Download Conscious Sedation

Conscious Sedation:
Etomidate
Rapid Induction for
Intubation
Program Goals
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Background on Intubation
Current Methods and Practices
New Medications and Theories
Patient Selection
Difficult Airway
Background
• Endotracheal
intubation is
considered the
“Gold Standard”
for airway
management.
Currently only
Oral and Nasal
Intubation are
available for
use.
Oral Intubation
• Orotracheal intubation is the most
commonly used means of securing the
airway in the adult patient.
• It can prove difficult in awake patients
or patients with an intact gag reflex.
• Success rates for oral intubation with
an acutely dyspnic patient are low.
• It can be difficult to secure the airway
of a breathing, conscious patient.
Nasal Intubations
• Blind Nasotracheal Intubation is an
under utilized skill, that is difficult to
be proficient in.
• It has a high occurrence of trauma
and infection.
• It is a blind procedure.
• Patient must be breathing.
New Practices
Etomidate
• Etomidate is a short acting hypnotic.
• When utilized, Etomidate will relax
the patient enough to produce
intubation conditions within 10-15
seconds.
• Etomidate has a relatively short half
life of 10 minutes.
• Proven efficacy of 80%.
Etomidate is NOT
• A paralytic
• An analgesic
Etomidate
• Contraindications:
• Known
Hypersensitivity to
Etomidate
• Under the Age of 10.
Precautions
• Possible hypoventilation or apnea
in overdosage.
• Myoclonus: Diffuse muscle
contraction.
• Pre-medicate with a Benzodiazepine
before administration of Etomidate
Side Effects
• Pain at injection site, try to use the
antecubital fossa.
• Hypotension
• Apnea
• Tachycardia
• Nausea and Vomiting
Etomidate
• Etomidate is not an analgesic,
anticipate reflex hypertension and
tachycardia.
• Not indicated to relax or reduce
trismus or clenching of the jaw.
• You must assess the patient as a
candidate for this procedure.
Clearing the Patient
• It is imperative that each possible
patient receive a thorough
examination for difficulty in
intubation. Any patient found to be
of high risk, or high degree of
difficulty should not receive
Etomidate.
MEDIC TUBES +T
• Mouth /
Mandible
• Excessive
Weight
• Deformity
• Incisors
• C-Spine
• Thyromental
Distance
• Uvula
• Burns
• Emisis
• Stridor
• TRISMUS
Mouth / Mandible
• Measure the opening size of the
mouth. Anything less than three
fingers should be considered a
potential problem
• Check to make sure the mandible is
centered and free from deformity
and fracture.
Excessive Weight
• Obese patients that have large
necks and small chins can be very
difficult to intubate.
• Be sure your patient has an
adequate range of motion in their
neck and lower jaw.
Deformity
• Inspect the face, neck, mouth, and
oropharnyx for deformity, swelling,
bleeding, or any potential problems.
Incisors
• Inspect the
mouth and teeth
for loose debris.
• Buckteeth may
result in poor
visualization.
• Check for dental
appliances and
remove any that
can be.
C-Spine
• Inspect the neck, patients with short
large necks can be difficult to
intubate.
• If the patient is immobilized be sure to
have in-line stabilization maintained.
• Remember it is more difficult to
intubate someone in c-spine because
the axis is not lined up correctly.
Thyromental Distance
• Measure the distance from the
chin to the thyroid cartilage,
anything under three finger
widths can be a difficult
intubation.
Protocol
1. Routine paramedic care
2. Routine preparation for intubation
3. Contact medical control for
etomiate
4. Administer 0.3 mg/kg IVP over 30
to 60 seconds
5. Intubate
6. Verify tube placement with third
party device
Post procedure
• Complete the etomidate survey and
clip to the QI/QA hospital copy