induction sequence

Question 1

1. what is the first thing you do when you get the patient in the room?
2. why?

Answer 1

1. put on pulse ox (and other monitors), then quickly give versed and fentanyl (judiciously in older/ smaller people)
2. you want to quickly decrease anxiety and facilitate amnesia

Question 2

1. when preparing to intubate, you hold the blade in your __hand?
2. what is the mouth opening technique?
3. what is the motion of entering the mouth?

Answer 2

1. hold blade in your left hand
2. “scissor” motion with your right hand to open the mouth
3. enter on the right and sweep left to control tongue

Question 3

1. what is a normal ETCO2?
2. when will it be higher
3. what can you do if it is low?

Answer 3

1. 35-45
2. copd patients, during insufflation, post tournicate release
3. adjust minute ventilation (decrease rate or Vt).

Question 4

PROPOFOL:

1. induction dose:
   a. ASA I or II____ / b.ASA III (elderly or hypovolemic)___ / c.cardiac anesthesia_____ / d.neurosurgical _____
2. onset:__/
3. peak
4. duration:__ /
5. infusion rate/ anesthesia maintainance:__/

Answer 4

1.propofol induction dose:
ASA I-II: 2-2.5 mcg/kg
ASA III, elderly, hypovolemic: 1-1.5 mcg/kg
cardiac anesthesia: 0.5-1.5 mcg/kg
neurosurgical: 1-2 mcg/kg
2. onset: 30-60 sec, 
3.peak: 1 minute
4. duration: 3-10 minutes
5: anesthesia maintainance/gtt: 100-200 mcg/kg/min or 25-50 mcg boluses

Question 5

ROCURONIUM: 
1.brand name?
2. available concentration?
3. intubation dose: a) RSI     b) standard intubation
4. onset:
5. peak:
6 duration:
7: obese patients- dose by\_\_\_ body weight?

Answer 5

1. ZEMURON
2. 10 mg/ ml
3. intubation dose
   a) 0.6-1.2 mg/kg b) 0.6 mg/kg (600 mcg/kg)
4. onset=1-2 minutes
5. peak= 1-4 minutes
6. duration= 30-40 minutes
7. obese patients dose by actual body weight

Question 6

2 and 2 ( what is it and who gets a 1 and 1)

Answer 6

2 cc of fentanyl (2cc=100 mcg)
2 mg of versed
(use cautiously in the elderly,(maybe give a 1 and 1 intitally) dehydrated and small body- young people metabolize it out well, so they can get a 2 and 2)

Question 7

EPHEDRA (ephedrine sulfate)

1. dose:
2. onset:
3. duration:
4. uses:

Answer 7

ephedra

1. dose: 2-25 mg iv (usually in 10-20 mg incriments)
2. onset: immediate
3. duration: 10-60 min
   4: indications: hypotension with bradycardia, bronchospasm