Airway Control and Ventilation... 1 Adult... 1 Pediatric... 1 Neonate... 2 Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION
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1 Airway Airway Control and Ventilation Adult Pediatric Neonate Calculating Tank Life FOR... SALE... OR.. DISTRIBUTION Table: Common Tank Sizes and Factors Table: Oxygen FOR Concentration SALE OR DISTRIBUTION to Liters Per Minute Flow Rapid Sequence Intubation Table: RSI Drugs for Sedation Table: RSI Drugs for Paralysis Table: Typical Properties and IV FOR Dosing SALE OR DISTRIBUTION of Nondepolarizing NBDs Neuromuscular Blockade Train of Four Monitoring for Patients Receiving Neuromuscular Blockade Airway Control and Ventilation 1 Give 100% inspired oxygen (FiO ) ASAP. Adult Deliver tidal volume 6 to 7 ml/kg ( ml) over 1 second. Perfusing rhythm Deliver 10 to 12 breaths/min (1 breath every 6-7 FOR seconds). SALE OR DISTRIBUTION Pulseless rhythm with advanced airway in place Deliver 8 to 10 breaths/min. Pediatric Deliver tidal volume that is minimal amount to make chest rise. Perfusing rhythm Deliver 12 to 20 breaths/min (1 breath every 3-5 seconds)... 1 Airway
2 Airway Pulseless rhythm with advanced airway in place Deliver 8 to 10 breaths/min. Neonate Deliver 40 to 60 breaths/min to achieve or maintain heart rate greater than 100 bpm. Calculating Tank Life 1 The following method can FOR help SALE you OR estimate DISTRIBUTION the amount of oxygen available in an oxygen cylinder: 1. Subtract Jones the & Bartlett safe Learning, residual LLC pressure (200 psi) from the tank pressure. 2. Multiply the answer by the tank s factor (cylinder constant); this equals the volume Jones of & Bartlett gas. Learning, LLC 3. Divide the volume by the liters per minute (LPM) delivery. The result equals the tank s life in minutes. Example: Tank pressure in an E cylinder is 650 psi. You are delivering 6 L/min of oxygen to the patient. Step 1. Subtract FOR SALE the OR safe DISTRIBUTION residual pressure from the tank s psi: Jones & Bartlett Learning, LLC Step 2. Multiply this answer by the E cylinder factor (0.28) to obtain the volume: FOR 5 SALE 126 OR DISTRIBUTION Step 3. Divide the volume by the LPM delivery to determine Jones & Bartlett the tank s Learning, life LLCin minutes: minutes Common Tank Sizes and Factors 1 Cylinder Factor D (400 L O 2 ) 0.16 Jumbo D (640 L O 2 ) 0.28 E (625 L O 2 ) 0.28 M (3450 L O 2 ) 1.56 Safe residual: 200 psi 2..
3 Oxygen Concentration to Liters per Minute Flow 1 Liters per Minute Oxygen Concentration 1 24% 2 28% 3 32% 4 36% 5 40% 6 44% Rapid Sequence Intubation 1 Preparation: Prepare all drugs and equipment. Preoxygenation: Give 100% O 2 for 5 minutes. Pretreatment: Consider administering FOR SALE OR DISTRIBUTION lidocaine, atropine, or opioids 3 minutes before intubation. Paralysis Jones (with & Bartlett sedation): Learning, LLCAdminister sedative, follow with neuromuscular blockade (see below). Placement of the tube: Place endotracheal (ET) tube. Postintubation FOR SALE OR DISTRIBUTION management: Secure FOR SALE tube, OR DISTRIBUTION then ventilate and monitor patient. RSI Drugs for Sedation Sedative Dose/IV Bolus Onset Duration Etomidate mg/kg 60 seconds 3-5 minutes Fentanyl Induction: 60 seconds minutes FOR SALE OR 2-10 DISTRIBUTION mcg/kg Sedation: 2-4 mcg/kg Ketamine mg/kg FOR SALE OR DISTRIBUTION seconds 15 minutes Midazolam Induction: 2 minutes 1-2 hours mg/kg Sedation: mg/kg Thiopental 3-5 mg/kg seconds 5-10 minutes RSI, Rapid sequence intubation... 3
4 RSI Drugs for Paralysis Drug Paralytic Dosage Onset Duration Atracurium Maintenance: 0.4 mg/kg 3-5 minutes minutes Pancuronium Maintenance: 0.1 mg/kg 3-5 minutes minutes Rocuronium Induction: mg/kg minutes 30 minutes Maintenance: 0.6 mg/kg Succinylcholine Induction: mg/kg seconds 4-6 minutes Vecuronium Induction: mg/kg minutes minutes RSI, Rapid sequence intubation. Typical Properties and IV Dosing of Nondepolarizing NBDs 2 Loading Intermittant Continuous Dosage Dose Dose Infusion Onset Duration Adjustment Drug Chemical Class (mcg/kg) (mcg/kg) (mcg/kg/min) (min) (min) Required Atracurium Benzylisoquinoline None (Tracurium) q30-60min 4..
5 Cisatracurium Benzylisoquinoline None (Nimbex) q30-60min Pancuronium Aminosteroid Renal failure (Pavulon) q1-3h Rocuronium Aminosteroid Hepatic failure (Zemuron) q1h Vecuronium Aminosteroid Hepatic failure (Norcuron) q1-2h Mivacurium Benzylisoquinoline Hepatic and (Mivacron) q15min renal failure Doxacurium Benzylisoquinoline Not recommended Renal failure (Nuromax) q30-45min Pipecuronium Aminosteroid Not recommended Renal failure (Arduan) q30-45min NBDs, Neuromuscular blocking drugs... 5
6 Neuromuscular Blockade 2 E: Patients receiving neuromuscular blockade should be receiving controlled mechanical ventilation. Obtain neurologic baseline (e.g., level of consciousness [LOC], motor function, sensory function, reflexes) before providing therapy. Neuromuscular blocking agents do not affect pain, LOC, or anxiety; patients may Jones require & Bartlett Learning, analgesics LLC and should receive concomitant sedation. Provide total patient care (e.g., eye care, turning and positioning, range FOR SALE of OR motion DISTRIBUTION [ROM], skin care), apply antiembolic hose, and avoid undue pressure on peroneal nerve. Assess paralysis level with peripheral nerve stimulator. Train of Four Monitoring for Jones & Patients Bartlett Learning, Receiving LLC Neuromuscular Blockade 3 FOR SALE OR DISTRIBUTION Apply electrodes to ulnar nerve about ½ inch apart, 2 inches from wrist FOR SALE crease, OR DISTRIBUTION and connect to peripheral nerve stimulator. Peripheral nerve stimulator With the TOF technique, four single-twitch stimuli are administered 0.5 second apart to the ulnar nerve. Patient is monitored (visually and with tactile assessment) for thumb twitch. One to two twitches usually indicates adequate paralysis. Neuromuscular blockade (NMB) is usually maintained within a 75% to 80% blockade. 6..
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