Download Rapid Sequence Induction

Rapid Sequence
Induction
Rapid Sequence Induction (RSI) is the method
used to secure the airway in a hemodynamically
stable, spontaneously breathing patient. It is
useful in patients who have a full stomach and
therefore are at risk for aspiration.
 Key Principles
 Anticipating and retrieving the appropriate
supplies and equipment.
 Understanding and anticipating the
sequence of events
 Knowledge of the frequently used
medications
Risk Factors for Aspiration
 Last oral intake is unknown
 Pregnancy
 Agitated/Combative requiring diagnostic
procedure
 Traumatic injury-esp head injury
 Intoxication
 GI problems- Ex. Bowel Obstruction
 Altered LOC with compromised airway
Aspiration is a serious
complication that causes:
 Increased length of stay
 Increased cost of treatment
 Increased chance of morbidity
Contraindications for RSI
 Allergies to medications
 Severe oral, mandibular or anterior neck
trauma
 Airway obstruction
 Significant hypotension, profound shock
state
 Age less than 3 months
The goal of RSI is to rapidly
secure and control the
airway. Its all about TIME.
RSI Procedure






Prepare
Pre-oxygenate patient
Administer induction agent
Administer rapid acting muscle relaxant
Insert ET tube
Verify placement of ET tube and ensure
airway is secured
 Post intubation management
Supplies








Establish IV Access
Cardiac Monitor
Oxygen
Pulse Oximetry
Suction- Wall and Yankauer
Crash Cart
Ventilator Prepared for Attachment
Medications
Intubation Supplies











Bag value mask
Ambu bag
Assorted ET tubes- (size 7 or 8)
CO2 detector
Laryngoscope blades-Mac and Miller
Laryngoscope handle
Stylet
LMA
Bougie
Fiberoptic scope access
Cric or trach tray on standby
Patient Preparation







Brief history and assessment
Use the mnemonic AMPLE
A= Allergies
M= Medications
P= Past Medical History
L= Last Meal
E= Existing Circumstances
Patient Preparation
 Pre-Oxygenation
 100% Oxygen- Non-rebreather mask or bag value
mask
 Pretreatment with medications to counteract
the body’s response to intubation. Intubation
causes
 Increased ICP
 Increased intraocular pressure
 Hypertension and tachycardia
Paralysis with Induction
 Induction/Sedation ALWAYS proceeds
paralysis.
 Induction agents should be administered
by or under direct supervision of persons
trained in the administration of general
anesthetics and in the management of
complications encountered during
general anesthesia (anesthesiologist, ED
physicians)
Cricoid Pressure
 Application of pressure
to the cricoid cartilage to
occlude the esophagus.
 Prevents the aspiration
of gastric contents.
 Do not release the
pressure until instructed
to do so.
Post Intubation
 Monitor Vital Signs Frequently
 Confirm Placement of ET Tube
 End tidal CO2
 Auscultation
 Chest X-ray
 Secure ET Tube
 Obtain Orders for Sedation and Pain
Control
 Obtain Vent Orders