Download RSI Check List

RSI Check List
Version 2
Step
People
Anaesthetist: (Unless patient in ED and ED seniors able to manage) Called ____:____
Arrives
ED Senior if patient in ED
Called ____:____
Arrives
XRay: Call in if not onsite.
Called ____:____
Arrives
Team leader / drug push
_____________ Hands off if possible
List speaker / scribe
_____________
Intubator
_____________]Prepare air way equipment
Intubator’s assistant
_____________]suction, pass tube, hold corner of mouth
Cricoid / External Laryngeal Manipulation _____________)
C-spine stabilisation if required
_____________)assist with drug preparation
Monitoring, lines, fluids
_____________)
Preoxygenate: Ambubag, CPAP or BIPAP, or 15L via reservoir mask > 3 minutes if possible

Check O2 supply and ambubag

Time preoxygenation started
Patient assessment
AMPLE Hx – if available

Allergies/sensitivities esp to anaesthetics

Medications

Past medical, surgical and anaesthetic Hx

Last ate or drank

Events – what got the patient into this state
Airway assessment. Risk of difficult BVM or intubation

Neck size and mobility (including potential c-spine injury)

Thyromental distance

Beard

Mouth opening and jaw protrusion

Dentition

Tongue size/masses

View of oropharynx / modified Mallampati (I: all of uvula; II: part of uvula; III: soft palate;
IV: hard palate only) ______________

If in ED: Call anaesthetist if signs of difficult BVM or intubation
Obs

Current Observations. Does technique need to be modified?

O2 sat _______%

RR
_______

HR
_______

BP
___/____

GCS E ___/4 V ___/ 5 M ___/6 = ___/15

Best Motor R ________ L ________

Pupils R ______mm Reactive ____ L ______mm Reactive ____
Ponder Is this the right thing to do now with the available resources?
Preparation
Drugs: Doses calculated, drawn up and labeled

Pressor eg phenylephrine or ephidrine

Anaesthetic eg propofol, ketamine, etomidate

Muscle relaxant eg suxamethonium or rocuronium

Sedative bolus + infusion eg propofol, midazolam, ketamine

Analgesic bolus + infusion eg fentanyl

Long acting muscle relaxant if not used for RSI eg rocuronium
Oxygen supply and ambubag checked if not already done
Suction on and under pillow
ETT

Lubed stylet or bougie in ETT: Adult male: 8. Adult female: 7.5. Paeds: age/4 +4

A smaller and larger ETT available
Monitoring x4

Audible oximetry

BP set to go every 2 minutes

ECG – check the trace to make sure you’re not missing something cardiac/tox

Capnography tested and attached to ambubag
Airways: Oral and nasal airways sized but not opened
Bougie
IV line x 2, IV fluid running, take bloods if required
Laryngoscope x 2 tested
LMA of correct size but not opened
Surgical airway available but not opened (unless “double set up” deemed necessary)
Position patient: ear canal in horizontal line with sternal angle
July 2011
Tick or Time
_____:_____
_____:_____
_____:_____
____:_____
____:_____



Put to sleep: Anaesthetic ________________ Dose ______mg
Paralyze ________________ Dose ______mg
Protection
C-spine if needed
Cricoid
Place tube
If difficulties:

External laryngeal manipulation

Bougie

LMA

Surgical
Tube type (circle): ETT LMA Surgical
Size _____ Depth _________ at Teeth/gums (Adults 24cm, Paeds 3 x ETT)
Placed by ____________ Attempt no: _____
Proof
End tidal CO2 ___________mmHg
Fogging of tube
Auscultate
O2 sats ______%
(Also check a BP now: _____/______)
Secure tube
CXR: Call for XRay now. Take XRay once NG/OG tube in situ
Post intubation management
Drugs

Sedative
o
Bolus ________________ Dose ______mg
o
Infusion ________________ Rate ______mg/hr

Analgesic
o
Bolus ________________ Dose ______mg
o
Infusion ________________ Rate ______mg/hr

Muscle relaxant
o
Bolus Rocuronium Dose ______mg
o
Next dose due: Time ____:_____ (30 minutes later)
Airway

Suction ETT

Insert NG or OG tube

Check tube position
o
Auscultate
o
Tube length at teeth/gums _________cm
o
Oximetry
________%
o
End tidal CO2 _______mmHg
o
XRay
Performed: _____:_____
Breathing: Put on ventilator eg SIMV, 6ml/kg TV, F = 16, 5cm PEEP, 100% O2
Circulation

HR ______ BP ____/_____

Fluids and pressors as required

Bloods eg VBG

Urinary catheter

Consider arterial line if time
D

Check patient adequately sedated: Look for HR or BP or tearing

Recheck pupils

Head up 30º if no spinal injury suspected

Consider mannitol if neurosurgery imminent
E: Thermoregulation as appropriate. Keep warm unless post VF arrest. Temp _____˚C
F: Inform family + gather history from them
G: BSL
______ mmol/L
H: Hx eg from old notes, family, GP. Document Hx and events in ED
I: Any further investigations needed: Bedside, lab, imaging
R: Refer
S: Secondary survey if not done
T: Tetanus, clean wounds, antibiotics if time
T: Thank the team
T: Transfer
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Viewed:
____:_____
_____:_____
____:_____
____:_____
NB: In ED the intubator is responsible for photocopying this sheet and putting a copy in Dr Cresswell’s pigeon
hole.