Rapid Sequence Induction (RSI)

• Indications:

  • Emergency intubation is warranted
  • Pt has a full stomach
  • Intubation is predicted to be successful - if failed, ventilation predicted to be successful
• Steps:

  1. Preparation
  2. Pre-Oxygenation
  3. Pretreatment
  4. Paralysis
  5. Placement of tube
  6. Post-intubation management
• Preparation:

  • Assess intubation
  • Prepare all drugs & equipment
  • Ensure patent IV lines
  • Explain procedure to pt
• Preoxygenation:

  • Preoxygenate pt - for 2-3 min
  • Consider pulse ox use
• Pretreatment:

  • Consider lidocaine to blunt a rise in ICP & prevent laryngospasm
  • Consider beta-blockers or opioids to reduce sympathoadrenal response
  • If your initial paralytic of choice is succinylcholine, then consider administering a defasciculating dose—typically 10% of the normal dose—of a nondepolarizing paralytic, if time permits
• Paralysis:

  • As long as patient is stable condition (systolic blood pressure of greater than 90 mm Hg), administer sedative agent to induce sedation & amnesia.
  • Administer paralytic agent - onset of paralysis takes 2 minutes.
  • Observe for apnea & check for laxity (looseness) of the mandible; these are signs of adequate paralysis.
  • Perform Sellick maneuver
  • Don't ventilate unless SPO2 falls below 90%
• Placement:

  • Perform intubation & confirm placement
• Postintubation: secure tube & initiate mechanical ventilation