Preparation and planning including technique, medications, team member roles, and contingencies is desirable prior to every rsi. Rapid sequence induction and intubation rsii is the preferred method of tracheal intubation in emergen. Rapid sequence induction bja education oxford academic. Figure 19 desaturation time for apneic, fully preoxygenated patients. This article will not be a complete or exhaustive resource for this topic, but it can serve as a starting point for medical students. Rapid sequence induction rsi is intended to reduce the risk of aspiration by minimising the duration of an unprotected airway. The lower airway begins at the trachea as it exits the neck and enters the chest. No part of this article or pdf by the american college of chest physicians, 3300 dundee road. Children, patients with comorbidity, and obese patients desaturate much more rapidly than healthy, normal adults. Pretreatmentagentsshouldbegiven3minutespriortointubation canbe giveninanyorder drug dose indication othernotes. In emergency medicine, rapid sequence intubation rsi comes into play when there is neither the time nor the luxury of adequately prepping a patient whose airway and breathing are compromised.
Preparing difficult airway equipment during planning of rapid sequence induction and intubation, giving roles and told to proceed their assigned role for the team, attempt to ventilate with a. Any patient complaining of chest discomfort or exhibiting signs, symptoms, or medical. When pain is treated, patients will be more comfortable and require less sedative medication. Rapid sequence induction and intubation request pdf. New hampshire prehospital rapid sequence intubation manual. Annals of pharmacotherapy rapidsequence intubation. Rapid sequence induction rsi is an established method of inducing anaesthesia in patients who are at risk of aspiration of gastric contents into the lungs. Appropriate rapid sequence intubation rsi with the use of neuromuscular blocking agents, induction drugs, and adjunctive. Rapidsequence intubation rapidsequence intubation rsi is a process for quickly. It involves loss of consciousness during cricoid pressure followed by intubation without face mask ventilation. Appropriate rapid sequence intubation rsi with the use of neuromuscular blocking agents.
Rapid sequence intubation course manual vermont department. This video demonstrates how to perform orotracheal intubation. Appropriate rapidsequence intubation rsi with the use of neuromuscular blocking agents, induction drugs. Rsi is a procedure that is used to facilitate tracheal intubation of a patient in a way that. Emergency orotracheal intubation is indicated in any situation that requires definitive control of the airway. Etomidate and ketamine are both used for sedation in rapid sequence intubation rsi. The purpose of rsi is to affect a state of unconsciousness and neuromuscular blockade, allowing for increased first pass success of endotracheal intubation. Early studies reported few adverse pulmonary or cardiovascular effects with etomidate use, but recent work describes potential increased mortality secondary to adrenal suppression, and possible hypotension with etomidate use in critically ill patients.