Rapid Sequence Intubation (part 1)

Rapid Sequence Intubation (part 1):beginner:


:ledger:(RSI) is an airway management technique that produces inducing immediate unresponsiveness (induction agent) and muscular relaxation (neuromuscular blocking agent) and is the fastest and most effective means of controlling the emergency airway

:ledger: Useful in the patient with an intact gag reflex, a “full” stomach, and a life threatening injury or illness requiring immediate airway control
:ledger:‘modified’ RSI is a term sometimes used to describe variations on the ‘classic’ RSI approach.

:rotating_light:INDICATIONS OF RSI​:rotating_light:

:thinking:The decision to perform RSI in the ‘out of theatre’ setting involves weighing the pros and cons:

:o:Lack of airway protection despite patency (swallow, gag, cough, positioning , and tone)
:o:hypoxia hypoventilation need for neuroprotection (e.g. target PaCO2 35-40mmHg)
:o:Impending obstruction (e.g. airway burn, penetrating neck injury)
:o:prolonged transfer combativeness humane reasons (e.g. major trauma requiring multiple interventions)cervical spine injury.
:o:diaphragmatic paralysis)

:rotating_light:AGAINST RSI​:rotating_light:

:timer_clock:urgent need to OT and theatre is available anatomically.
:timer_clock: pathologically difficult airway (e.g. congenital deformity, laryngeal fracture)
:timer_clock:Close proximity to OT paediatric cases (especially <5 years of age)
:timer_clock:hostile environment
:timer_clock:poorly functioning team
:timer_clock:lack of requisite skills among team
:timer_clock:Airway is not possible (e.g. neck trauma, tumour)


:bookmark:RSI is useful if the following are present ::arrow_right:
:bookmark:Dynamically deteriorating clinical situation, i.e., there is a real “need for speed”
:bookmark:Non-cooperative patient
:bookmark:Respiratory and ventilatory compromise
:bookmark:Impaired oxygenation
:bookmark:Full stomach (increased risk of regurgitation, vomiting, aspiration)
:bookmark:Extremely short safe apnea times
:bookmark:Secretions, blood, vomitus, and distorted anatomy

:rotating_light:PROCESS OF RSI​:rotating_light:

:thinking:Remembered as the 9Ps::arrow_right:
:crayon:Preparation (drugs, equipment, people, place
:crayon:Protect the cervical spine
:crayon:Positioning (some do this after paralysis and induction)
:crayon:Pretreatment (optional; e.g. atropine, fentanyl and lignocaine)
:crayon:Paralysis and Induction
:crayon:Placement with proof
:crayon:Postintubation management
:crayon:Some add a 10th P for (cricoid) pressure after pretreatment but this procedure is optional and has many drawbacks

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