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Chapter 35. Airway Management of an Uncooperative Down Syndrome Patient with an Upper GI Bleed

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Down syndrome patients are known to have the following attributes that may lead to failed intubation:

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A. obstructive sleep apnea

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B. large tongue

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C. tendency to have subglottic stenosis

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D. C-spine subluxation

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E. all of the above

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(E) Down syndrome patients are known to have all these attributes that may lead to failed intubation.

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Ketamine used in the uncooperative patient

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A. aggravates the degree of cooperation because it is a dissociative agent

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B. produces such salivation that laryngospasm is a common problem

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C. is contraindicated because of the high incidence of emergency delirium

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D. can be administered PO or IM

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E. midazolam has been proven to reduce the incidence of ketamine-induced emergency delirium in adults and children

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(D) Even though emergence delirium can occur (incidence varies but may be as high as 10%–30% in adults with a much lower occurrence in children), oral and IM ketamine remains a useful drug in the management of uncooperative patient. Unfortunately, midazolam has not been shown to reduce the incidence of ketamine-induced emergency delirium.

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Oral or IM ketamine is useful in the management of the uncooperative patient. Which of the following is TRUE?

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A. The dose of oral ketamine is 7.0 mg·kg−1.

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B. Midazolam prevents emergence reactions.

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C. Glycopyrrolate should be coadministered with ketamine to prevent laryngospasm.

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D. Ketamine is contraindicated in developmentally delayed individuals.

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E. All of the above.

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(A) Ketamine is useful in the management of uncooperative patients, including mentally challenged individuals and the dose of oral dose is 7.0 mg·kg−1.

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