rapid sequence induction Flashcards
What is Rapid Sequence Intubation (RSI)?
An airway management technique that induces immediate unresponsiveness and muscular relaxation.
What are the risks associated with cessation of spontaneous ventilation?
Considerable risk if intubation or ventilation is not performed timely.
In which patient scenarios is RSI particularly useful?
Patients with an intact gag reflex, a ‘full’ stomach, and life-threatening injuries or illnesses.
What does ‘modified’ RSI refer to?
Variations on the classic RSI approach, such as ventilation during apnea and titration of induction agents.
What are the indications for intubation and mechanical ventilation? List them.
- Airway protection and patency
- Respiratory failure
- Minimize oxygen consumption
- Unresponsive to pain
- Temperature control
- Humanitarian reasons
What factors support the decision to perform RSI?
- Lack of airway protection
- Hypoxia
- Need for neuroprotection
- Impending obstruction
- Prolonged transfer
- Combativeness
- Humane reasons
- Cervical spine injury
What factors argue against performing RSI?
- Urgent need to go to OT
- Anatomically or pathologically difficult airway
- Close proximity to OT
- Pediatric cases
- Hostile environment
- Poorly functioning team
- Lack of requisite skills
- Emergency surgical airway not possible
What does the 9Ps acronym stand for in the RSI process?
- Plan
- Preparation
- Protect the cervical spine
- Positioning
- Preoxygenation
- Pretreatment
- Paralysis and Induction
- Placement with proof
- Postintubation management
What does the SOAPME mnemonic stand for?
- Suction
- Oxygen - 15LPM O2
- Airways
*Pre-oxygenate - Monitoring equipment/Medications
- End Tidal CO2
What is the ideal characteristic of an RSI induction agent?
To quickly render the patient unconscious, provide analgesia, maintain stable cerebral perfusion, be reversible, and have minimal side effects.
What is Rapid Sequence Intubation (RSI)?
Emergency method for securing the airway
What are the seven Ps for RSI?
- Preparation
- Pre-oxygenation
- Pre-intubation optimisation
- Paralysis with induction
- Positioning/protection
- Placement with proof
- Postintubation management
What does the preparation phase of RSI involve?
Assessment of airway, gather medications and team
How long should pre-oxygenation last before intubation?
A minimum of 3 minutes at highest flow rate (NRM or bag-valve)
What is the target saturation for hypoxaemia during pre-intubation optimisation?
Sats >92
What is the target mean arterial pressure (MAP) during pre-intubation optimisation?
MAP >65
What are common induction agents used in RSI?
- Etomidate
- Ketamine
- Propofol
- Midazolam
What is the most common neuromuscular blocking (NMB) agent for RSI?
Succinylcholine IV
What is used if succinylcholine is contraindicated?
Rocuronium
What position is recommended for intubation?
Sniffing position
What controversial manoeuvre is used to help prevent aspiration during intubation?
Pressure on cricoid (Sellick manoeuvre)
What is the purpose of laryngoscopy during placement?
To visualise glottic aperture, placement and inflation of ETT
What provides proof of successful intubation?
Waveform capnography
What is a key aspect of postintubation management?
Secure ETT (taping, tying, tube holder)
