Category: Critical Care Nursing In critically ill patients, induction agents have the potential to exaggerate hypotension. Peri-intubation cardiac arrest, typically pulseless electrical activity, complicates up to 4% of emergency rapid sequence intubations.
Category: Critical Care Nursing Rapid sequence intubation is the recommended technique for intubation of a patient in status asthmaticus. Difficult airway considerations are complex in an asthmatic patient because of impending respiratory arrest.
Category: Critical Care Nursing Because of the propensity of propofol to cause hypotension through vasodilation and direct myocardial depression, the dosage is reduced or the drug is avoided altogether in hemodynamically compromised patients.
Category: Critical Care Nursing Because of its superior hemodynamic profile, ketamine is an excellent alternative to etomidate for a hemodynamically unstable patient. However, all sedative induction agents can provoke further hypotension or cardiovascular collapse.
Category: Critical Care Nursing The principal uses of ketamine in airway management are as a sedative agent for awake intubation and as the induction agent during rapid sequence intubation for patients with acute severe asthma or hemodynamic instability.
Category: Critical Care Nursing As a dissociative anesthetic agent, ketamine induces a cataleptic state rather than a true unconscious state. The patient has anesthesia but may have her or his eyes open. Protective airway reflexes and ventilatory drive usually are preserved.
Category: Critical Care Nursing Ketamine has been widely used as a general anesthetic agent since 1970. After an IV dose of 1 to 2 mg/kg, ketamine produces loss of awareness within 30 seconds, peaks in approximately 1 minute and has a clinical duration of 10 to 15 minutes.
Category: Critical Care Nursing When a patient has a contraindication to succinylcholine, rocuronium bromide is the paralytic agent of choice. Rocuronium achieves intubating conditions similar to those of succinylcholine and lasts 50 minutes.
Category: Critical Care Nursing Succinylcholine has been associated with severe hyperkalemia when administered to patients with specific predisposing clinical conditions. The mechanism is related to receptor upregulation on the postsynaptic muscle membrane.
Category: Critical Care Nursing Succinylcholine is rapidly active, typically producing intubating conditions within 45 seconds of administration by rapid IV bolus injection. The clinical duration of action before spontaneous respiration is 6 to 10 minutes.
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.
