Intubation Preparation

[punkstar]

For possible and certain intubations, I was just curious as to how much of each medication do you draw up? What medications do you use? I know we have a kit containing all the neuromuscular blockers that needs to be used in an intubation. What does your kit contain? I'm also still trying to understand the medications and how they work...one is a muscle paralyzer...lidocaine is for something else...please fill me in on this ASAP. I don't get much experience as to seeing what medications come into play. Thanks.

[Larry77, RN]

Ares get premedicated with Lido and benadryl, then they get versed, then morphine, fentanyl, or demerol drops down the line, then they get either sucs or vec, and then there tubed, then there put on a propofol drip or a versed gtt.

That's a lot of steps...we use succs and etom...then propofol for cont sedation.

[ZippyGBR, BSN, RN]

a lot depends on 'crash' intubation or 'planned emergency' intubation ...

[nuangel1, BSN, RN]

we use etominate and succ to intubate rsi .then may use pavulon if we need ct etc or to keep em down longer then more sedative usually morphine or fentanyl ativan or versed .it depends on the dr and the reason for intubation.

[rgroyer1RNBSN, BSN, RN]

That's a lot of steps...we use succs and etom...then propofol for cont sedation.

Yeah, tell me about it, but its what the chief wants, so we do it, we use to only give versed, sucs, and etom., and put on a propofol drip, but doc says that a narcotic will blunt hemodynamic responses so we do what he wants its alot of work to draw up all those, some of the other docs dont follow it they just go with the sucs, versed, and etom.

[GilaRRT]

Yeah, tell me about it, but its what the chief wants, so we do it, we use to only give versed, sucs, and etom., and put on a propofol drip, but doc says that a narcotic will blunt hemodynamic responses so we do what he wants its alot of work to draw up all those, some of the other docs dont follow it they just go with the sucs, versed, and etom.

Actually, not an incorrect way to go about an RSI if you have the time. Many people advocate a procedure of "pre-medication" prior to the prcedure. However, little evidence supports the thought that lidocaine will blunt ICP changes during RSI. Then again, little evidence proves lidocaine is harmful.

Some may know of the word LOAD. Lidocaine, Opiate, Atropine, Defasciculating dose of non-depolarizing NMB. I find most people who advocate premedication, like to wait at least two minutes after pushing the lidocaine.

Why the benadryl? Is this to blunt the histamine release and possible B/P changes associated with some narcotics? (Morphine) Seems like simply pushing fentanyl would be the way to go IMHO.

[rgroyer1RNBSN, BSN, RN]

Actually, not an incorrect way to go about an RSI if you have the time. Many people advocate a procedure of "pre-medication" prior to the prcedure. However, little evidence supports the thought that lidocaine will blunt ICP changes during RSI. Then again, little evidence proves lidocaine is harmful.

Some may know of the word LOAD. Lidocaine, Opiate, Atropine, Defasciculating dose of non-depolarizing NMB. I find most people who advocate premedication, like to wait at least two minutes after pushing the lidocaine.

Why the benadryl? Is this to blunt the histamine release and possible B/P changes associated with some narcotics? (Morphine) Seems like simply pushing fentanyl would be the way to go IMHO.

Yes, I understand this and this is the way to go if you have time, As for the benadryl I have no clue why he insists on this except exactley what you said, or maybe he uses it as a sedation drug, I know when we do endo's with dilatation we give it as a premedicate to blunt inflamatory response to dilatation.

[wtbcrna, MSN, DNP, CRNA]

Actually, not an incorrect way to go about an RSI if you have the time. Many people advocate a procedure of "pre-medication" prior to the prcedure. However, little evidence supports the thought that lidocaine will blunt ICP changes during RSI. Then again, little evidence proves lidocaine is harmful.

Some may know of the word LOAD. Lidocaine, Opiate, Atropine, Defasciculating dose of non-depolarizing NMB. I find most people who advocate premedication, like to wait at least two minutes after pushing the lidocaine.

Interesting, I never heard of using lidocaine to blunt ICP changes. We are taught in CRNA school to use lidocaine to blunt the responses of direct laryngoscopy in order to help prevent bronchospasm.

[GilaRRT]

Yes, liodcaine is used for the potential benefit of blunting ICP changes. However, real evidence supporting this thought is lacking.

I know when I go to OR, the anesthesia providers will give a topical dose of lidocaine into the glottis prior to the inubation. I remember the old saying " tight heads/tight lungs, get lidocaine." At least the second part of that statement may actually be true IMHO.

Hmm...benadryl for dilatation. Sometimes you just have to shake your head and say "well... alright then."

[rgroyer1RNBSN, BSN, RN]

Yes, liodcaine is used for the potential benefit of blunting ICP changes. However, real evidence supporting this thought is lacking.

I know when I go to OR, the anesthesia providers will give a topical dose of lidocaine into the glottis prior to the inubation. I remember the old saying " tight heads/tight lungs, get lidocaine." At least the second part of that statement may actually be true IMHO.

Hmm...benadryl for dilatation. Sometimes you just have to shake your head and say "well... alright then."

Well I agree about the benadryl thing, never heard of doing that till I started working here, and thats the only answer I got so far about that, and that was from some cocky chief resident smart@$$ in surgery!

[rgroyer1RNBSN, BSN, RN]

But really all in all, it depends on your facility, department, and doc.

[GilaRRT]

Well I agree about the benadryl thing, never heard of doing that till I started working here, and thats the only answer I got so far about that, and that was from some cocky chief resident smart@$$ in surgery!

Yeah, I feel ya. My companie's RSI protocol calls for lidocaine premedication; however, we are not to premedicate with an opiate. We ask the medical director if we can give fentanyl during the two minute wait after giving lido and defasciculating, and he says no. When asked to explain, he says "it takes too much time." What the?!?!, I have two minutes to whistle dixi all day long. So, I take time to give something that may not even work, but cannot give something known to work. But hey, what do you do? Take the wife out to dinner on pay day, thats what.

[rgroyer1RNBSN, BSN, RN]

Yeah, I feel ya. My companie's RSI protocol calls for lidocaine premedication; however, we are not to premedicate with an opiate. We ask the medical director if we can give fentanyl during the two minute wait after giving lido and defasciculating, and he says no. When asked to explain, he says "it takes too much time." What the?!?!, I have two minutes to whistle dixi all day long. So, I take time to give something that may not even work, but cannot give something known to work. But hey, what do you do? Take the wife out to dinner on pay day, thats what.

Exactley!!!