Incredibly important to the long term psychological outcomes of patients who undergo ETI and particularly when unplanned.
Can be achieved with the use of: ketaMINE or mIDAZOLam.
Is not just about making the patient more comfortable but also lessens the amount of sedation required to maintain post intubation sedation pharmacological synergy.
ketaMINE does have some analgesic properties.
mIDAZOLam does not have analgesic properties.
Almost all patients require resuscitation in the peri-intubation phase.
Utilize the SI and your clinical assessment to determine who is at risk for hypotension in the setting of ETI.
Minimum Fluid Bolus of 500cc (Adults).
Use a push pressor such as PHENYLephrine or EPINEPHrine.
Produces the best views possible however it is also fraught with complications and potential dire consequences.
Lower dose of sedation required.
Usually achieved with either: Succinylcholine (Depolarizing) or Rocuronium (NonDepolarizing)
Deep sedation does NOT result in Areflexia but rather suppresses any response to stimulus.
Adult Doses Below. See individual Drug Monographs for Pediatric and expanded dose strategies.
|Goal||Options||Induction (Phase I)||Maintenance (Phase II)||Emergence (Phase III)|
50 - 100mcg PRN
|KetAMINE 2mg/kg (1mg/kg for Shock Physiology)||KetAMINE 1mg/kg (0.5mg/kg for Shock Physiology)||mIDAZOlam 1 - 5mg PRN|
|Autonomic Stability||IV Fluids
|IV Fluids N/S 500cc
(Target SBP > 90mmHg)
|IV Fluids N/S 500cc PRN