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution,  seek medical advice from a licensed physician, and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of,  any medical institutions, educational facilities, or other healthcare programs.Support the show

In Part One of this "Mini Grand Rounds" series, we discuss the factors that determine how to dose meds, in this case rocuronium, in obesityClick HERE to leave a review of the podcast!Subscribe HERE!References:All references for Episode 84  are found on my Read by QxMD collectionDisclaimer: The information contained within the  ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution,  seek medical advice from a licensed physician, and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of,  any medical institutions, educational facilities, or other healthcare programs.Support the show

A review of oxygenation in the context of critical illness and Rapid Sequence Intubation. What are the historical recommendations, how has this changed over time, and what does the evidence support currently?

Medications utilized in rapid sequence intubation vary in preference and dosing in special populations. This podcast episode focuses on RSI in obese patients.   The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

Rapid Sequence Intubation (RSI) Special Guests: Haley Peters, PharmD, BCCCP   Show Notes: https://pharmacytodose.files.wordpress.com/2021/06/rsi-show-notes.pdf   Reference List: https://pharmacytodose.files.wordpress.com/2021/06/rsi-references.pdf   05:05 – Over-arching considerations; 09:45 – Neuromuscular blockers; 31:35 – Pre-induction agents; 46:46 – Induction agents; 72:23 – Obesity dosing considerations; 81:21 – Difficult airways; 84:30 – Take-home points   PharmacyToDose.Com @PharmacyToDose on Twitter PharmacyToDose@Gmail.com

In this episode, Eric discusses the current evidence and analysis of the RCT on Ketamine use in RSI as published in the Air Medical Journal. Does this RCT show us anything we didn't already know? How can we optimize a neutral hemodynamic response in our sickest patients? Join us for "Prehospital Ketamine Use for Rapid Sequence Intubation - RCT Review"! Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean and many more.

In this episode, Eric discusses the current evidence and analysis of the RCT on Ketamine use in RSI as published in the Air Medical Journal. Does this RCT show us anything we didn't already know? How can we optimize a neutral hemodynamic response in our sickest patients? Join us for "Prehospital Ketamine Use for Rapid Sequence Intubation - RCT Review"! Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean and many more.See omnystudio.com/listener for privacy information.

In this episode, I ll discuss an article about hypotension from ketamine for rapid sequence intubation. Evidence linked at pharmacyjoe.com/episode597. The post 597: Hypotension from ketamine for rapid sequence intubation appeared first on Pharmacy Joe.

In today's ALL NEW episode of the #medicmaterialspodcast we postpone our discussion on EMS Education with our special guest Matt. Due to a horrific scheduling conflict we switch gears and showcase an old unheard discussion on Rapid Sequence Intubation or RSI/MFI. We chat about medications, techniques, mindset and overall failures and successes. We are joined with Gerard (NYS AEMTP) and Emily (NYS EMT, ER-RN). BECOME A VIP PROVIDER by joining our PATREON PAGE & get instant access to our THIRD Monthly Podcast episode! Sign Up HERE: http://patreon.com/medicmaterials Medic Materials Podcast Links: LISTEN on your FAVORITE platform, just choose your LINK...https://linktr.ee/MedicMaterialsPodcast Do you have a great or thought provoking call YOU WANT US to review ON THE MEDIC MATERIALS PODCAST? Submit it here: https://rb.gy/2jugcr Support Medic Materials directly!! Grab your Medic Materials MERCH: https://bit.ly/3dd0SNn Like Us on Facebook: @MedicMaterialsEdu Follow Us on Instagram: @MedicMaterialsEduJoin our growing community of Like Minded EMS Providers in our Private Facebook Group: https://rb.gy/thhvqm Send the show an email: info@medicmaterials.comVisit our Website: https://www.MedicMaterials.com/ See ALL our Links on our LINKTREE: https://linktr.ee/MedicMaterials Want your own custom wooden American Flag? Contact US Military Veteran Jared for more information. Instagram @Ledslinger85 -Affiliate Link: By purchasing from one of the links below, Medic Materials will earn a portion of the sale at no added expense to you. --Get Your Pair of LEATHERMAN RAPTOR SHEERS: https://rb.gy/w0uctdDISCLAIMER: This audio is for Demonstration purposes only. The information provided in this audio is no replacement for proper EMT/Paramedic training, education and or practice. The skills, techniques, ideas and theories offered in this audio represent the individual participants featured in this audio and are not intended to showcase the only method of performing these skills. Please continue to consult with your local EMS system, Agency Standard Operating Procedures/Medical Director, Your Local and State Protocols and your EMS educator for clarification and further proper EMT/Paramedic training.Intro/Outro Music: https://rb.gy/tais0a Microphone Used: Blue SnowballSoftware Used In Production: Canva, Sony Movie Studio 16 Platinum, Voicemeeter Potato

What happens when/ if etomidate goes on shortage? Are methohexital or ketamine viable options for RSI in the ER? Find out this week.References:Farrell NM, Killius K, Kue R, et al. A comparison of etomidate, ketamine, and methohexital in emergency department rapid sequence intubation. J Emerg Med. 2020; 59(4): 508-514

اپیزود هشتم کمی متفاوت‌تر از اپیزودهای قبلیه و بیشتر مورد استفاده پزشک‌ها و رزیدنت‌های اورژانسه. اینتوبیشن یکی از پروسیجرهای پر استفاده و در عین حال تهاجمیه که اگر به درستی انجام نشه میتونه عوارض زیادی رو به بیمار تحمیل کنه. Rapid Sequence Intubation یکی از تکنیک‌هاییه که میتونه عوارض اینتوبیشن را به حداقل برسونه. توی این اپیزود دکتر هامون روزدار، متخصص طب اورژانس، مراحل RSI رو قدم به قدم برامون توضیح میدن.

In this episode we explain what rapid sequence intubation or RSI is and the indications for its use in securing a definitive airway. More importantly, we share lessons learned regarding COVID-specific considerations for intubating patients with acute hypoxemic respiratory failure.

Editor's Summary by Howard Bauchner, MD, Editor in Chief of JAMA, the Journal of the American Medical Association, for the December 17, 2019 issue

Using a case-based approach, Dr. Calvin Brown discusses three research studies focusing on the HEAVEN criteria, drug order in Rapid Sequence Intubation, and post-intubation sedation.

Background Information: The sequential administration of a sedative and neuromuscular blocking agent (NMBA) to facilitate the passage of an endotracheal tube is a common method of... The post REBEL Cast Episode 65: Optimal Order of Drug Administration in Rapid Sequence Intubation appeared first on REBEL EM - Emergency Medicine Blog.

Show notes at pharmacyjoe.com/episode386. In this episode, I ll discuss an article about drug order in rapid sequence intubation. The post 386: Does drug order in rapid sequence intubation matter? appeared first on Pharmacy Joe.

How to intubate a patient… 

The most important thing to do when preparing for RSI is to PREOXYGENATE the patient. Step 1: Choose Your Equipment Miller or Mac blade? Miller blade is straight (like the ‘L' in miller) Frequently used in kids Mac blade is curved (like the ‘c' in mac) (Generally, this is the best choice to use on […]

Using push dose pressors have become common practice in the pre-hospital and critical care environments. We have seen many companies adopt protocols that guide the use of medications such as Epinephrine and Phenylephrine as the go-to medications in the setting of Rapid Sequence Intubation, with associated hemodynamic compromise. However, are these the best medication? We know that both Epinephrine and Phenylephrine come with many potential side effects. Is there a better option? Join us to find out more about "The New KID On The Block." Lastly, we couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!

Using push dose pressors have become common practice in the pre-hospital and critical care environments. We have seen many companies adopt protocols that guide the use of medications such as Epinephrine and Phenylephrine as the go-to medications in the setting of Rapid Sequence Intubation, with associated hemodynamic compromise. However, are these the best medication? We know that both Epinephrine and Phenylephrine come with many potential side effects. Is there a better option? Join us to find out more about "The New KID On The Block." Lastly, we couldn't make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!See omnystudio.com/listener for privacy information.

Educational Pearls: RSI includes induction agent (sedative) and a paralytic Succinylcholine is a depolarizing paralytic of rapid onset and short duration with contraindications in hyperkalemic states and muscular dystrophy Rocuronium and vecuronium are longer acting, non-depolarizing paralytic, more commonly Common induction agents are etomidate and ketamine Ketamine can be particularly beneficial for bronchodilator effects in those with reactive airway disease References:   Stollings JL, Diedrich DA, Oyen LJ, Brown DR. Rapid-sequence intubation: a review of the process and considerations when choosing medications. Ann Pharmacother. 2014 Jan;48(1):62-76. doi: 10.1177/1060028013510488. Epub 2013 Nov 4. Review. PubMed PMID: 24259635. Summary by Travis Barlock, MS4  | Edited by Erik Verzemnieks, MD

The decision to administer paralytics may well be the most significant decision that we make as emergency providers. We have to understand and know paralytic pharmacology 100% stone cold. Join Dr. Patrick today for a review of our two most commonly encountered paralytic medications - succinylcholine and rocuronium. Homage to the old school and an investigation of newer practice shifts will be given equal airtime. References: 1. Tran DT et al. Rocuronium Versus Succinylcholine for Rapid Sequence Induction Intubation. Cochrane Database Syst Rev 2015. 2. Shoenberger JM, Mallon WK. Rocuronium Versus Succinylcholine Revisited: Succinylcholine Remains the Best Choice. Ann Emerg Med 2018; 71(3): 398-9. 3. Swaminathan A, Mallemat H. Rocuronium Should Be the Default Paralytic in Rapid Sequence Intubation. Ann Emerg Med 2018; 71(3): 397-8.

Preoxygenation is not just a step included in the process of Rapid Sequence Intubation, it is critical! The EM GuideWire team takes a quick look on how to optimize the preoxygenation process and what techniques can be applied most practically in the ED.

Continue along for the New York State Collaborative Protocol series with Dr. Chris Fullagar @87MD1 as he reviews the indications, ideal pre-oxygenation strategies, laryngoscopy techniques, confirmation of tube placement as well as guidelines for post-intubation sedation for prehospital providers operating in New York State.   Christopher J. Fullagar, MD, EMT-P, FACEP @87MD1   Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org

This episode of PEM Currents, featuring Preston Dean – @prestonndean on Twitter, a senior Pediatric Resident at Cincinnati Children’s, is about all things Rapid Sequence Intubation. You’ll learn about equipment, techniques, drugs and more! PEMBlog.com

Host Dr. Ryan Stanton talks to Darren Braude, MD, MPH on limiting the use of cervical collars when transporting patients. Additionally, they delve into rapid sequence intubation updates.

Let's dig into RSI, Rapid Sequence Intubation. This show is all about how to take a person who is currently awake but needs to be asleep with an endotracheal tube in place. We'll discuss principles of RSI management and talk a lot about the drugs to make this happen. Catch the show notes at: http://cbcemp.proboards.com/thread/56/episode-2-rsi-principles

Today’s shorty discusses which paralytic is preferable to use for RSI? The debate has been going on in emergency medicine and anesthesia for quite some time, and the conclusion tends to boil down to provider preference. Today’s article is “Update: Does Rocuronium Create Better Intubating Conditions Than succinylcholine for Rapid Sequence Intubation?” from the May 2017 Annals of Emergency Medicine by Julie Welch ... Read More The post MSM Shorty- Rocouronium vs. Succinylcholine appeared first on Medschoolmedic.

https://ampa.org/   Happy Friday of #EMSWeek2017! https://emcrit.org/wp-content/uploads/push-dose-pressors.pdf    Resuscitation - beginning from initial patient contact to the emergency department to the intensive care unit is a continuun of care - though the first few minutes of patient contact with a critically ill patient can have tremendous repercussions on the patient's ultimate outcome.  Whether in critical care transport or in 911 emergency response, patient's may require a medication in small aliquots immediately that would be either unfeasible or cumbersome to administer via infusion on a dedicated pump.  While circumstances in which a patient needs a push dose medication may be uncommon, the administration of these drugs can be potentially lifesaving.  There are two prehospital scenarios in which the paramedic carries the necessary medication in their armamentariam and with appropriate instruction and training can safely reconstitute into an appropriate dose for use in out-of-hospital resuscitation for the critically ill patient.  Push dose pressors are often employed in profoundly hypotensive patients that will require endotracheal intubation.  Rapid Sequence Intubation and Positive Pressure Ventilation are both associated with hypotension, thus in the patient that requires advanced airway and is hypotensive upon EMS arrival, push dose pressors may be employed to effectively "resuscitate before you intubate".  Typically Epinephrine is diluted to an appropriate dose and adminstered in small aliquots (10mcg/ml) for inotropoic support to optimize hemodynamics prior to RSI or intubation.  There is also anaesthesia literature supporting the use of neosynephrine as well as phenylephrine for this purpose, though these medications are less readily available prehospitally.  Even brief episodes of relative hypotension can cause effects seen days later; in critically hypotensive patients these may be even more pronounced.  By using push dose pressors, a field provider can safely and effectively resuscitate their patient in order to mitigate the risks associated with endotracheal intubation prior to securing an advance airway. Conversely, a separate and distinct class of patients who suffer from decompensated heart failure may present with respiratory distress due to volume overload with pathophysiology associated with marked systemic hypertension. While CPAP is the mainstay of therapy for these patients prehospitally and has significantly reduced intubation of the CHF patient over the past several years, IV Lasix and topical Nitroglycerin play little role in the EMS management of the decompensated heart failure patient.  Nevertheless, these patients often require preload and afterload reduction to manage their symptomatology; it is common to initiate nitroglycerin infusions in critical care transport as well as in the emergency department for management of this hypertension.  Nitroglycerin lowers preload via venous vasodilation at low doses and lowers after load via arterial vasodilation at higher doses, making the patient's vascular container larger lowering the systemic pressure. Aggressive, high dose NTG paired with the recruitment of the alveoli using CPAP & PEEP make up the mainstay of pre-hospital treatment of APE and decompensated heart failure. Bolus doses as high as 2 mg (2000 mcg) of nitroglycerin have been given safely and effectively in previous studies.  In emergent resuscitations we need to focus on bolus dose medications in the acute phase versus starting and titrating critical care infusions while a patient is in extremis. The goal is to achieve clinical end points of treatment faster with bolus dosing at the bedside and then begin maintenance infusions once resuscitation goals are met and the hemodynamics are stable.  Similar to push dose pressors in the acutely hypotensive EMS patient requiring resuscitation, patients with decompensated heart failure may benefit acutely with push dose nitroglycerin, a potent vasodilator.   @AmpaDocs #CCTMC17 Mark your calendars for #CCTMC18 April 9-11th 2018 Wyndham Riverwalk - San Antonio Texas     Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org

Sean P. Kane, PharmD, BCPS, speaks with Joseph Muench, PharmD, BCPS about airway pharmacology. In the episode, the most common sedatives and paralytics for rapid sequence intubation are discussed, including concepts regarding dosing, adverse effects, onset and duration of effect, and clinical pearls.

Sean P. Kane, PharmD, BCPS, speaks with Joseph Muench, PharmD, BCPS about airway pharmacology. In the episode, the most common sedatives and paralytics for rapid sequence intubation are discussed, including concepts regarding dosing, adverse effects, onset and duration of effect, and clinical pearls.

Ben Kerrey is a rising star in Pediatric Emergency Medicine and is the point man for an ongoing initiative at Cincinnati Children’s centered around improving safety and limiting complications during rapid sequence intubation. I recently sat down with Ben to talk about the state of RSI in pediatric patients, the difference between a checklist and a […]

The new improved version of the EMCrit RSI checklist

Ep #21 Ketamine Induced Rapid Sequence Intubation with Faizan H. Arshad, MD @emscritcare Happy #EMSWeek #EMSStrong #EMSNation   SKEPTIC = Safety & Efficacy of Ketamine in Emergent Prehospital Tracheal Intubation – a Case Series   Brand new paper from Sydney HEMS on Ketamine and Shock Index in Annals of EM! http://www.annemergmed.com/article/S0196-0644(16)30002-6/abstract   Additional References: Carlson JN, Karns C, Mann NC, et al. Procedures performed by emergency medical services in the united states.Prehosp Emerg Care. 2015. Jacobs PE, Grabinsky A. Advances in prehospital airway management.International Journal of Critical Illness & Injury Science. 2014;4:57-64. Prekker ME, Kwok H, Shin J, Carlbom D, Grabinsky A, Rea TD. The process of prehospital airway management: Challenges and solutions during paramedic endotracheal intubation.Crit Care Med. 2014;42:1372-1378. Wang HE, Kupas DF, Greenwood MJ, et al. An algorithmic approach to prehospital airway management.Prehospital Emergency Care. 2005;9:145-155. Mace SE. Challenges and advances in intubation: Airway evaluation and controversies with intubation.Emerg Med Clin North Am. 2008;26:977-1000. Combes X, Jabre P, Jbeili C, et al. Prehospital standardization of medical airway management: Incidence and risk factors of difficult airway.Acad Emerg Med. 2006;13:828-834. Drummond GB. Comparison of sedation with midazolam and ketamine: effects on airway muscle activity. Br J Anaesth. 1996;76:663-667. Jackson APF, Dhadphale PR, callaghan ML, Alseri S. Haemodynamic studies during induction of anaesthesia for open-heart surgery using diazepam and ketamine. Br J Anaesth. 1978;50:375-378. Price B, Arthur AO, Brunko M, et al. Hemodynamic consequences of ketamine vs etomidate for endotracheal intubation in the air medical setting. Am J Emerg Med. 2013;31:1124-1132. Scherzer D, Leder M, Tobias JD. Pro-Con Debate: Etomidate or Ketamine for Rapid Sequence Intubation in Pediatric Patients. J Pediatr Pharmacol Ther. 2012;17:142-149. Bruder Eric A, Ball Ian M, Ridi S, Pickett W, Hohl C. Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients.Cochrane Database of Systematic Reviews. 2015 Thompson Bastin ML, Baker SN, Weant KA. Effects of Etomidate on Adrenal Suppression: A Review of Intubated Septic Patients.Hospital Pharmacy. 2014;49:177-183. Arnold C. The promise and perils of ketamine research Ketamine began its life as an anaesthetic , but has enjoyed a recent renaissance as a potential. Lancet Neurol. 2013;12:940-941. Craven R. Ketamine. Anaesthesia. 2007;62:48-53. Perkins ZB, Gunning M, Crilly J, Lockey D, O’Brien B. The haemodynamic response to pre-hospital RSI in injured patients. Injury. 2013;44:618-623. Aroni F, Iacovidou N, Dontas I, Pourzitaki C, Xanthos T. Pharmacological Aspects and Potential New Clinical Applications of Ketamine: Reevaluation of an Old Drug. J Clin Pharmacol. 2009;49:957-964. Manthous CA. Avoiding circulatory complications during endotracheal intubation and initiation of positive pressure ventilation.J Emerg Med. 2010;38:622-631. Kohrs R, Durieux ME. Ketamine. Anesth Analg. 1998;87:1186-1193. Moy RJ, Clerc S Le. Trends in Anaesthesia and Critical Care Ketamine in prehospital analgesia and anaesthesia. Trends Anaesth Crit Care. 2011;1:243-245. Reich DL, Silvay G. Ketamine: an update on the first twenty-five years of clinical experience. Can J Anaesth. 1989;36(2):186-197. Porter K. Ketamine in prehospital care. Emerg Med J. 2004;21:351-354. Svenson JE, Abernathy MK. Ketamine for prehospital use: new look at an old drug. Am J Emerg Med. 2007;25:977-980. Johansson J, Sjöberg J, Nordgren M, Sandström E, Sjöberg F, Zetterström H. Prehospital analgesia using nasal administration of S-ketamine--a case series. Scand J Trauma Resusc Emerg Med. 2013;21:38. Filanovsky Y, Miller P, Kao J. Myth: Ketamine should not be used as an induction agent for intubation in patients with head injury. Can J Emerg Med. 2010;12:154-201. Himmelseher S, Durieux ME. Revising a Dogma: Ketamine for Patients with Neurological Injury? Anesth Analg. 2005;101:524-534. Kropf J a., Grossman MD, Genzlinger M a., Stoltzfus J, Stehly CD. 328 Ketamine versus Etomidate for Rapid Sequence Intubation in Traumatically Injured Patients: An Exploratory Study. Ann Emerg Med. 2012;60:S117. Angus DC, van dP. Severe sepsis and septic shock.N Engl J Med. 2013;369:840-851. Jabre P, Avenel A, Combes X, et al. Morbidity related to emergency endotracheal intubation-A substudy of the KETAmine SEDation trial. Resuscitation. 2011;82:517-522. Shafi S, Gentilello L. Pre-Hospital Endotracheal Intubation and Positive Pressure Ventilation Is Associated with Hypotension and Decreased Survival in Hypovolemic Trauma Patients: An Analysis of the National Trauma Data Bank. The Journal of Trauma: Injury, Infection, and Critical Care. 2005;59:1140–1147. Seymour CW, Band RA, Cooke CR, et al. Out-of-hospital characteristics and care of patients with severe sepsis: A cohort study.J Crit Care. 2010;25:553-562. Williams E, Arthur a., Price B, Banister NJ, Goodloe JM, Thomas SH. 175 Ketamine versus Etomidate for Use in Helicopter Emergency Medical Services Endotracheal Intubation. Ann Emerg Med. 2012;60:S63-S64 Bruns, B, Gentilello, L, Elliott, A, Shafi, S. Prehospital Hypotension Redefined. The Journal of Trauma: Injury, Infection, and Critical Care. 2008;65:1217–1221. Seymour, CW, Cooke, CR, Heckbert, SR, et al. Prehospital Systolic Blood Pressure Thresholds: A Community-based Outcomes Study. Acad Emerg Med Academic Emergency Medicine. 2013;20:597–604. Kristensen AKB, Holler JG, Mikkelsen S, Hallas J, Lassen A. Systolic blood pressure and short-term mortality in the emergency department and prehospital setting: a hospital-based cohort study.Critical Care. 2015;1:158. Heffner AC, Swords DS, Neale MN, Jones AE. Incidence and factors associated with cardiac arrest complicating emergency airway management. Resuscitation. 2013;84:1500-1504. Salt PJ, Baranes PK, Beswick FJ. Inhibition of neuronal and extraneuronal uptake of noradrenaline by ketamine in the isolated perfused rat heart. Br J Anaesth. 1979;51:835-838. Sprung J, Schuetz SM, Stewart RW, Moravec CS. Effects of Ketamine on the Contractility of Failing and Nonfailing Human Heart Muscles in Vitro. Surv Anesthesiol. 1999;43:230-231. Kunst G, Martin E, Graf BM, Hagl S, Vahl CF. Actions of Ketamine and Its Isomers on Contractility and Calcium Transients in Human Myocardium. Anesthesiology. 1999;90:1363-1371. Lundy PM, Lockwood PA, Thompson G, Frew R. Differential Effects of Ketamine Isomers on Neuronal and Extraneuronal Catecholamine Uptake Mechanisms. Anesthesiology. 1986;64:359-363. Selde W. Push dose epinephrine. A temporizing measure for drugs that have the side-effect of hypotension.JEMS. 2014;39:62-63.   Sponsored by @PerfectCPR Apple Watch App with Audio and Haptic Feedback to Optimize Cardiac Arrest Training and Improve Quality of CPR Delivery PerfectCPR.com     Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org  

Rapid-sequence Intubation and the Role of the Emergency Department Pharmacist Author Jeremy Hampton discusses with Pamela Hsieh, Assistant Editor of AJHP, the role of the pharmacist in rapid-sequence intubation in the emergency department. Dr. Hampton explains how selection of an appropriate sedative and paralytic agent may depend on the status of the patient. The article under discussion appears in the July 15, 2011, issue of AJHP. For more information visit www.ajhp.org.

Host: Shira Johnson, MD Guest: Calvin A. Brown III, MD Once the sole domain of anesthesiologists, rapid sequence intubation is now a skill practiced by all emergency department physicians. Dr. Calvin Brown III, attending physician in the emergency department at Brigham and Woman's Hospital in Boston, explains the state of the art in intubation. Dr. Brown is interviewed by Dr. Shira Johnson as he reviews the basic technique of RSI, some of the pearls and pitfalls, and what is on the horizon for this skilled intubation technique.