‫ﻪ‬

‫ﻴ‬‫ﻨ‬‫ﻤ‬
‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺭ‬‫ﻮ‬‫ﻬ‬
‫ﻤ‬‫ﻟﺠ‬
‫ﺍ‬

‫ﻟﻲ‬
‫ﺎ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻢ‬‫ﻠ‬
‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺯ‬
‫ﻭ‬

‫ﺔ‬
‫ﻳ‬‫ﺮ‬‫ﺒﺸ‬
‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻴ‬‫ﻤ‬
‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍﻝ‬‫ﺯ‬
‫ﺁ‬‫ﺔ‬‫ﻌ‬
‫ﻣ‬‫ﺎ‬‫ﺟ‬

‫ﺔ‬
‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬
‫ﺍ‬‫ﻡ‬‫ﻮ‬
‫ﻠ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻠ‬‫ﻛ‬

‫ﻊ‬
‫ﺑ‬‫ﺍ‬‫ﻮﻯﺭ‬
‫ﺘ‬‫ﻳ ﺾﻣﺴ‬
‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻗﺴﻢ‬

‫ﺔ‬
‫ﺒ‬‫ﻟ‬
‫ﺎ‬‫ﺍﻄ‬
‫ﻟ‬
‫ﺩﺍ‬‫ﺍ‬
‫ﺪ‬‫ﺇﻋ‬

‫ﻴﻦ‬
‫ﺀﺣﺴ‬
‫ﺎ‬‫ﻔ‬‫ﻴ‬
‫ﻫ‬
‫ﺭ‬
‫ﻮ‬‫ﺘ‬‫ﻛ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﺍﻑ‬‫ﺮ‬
‫ﺇﺷ‬

‫ﻟﺠﻼﻝ‬
‫ﺍ‬‫ﻴﺐ‬
‫ﺒ‬‫ﺣ‬
I
ntr
oduct
ionofendot
racheal
tube
I
tisknownasiser
ti
ngatubethrought henoseor
mouththr
oughthethr
oati
ntothetrachea,i
nordert
o
fr
eetheai
rwaysandensur
ethev enti
lati
onofthe
pati
ent
.

 Duri
ngouranesthesia,thepati
ent'
svent
il
ati
onis
art
if
ici
alandt
hepat ient'
sbreat
hingisi
nhibi
tedbyt
he
useofmusclerelaxants.

 Aninhaleddrugisgi
vent
hroughitandmaybeusedas
awayt ogivemedici
neswhenthereisnoi
ntr
avenous
i
ntake,asincasesofCPR.

 Thi
sprocedur
eisimport
antforever
ydoctorwho
worksi
nemergency,ext
ernalambul
anceorgener
al
medici
ne.

 Nasali
ntubat
ioni
sabl
i
ndt
uni
ngt
hati
sdonewi
thout
anendoscope.

Itwaspr eviousl
yperf
ormedinint
ensi
vecare,wher
e
thepatientremainsforweeks,
whichresul
tsinchr
onic
sinusi
tis,andcontr
ibut
estopneumoniainducedwit
h
resist
antger ms.

I
ndi
cat
iont
oent
eri
ngt
hist
ube:
1)Di
ff
icul
tyopeni
ngt
hemout
hduet
ojawf
ract
ures

2)Bur
nScar
s

3)Thebr
uisi
ngoft
heneckcol
umn

4)def
ormi
ti
esoft
hecer
vical
joi
nts

Di
sadv
ant
ages

1.I
ntr
oduci
ngnasal
ger
mst
otr
achea

2.Si
nusi
ti
s
 3.Epi
staxi
s

4.Noseandbackphar
ynxbr
uises

Thenasal
tubei
snol
ongerusedasbef
ore,
duet
othemany
def
ects

t
rachealt
ubat
iont
ool
s

Weneedt
racheai
ntubat
ion,
whi
char
etool
s.
1_
ETT(
endot
rachealt
ube)

Weprepar
etheappr
opri
atetubeandthesmal
lerandl
arger
measur
ement,asapr
ecauti
on,ensur
ingt
hevali
dit
yoft
heball
oon

2_
Lar
yngoscope

Wepr
epar
etwobl
adeswi
tht
wodi
ff
erentsi
zes

3_
Ambowi
tht
her
ightf
acemask

I
naddi
ti
ont
opr
epar
ingt
heoxy
genl
i
nk

4_
Sty
let

Hel
pschanget
het
ubul
arbendi
ncaseofdi
ff
icul
tyi
ntubat
ion

5_
Magi
l
lfor
ceps

Hel
psinst
reami
ngt hetr
acheatubeduri
ngthenasali
ntubat
ion,
as
wel
lasint
heint
roducti
onofthegastr
icnasalt
ube.

I
tisnol
ongerusedduet
othel
ackofnasal
tracheai
ntubat
ion.

6_
Airbal
l
oonbl
owi
ngsy
ringes
7_
Secr
eti
onext
ract
iont
ubes

I
tisusedt
owi
thdr
awbl
ood,
vomi
ti
ng,
andheav
ysecr
eti
ons

8_
Ast
ickysubst
ance

Faci
l
itateent
ryofthet
ubecont
ainsal
ocal
anest
het
ic,
whi
chi
sto
i
mprov ethet
oler
anceoft
hetube.

9_
aircondi
ti
oner

Pr
e-massagepr
e-i
nst
all
ati
oni
sint
ended

10_
Meansofpr
event
ion

Goggl
es,
rubbergl
oves,
andpr
otei
vemasks

11_
Agoodv enousl
i
newi
tht
hepr
epar
ati
onoft
henecessar
y
medici
nes

12_
Pal
sterToi
nst
all
thet
ube

13_Pi
ll
owsTogi
vet
hepat
ient
'sheadt
heappr
opr
iat
eposi
ti
onf
or
i
ntubat
ion

14_
stet
hoscopet
ocheckwher
ethet
ubei
s

15_
nor
mal
sal
i
ne

16_
car
diacmoni
tor

Ty
pesofendot
racheal
tube:

1)Rubbert
ubes:Themagi
letubeswer
ecal
l
ed
st
eri
li
zat
ionsever
alt
imes,
andt
 heyar
enol
ongerused.

2)Plasti
ctubes:aremadeof
disposabl
emat eri
als
polyni
vylchlori
de(PCV)t
hat
arelesssati
sfi
edandbett
eri
n
termsofsteril
i
zati
on

3)reinf
orcedtubes,incl
udingsnail
-shapedsuppor
ti
ve
ri
ngs,topreventblockagesandforging,
usedinhead
andnecksur geryandneurosurgery.

4)Pulmonaryi
nsulat
iontubesareequippedwit
htwo
shi
nes,eachlungseparat
elycont
ainsthesl
eeveoft
he
neural
tube,t
heotherlust
erofthetracheat
ube.
:

A)
Whi
tet
ubef
orv
ent
il
ati
onoft
her
ightl
ung

B)
Kar
stubef
orl
eftl
ungv
ent
il
ati
on
Usessur
geryt
horaxi
cThelungsonwhicht
hesur
geonworksar
e
i
solat
edfr
om vent
il
ati
onandotherl
ungsar
event
il
ated.

Lungi
solat
iont
ubesareequippedwi
thtwol
umenstoventi
l
ate
eachl
ungseparat
ely
.Itcont
ainsasl
eev
eforthebr
onchi
alt
ube
(t
hefi
rstl
umen)

Whi
tet
ubef
orr
ightl
ungv
ent
il
ati
on

Car
lenst
ubef
orl
eftl
ungv
ent
il
ati
on

I
tisusedint
hor
acicsur
ger
y,wherethel
ungthatthesur
geoni
s
oper
ati
ngisi
sol
atedfr
om v
enti
lat
ionandtheotherl
ungis
vent
il
ated

Hardlar
yngoscope:
Iti
susedt
oexposet
hel
ary
nxandf
aci
l
itat
e
i
ntubati
on

Itconsist
sofahandl
econtaini
ng..
.Al i
ghtsour
ceandabl
adet
hat
containsalampi
nitshead,andtherearet
wot y
pes:

1_
Str
aightcutf
orchi
l
drenundert
hreey
ear
s

Itprovi
desbet
tervi
sionandi
tsheadi
ssur
roundedbyt
he
epiglot
ti
sandisol
ated

2_Curv
edandcal l
edMcI ntosh:I
tprovi
desawiderar
eaandtheti
p
ofthi
sbladeenter
st hegroovebetweenthebaseoft
hetongue
andtheepigl
ott
is(astr
oli
ngualfol
d).
TubeMeasurements:Tubemeasur
ementandl
engt
hvar
y
accor
dingt
ot hepat
ient
'sage.

(‫ﺳ‬
‫ﻮﻝ) ﻢ‬
‫ﻟﻄ‬‫ﺍ‬ (
‫ﻠﻢ‬‫ﻤ‬
‫)ﺑ‬‫ﻠﻲ‬
‫ﺍﺧ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﻘﻄ‬‫ﻟ‬
‫ﺍ‬ ‫ﺮ‬
‫ﻤ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬

12 3.
5 ‫ﻤﻞ‬
‫ﻟﺤ‬‫ﺍ‬
‫ﻡ‬‫ﺎ‬‫ﻤ‬
‫ﺘ‬‫ﺪﺑ‬
‫ﻴ‬‫ﻟ‬‫ﻮ‬
‫ﻟ‬‫ﺍ‬

12 2.
5 ‫ﺪﺝ‬
‫ﻟﺨ‬‫ﺍ‬
‫ﺪ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﻟ‬
‫ﺍ‬

14+‫ﺮ‬
‫ﻤ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬
/2 4+4/
‫ﺮ‬‫ﻤ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬ ‫ﻔﻞ‬
‫ﻟﻄ‬‫ﺍ‬

24 7_
7.5 ‫ﻎ‬
‫ﻟ‬‫ﺎ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻨﻰ‬
‫ﺛ‬‫ﺍﻻ‬

24 8_
9 ‫ﻎ‬
‫ﻟ‬‫ﺎ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻛ‬
‫ﺬ‬‫ﻟ‬‫ﺍ‬

Car
eofi
ntubat
ion

Fi
rst
1)Thepatientmustbe
fasti
ngforatleastsi
xhour
s
beforepreparat
ion:

2),
thet
ool
sar
epr
epar
ed

3)thepati
enti
splacedi
nan
appropr
iat
eposit
ion:

Weraiset
heheadsl
i
ght
lywhi
l
eext
endi
ngt
heat
las
j
oint

4)
Thi
rd,
checkt
het
ubeandmakesur
eiti
snotl
eaki
ng

5)r
emovethear
ti
fi
cial
teet
hthatmayhi
ndert
he
i
nst
all
ati
onoft
hetube
 Suchasar
ti
fi
cial
teet
h,whi
chmaybr
eakandbl
ockt
he
ai
rway

6)pre-
oxygenati
on,wherethepati
entmustbepre-
oxy
genat
ed
bygiv
ingseverali
nhalat
ionsofoxygenthr
oughthemaskfor
sev
eralminutes.

Pre-
oxygenat
ionai
mst
omai
ntai
nasaf
etymar
ginf
ort
hreet
o
f
iveminutes

Becausether
emainingf
uncti
onalcapaci
tyoft
hel
ungi
sdev
oidof
ni
trogengasandf
il
ledwithoxygen

Secand:
I
.Weargl
aves

I
I.Thelef
thandisusedtoexposethel
ary
nxwi t
hthe
scopeandtheri
ghthandisusedtoi
nsertt
hetube

I
II
.Theendoscopebladeisfi
rsti
nsert
edalongtheri
ght
edgeofthetongue,wit
hthetongueshif
tedtothe
l
eftMakesurethetonguefi
tsunderthebladeonthe
l
eftsi
deofthemout h

I
V.Thelar
yngoscopei
sr aisedupwardandfor
wardin
ordert
orai
setheepiglotti
sandreveal
thevocal
cords,
 whi
l
ebei
ngcar
eful
nott
orestont
het
eet
h.

V.Thet ubeisi nsertedupt o21cm i nwomenand23cm

i
nmen.Somet i
mesi tmaybenecessar ytoapply
pressureont helarynxinor dertofaci
li
tatetheinserti
on
ofthet ube,asi tmustbeposi ti
onedatt hedist
al endof
theendot racheal tubeafteritsi
nserti
onatadi stance
of3-7cm f r
om t hetracheal sat
urati
on.

VI
.Fi
xthetubewit
hpl
ast
eraf
terensur
ingt
hati
tisi
nit
s
cor
rectl
ocat
ion

VI
I. Youmustcont
inuetomonit
oryourbl
ood
pressur
e,pul
se,
andoxygenat
iondur
ingthepr
ocedur
e

VI
II
. Theendot r
achealballoonpressurei
salso
monitor
edimmediat
elyafterint
ubati
onandrepeat
edl
y
ther
eaft
er,
asitmustnotexceedt hepulmonary
capil
l
arypr
essur
einthetrachealwall.
Adul
tamount
20_30mmHg

Thi
rdThel
ocat
ionoft
het
ubei
sconf
ir
med:
Ver
if
icat
ioni
sdonei
ntwoway
s,asf
oll
ows:

1_
Dir
ectv
iewoft
het
ubebet
weent
hev
ocal
cor
ds

2_Measur ingthepercent
ageofcarbondioxi
deandtheendof
exhalati
oni sthemostimport
antmet hodIti
sconduct
edusi
nga
detectorthatchangescooruponlaunchandisdeli
ver
edtotheend
ofthear ea,orthr
oughaspecial
moni tor
ingdev
ice

I
tcanal
sobeveri
fi
edinanot
hermostimpor
tantway
Itcanal
sobe
v
eri
fi
edinanot
hermostimpor
tantway
Buti
fthesi
tuat
ioni
sanemer
gencyandanemer
gencyandt
he
st
omachisfull
:

Fi
rst,
pre-
oxy genati
onisperf
ormedduri
ngspont
aneousbreathi
ng
befor
eadmi ssion,meani
ngthatbr
eathi
ngmustbespontaneous
andnotwithposi t
ivepr
essure.

Becausethest
omachisf
ull
,vomiti
ngandi nhal
ati
onofthe
content
smayoccurwhenposit
ivepressur
eoxygenat
ionis
perf
ormed

Secandsleepandr
elaxat
ion,
fast
-act
inghy
pnot
icsandr
elaxant
s
areused

Third,
toperformthei
ntubati
on,iti
spreferabletohavean
assist
antinthisst
epbecausetheintubati
onmustbedonei na
veryquickstepwit
hquickinf
lat
ionofthesl eevetoavoi
dvomi
ti
ng
andaspi r
ati
on.TheSi
lkmaneuv eri
salsoper formedduri
ng
i
ntubation.
Compl
i
cat
ionofi
ntubat
ion:
a)Hy
poxemi
a

b)-Dy
srhy
thmi
a(i
ncl
udi
ngBr
ady
car
dia)

c)-Hy
po/Hy
per
tensi
on

d)-Br
onchospasm

e)-Lar
yngospas

f
)-Tr
aumat
otot
hel
i
psandmout
h

g)Esophageal
int
ubat
ion

h)-Esophageal
per
for
ati
on

i
)-Br
onchi
ali
ntubat
ion

Dr
ugsbef
orei
ntubat
ion:
Commonl yusedpremedicat
ionsincludingfentanyl
,midazolam,
andatropine;i
nducti
onagentsincludingetomidateandket amine;
paral
yti
csi ncl
udi
ngrocuroni
um andsucci nylcholi
ne;andreversal
agentsincludi
ngnaloxone,f
lumazenil,andparalyt
icsarereviewed.
1)f
ent
any
l

Mechani
sm ofAct
ionf
ent
any
l
isasy nthet
icopioidagonist
,whichact
s
pri
marilyattheμ-opioidr
eceptor
.Iti
s100
ti
mesmor epotentthanmor phi
neresul
ti
ngin
anestimatedconv ersi
onrati
oof1t o100to
provi
deanequal degr eeof

Uses
t
otr
eatacut
e(shor
tter
m),

sev
erepai
ncausedbymaj
ort
raumaorsur
ger
y

,
aswel
lasf
orchr
oni
cpai
ncausedbycancer

.Howlongy ouneedt
otakef
ent
any
lforwi
l
ldependonwhyi
thas
beenprescr
ibed

Dose
1_
50_
100mcq/
doseI
M sl
owl
yor30_
60mi
nIV

2_
25_
100mcq/
dose1_
2mi
nIV

f
ent
any
lpr
oducesef
fect
ssuchas:
r
elaxat
ion,

euphor
ia,

pai
nrel
i
ef,

sedat
ion,

conf
usi
on

dr
owsi
ness

,
dizzi
ness,

nausea
andv
omi
ti
ng,

ur
inar
yret
ent
ion

,
pupi
l
lar
yconst
ri
cti
on,

r
espi
rat
orydepr
essi
on

2)
Midazol
am

Mechani
sm ofact
ion
Midazolam bindst ot heGABAr eceptor
butdoesnotdi splaceGABA; r
at her,
it
enhancest heaf fi
nityofGABAf orits
receptorsit
eont hesamer ecept or
compl ex.Thephar macodynamic
consequencesofbenzodi azepineagonistact
ionsi
ncl
ude
antianxi
etyeffects,sedati
on,andr educt
ionofsei
zur
eact
ivi
ty

Uses
bef
oremedi
cal
procedur
esand

sur
ger
ytocausedr
owsi
ness,

r
eli
eveanxi
ety
,

pr
eventanymemor
yoft
heev
ent

.I
tisal
sosometimesgiv
enaspar toftheanest
hesi
adur
ing
sur
geryt
oproducealossofconsciousness

Dose
I
M.70-
80mcg/
kg(
doser
ange~5mg)30-
60mi
nut
es

Si
desef
fect
maymakey
ouv
erydr
owsyandmayaf
fecty
ourmemor
y

,
thi
nki
ng,
mov
ement
s.

Donotdri
veacarordoot heracti
vit
iesthatrequi
reyoutobeful
ly
al
ertf
oratleast24hoursaft
errecei
v i
ngmi dazol
am andunt
ilt
he
ef
fect
softhemedi cat
ionhavewor n

3)
Atr
opi
n

Mechani
sm ofAct
ionat
ropi
n:
inhi
bitsthemuscari
nicacti
onsofacetyl
chol
i
neonst
ruct
ures
i
nnervatedbypostgangl
ioni
ccholi
nergi
cnerv
es,
andonsmooth
muscles,whichr
espondt oendogenous
acet
ylcholi
nebutarenotsoinnervat
ed

Uses
toreducesali
vaandfl
uidi
nthe
r
espir
atoryt
ractdur
ingsur
gery

.I
tisalsousedt
otreati
nsect
ici
deor
mushroom poi
soni
ng.

I
tcanbeusedi
nanemer
gencyt
otr
eatasl
owhear
tbeat

Dose
fr
om 0.5mgt o1mg(5-10mLoft he0.1mg/mLsol
uti
on)f
or
anti
sial
agogueandot
herant
ivagal
effect
s..

Si
desef
fect
Bi
gger
,di
l
ated,
orenl
argedpupi
l
s.

bl
i
ndness.

chestpai
n,di
scomf
ort
,ort
ight
ness.

cough.

decr
easedv
isi
on.

decr
easei
nur
inev
olume.
decr
easei
nfr
equencyofur
inat
ion.

di
ff
icul
tyi
npassi
ngur
ine.

4)
Etomi
dat
e
Mechani
sm ofact
ion:

isahy poti
cagentthatisusedf ort
heinducti
onofanest hesi
a.It
producesitsef
fectbyactingasaposi t
iveal
loster
icmodul at
oron
theγ-aminobut
yricacidtypeAreceptorandthusenhanci ngthe
effectoft
heinhibi
toryneurot
ransmitt
erγ-aminobuty
ricacidin

Uses
Etomidateisal
sousedt omaintain
anesthesiaandforshortoper
ativ
e
proceduressuchasr educi
ngdisl
ocat
ed
j
oint

,
tracheal
int
ubat
ion

,
car
diov
ersi
on,

di
l
ati
on,

cur
ett
age,

cer
vical
coni
zat
ion

Dose:
0.
3mg/
kg,
inj
ect
edov
eraper
iodof30t
o60seconds.

Si
desef
fect
I
nject
ionsi
tepai
n,

skel
etal
muscl
emovements(
e.g.
,myocl
oni
c,av
erti
ng,t
oni
c,or
ocul
armovement
s),
post
oper
ativ
enauseaandvomit
ing
My
ocl
onusoccur
sfr
equent
ly

.Mostepisodesar
emildtomoderat
einsever
it
y,al
though
di
stur
bingmov ement
srepor
tedoccasi
onal
l
y

5)
Ket
ami
ne

Mechai
nism ofact
ion:
interactswithN- methyl-
D-
aspartate(NMDA)r eceptor
s,
opioi
dr eceptors,monoami nergi
c
receptors,muscar i
nicrecept
ors
andv olt
agesensi ti
veCai on
channels.Unlikeothergeneral
anaestheticagents,ketamine
doesnoti nteractwithGABA
receptor

Uses
Ket
ami
necani
nduceast
ateofsedat
ion(
feel
i
ngcal
m andr
elaxed)
,

i
mmobi
l
ity
,

r
eli
eff
rom pai
n,

andamnesi
a(nomemor
yofev
ent
swhi
l
eundert
hei
nfl
uenceof
t
hedrug)

.I
tisabusedf
ori
tsabi
l
ityt
opr
oducedi
ssoci
ati
vesensat
ions

hal
l
uci
nat
ions.

Ket
ami
nehasal
sobeenusedt
ofaci
l
itat
esexual
assaul
t

Dose
IV:1-
4.5mg/
kgsl
owI
Vonce;
Alt
ernat
ivel
y(of
f-
label
):0.
5-2mg/
kg
sl
owIV
Si
desef
fect

1)
all
ergi
creact
ions(
ski
nrash,
itchi
ngorhi
ves;
swel
l
ingoft
hef
ace,
l
i
ps,
ort
ongue)

2)
hal
l
uci
nat
ions.

3)
heart
beatrhy
thm changes(tr
oublebr
eat
hing;
chestpai
n;
di
zzi
ness;f
ast,i
rr
egularhear
tbeat
;

4)
feel
i
ngf
aint

5)l
i
ght
headed,

6)
fal
l
s

5)
Rocur
oni
um br
omi
de

Mechani
sm ofAct
ion

isanondepolari
zingneuromuscul arbl
ocking
agentwit
har apidtoi
ntermediateonset
dependi
ngondoseandi ntermediatedurat
ion.I
t
actsbycompet i
ngforcholiner
gicrecept
orsat
themotorend-pl
ate

used

withgeneralanesthesiamedicinesf orrapid
sequenceintubat
ionandr outi
net rachealint
ubat
ion.Thi
smedici
ne
i
salsousedt ohel prel
axthemuscl esduringsur
geryor
mechanicalventi
lati
on.Thismedi cineistobegivenonlybyy
our
doctororothertr
ainedhealthprofessional.

Dose

50mg/
5ml
(10mg/
ml)

Si
desef
fect
s

1.
Cough.
2.
dif
fi
cul
tywi
thbr
eat
hing.

3.
fai
nti
ng.

4.
fast
,sl
ow,
ori
rr
egul
arhear
tbeat
.

5.
noi
sybr
eat
hing.

6.
swel
l
ingatt
hei
nject
ionsi
te.

7.
ti
ght
nessi
nthechest
.

7)
Succi
nyl
chol
i
ne

Mechani sm ofact i
onAdepol arizingneur omuscularblocki
ngagent
,
succinylcholi
neadher est opost -synapticcholi
nergic
receptorsoft hemot orendpl ate,inducingcontinuous
disrupti
ont hatresult
si ntransientf asci
culat
ionsor
i
nv olunt
arymuscl econt ractionsandsubsequent
skeletalmuscl eparalysi
s.2

Uses

Succinyl
choli
neisaskeletal
musclerelaxantforintr
avenous(I
V)
administr
ati
onindi
catedasanadjunctt ogeneralanesthesi
a,t
o
faci
li
tatetr
acheali
ntubati
on,andt
opr ovideskeletalmuscle
rel
axati
ondur i
ngsurgeryormechani
cal venti
l
ation.

Dose:

1_
1.5or20mg/
mlt
heonestofef
fect:
30_
60sec3/
10mi
n

Si
desef
fect

1.al
ler
gicreact
ionsl
ikeski
nrash,
itchi
ngorhi
ves,
swel
l
ingoft
he
face,l
ips,
ortongue.

2.
breat
hingpr
obl
ems.

3.
eyei
rr
it
ati
on,
itchi
ng.

4.
faci
alf
lushi
ng.
5.
signsandsymptomsofincr
easedpotassi
um l
i
kemuscl
e
weakness;
chestpai
n;orf
ast,
irr
egul
arheart
beat
.

8)
Flumazeni
l

Mechani
sm ofAct
ion

isabenzodi azepineant
agoni st.I
tcompet i
ti
vel
yinhi
bit
sthe
acti
vityofbenzodi azepi
neandnon- benzodi
azepi
nesubstances
thatinteractwithbenzodiazepine
receptorssiteont he
GABA/ benzodiazepiner
eceptor
compl ex.

Uses:isusedt ohelpyouwakeup
afterasurgeryormedical
procedureinwhi cha
benzodiazepinewasusedasasedat i
ve.Flumazenili
sal
sousedt
o
tr
eatbenzodi azepi
neoverdosei
nadult
s.Flumazenilmayal
sobe
usedf orpurposesnotli
stedint
hismedicati
onguide.

Dose

0.
2mgIVover15sec.I
Faft
er45secnor
esponse,
admi
nist
er0.
2
mgagai
nov
er1mi n;may

Si
desef
fect

1)
pai
nori
rr
it
ati
onwher
ethemedi
cinewasi
nject
ed,

2)
agi
tat
ionort
remor
s(shaki
ng)
,

3)
fl
ushi
ng(
war
mth,
redness,
ort
ingl
yfeel
i
ngundery
ourski
n),

4)
dizzi
ness,

5)
sweat
ingorshi
ver
ing,

6)
headache,

7)
blur
redv
isi
on,
orr
ingi
ngi
nyourear
s.

9)
propof
ol
Mechani
sm ofact
ion

Theact i
onofpropofoli
nvol
vesa
positi
vemodulati
onoftheinhi
bit
ory
functi
onoftheneurotr
ansmitt
ergama-
ami
nobut
yri
caci
d(GABA)
throughGABAAr ecept
ors

Uses:

tohelpyour el
axorsleepbefor
eanddur i
ngsurgeryorother
medicalprocedur
es.Thismedici
neisananestheti
candasedat i
ve.
Propofolmayalsobeusedt osedat
ecoronavir
us(COVID-19)
pati
entswhoneedmechani calvent
il
ati
onintheint
ensivecareuni
t
(I
CU)

Dose:Mostpatient
srequi
re100t
o150mcg/ kg/
min(6t
o9
mg/kg/h)for3to5mi nut
esorasl
owinj
ect
ionof0.5mg/kgov
er
3to5mi nutes

Si
desef
fect

1)Bl
urr
edv
isi
on.

2)conf
usi
on.

3)dizzi
ness,
fai
ntness,orl
i
ghtheadednesswhenget
ti
ngup
suddenlyf
rom alyi
ngorsit
ti
ngposition.

4)f
ast
,sl
ow,
irr
egul
ar,
orpoundi
nghear
tbeatorpul
se.

5)headache.

6)poundi
ngi
ntheear
s.

7)pr
obl
emswi
thmov
ement
.

8)sweat
ing.

10)
Nal
oxone
Mechani
sm ofact
ion

Naloxonei sanopioid
antagonistmedicati
on
usedtobl ockorreverse
theeffectsofopioi
ddr ugs,
parti
cularl
ywithi
ntheset t
ingofdr
ugoverdoseswhichar
e
rapi
dlybecomi ngaleadingcauseofdeat
hwor l
dwide

Uses

Anti
doteofopioi
dtoxi
cicty(usedalongwi t
hemer gency
medicalt
reat
mentt or
ev er
set heli
fe-thr
eat
eningeffect
s
ofaknownorsuspectedopi ate(narcoti
c)overdosein
adul
tsandchil
dren.Naloxonenasal sprayi
sinacl assof
medicat
ionscall
edopiateantagonists)

dose:
4mg/
10ml
(0.
4mg/
ml)

Si
desef
fect:

Adv erseeventssuspectedtober el
atedtonaloxone
treat
mentwer ereport
edi n45%ofepi sodes.Themost
commonadv erseeventswererelatedt oopi
oidwit
hdrawal
(33%)suchasgast roi
ntesti
naldi
sor ders,
aggressi
veness,
tachycardi
a,shi
veri
ng,sweatingandt remor

si
deef
fect
sofnal
oxonef
ort
hehear
t?

1)
Ser
ioussi
deef
fect
sofNal
oxone

2)
Agi
tat
ion.

3)
bodyaches.
5)
chestpai
n.

6)coughi
ngt
hatsomet
imespr
oducesapi
nkf
rot
hy
sputum.

7)
cry
ingmor
ethant
heusual
(inbabi
es)

8)
dif
fi
cul
tort
roubl
ebr
eat
hing.

9)
excessi
vecr
ying.

10)
fast
,poundi
ng,
ori
rr
egul
arhear
tbeatorpul
se

Thanky
ou