Category: Critical Care Nursing Glottic visualization is paramount in airway management. With direct laryngoscopy, if the vocal cords can be seen, the chance of intubation success is high. However, when the glottic aperture cannot be visualized, intubation success is less likely.
Category: Critical Care Nursing Airway difficulty exists on a spectrum and is contextual to the provider's experience, environment and armamentarium of devices. Airways predicted to be difficult when using a direct laryngoscope may not be difficult when video laryngoscope is used.
Category: Critical Care Nursing Preintubation assessment should evaluate the patient for potential difficult intubation and difficult BMV, placement of and ventilation with an extraglottic device and cricothyrotomy. Knowledge of all four domains is crucial to successful planning.
Category: Critical Care Nursing Gas exchange is required for vital organ function. Ventilatory failure that is not reversible by clinical means or persistent hypoxemia despite oxygen supplementation is a primary indication for intubation.
Category: Critical Care Nursing A patent airway is essential for adequate ventilation and oxygenation. If a patient is unable to maintain a patent airway, the airway should be established by using repositioning, chin lift, jaw thrust, or insertion of an oral or nasal airway.
Category: Critical Care Nursing The decision to intubate should be based on: (1) failure to maintain or protect the airway; (2) failure of ventilation or oxygenation; and (3) the patient's anticipated clinical course and likelihood of deterioration.
Category: Fundamentals Smoking is strongly associated with the development of peripheral arterial disease (PAD). In addition, continued smoking in patients with PAD is associated with accelerated disease progression and poor outcomes.
Category: Fundamentals Amiodarone has a complex effect on thyroid hormones because it contains iodine and shares a structural similarity to thyroxin. It can inhibit the peripheral conversion of T4 to T3 with a rise in the serum level of T4 and a small fall in the level of T3.
Category: Fundamentals Contraindications to amiodarone are severe sinus node dysfunction with marked sinus bradycardia or syncope, second- or third-degree heart block, known hypersensitivity, cardiogenic shock and severe chronic lung disease.
Category: Fundamentals Amiodarone is a unique “wide-spectrum” anti-arrhythmic agent, chiefly class III but also with powerful class I activity and ancillary class II and class IV activity. It blocks sodium, calcium and repolarizing potassium channels.
Category: Fundamentals Mexiletine has neurological side effects that include dizziness, tremor, ataxia, paresthesia and blurred vision. Additional rare but important side effects include blood dyscrasias such as marked leukopenia or thrombocytopenia.
Category: Fundamentals The major side effect of mexiletine is GI intolerance, namely nausea, vomiting and diarrhea. Many of these GI intolerances can be mitigated by taking the medication with food or by administering a concomitant proton pump inhibitor antacid.
Category: Fundamentals Mexiletine is commonly used for management of ventricular arrhythmias. As monotherapy, mexiletine is often not very effective, so it is most commonly combined with oral amiodarone when amiodarone monotherapy has failed.
Category: Fundamentals Class IB anti-arrhythmics, lidocaine and mexilitine, inhibit the sodium current while shortening the action potential duration. They also have rapid kinetics, which means they associate and dissociate from the sodium channels rapidly.
Category: Fundamentals Procainamide has a risk of proarrhythmia, particularly heart block and QT prolongation. One of the major limitations of procainamide is the development of a drug-induced lupus erythematosus-like syndrome.
