Definition rapid sequence intubation rsi is the virtually simultaneous administration of a sedative and a neuromuscular blocking paralytic agent to render a patient rapidly unconscious and flaccid in order to facilitate emergent endotracheal intubation and to. Reference list rapid sequence induction agents for emergency intubation 2 authors. While an advisory opinion is not law, it is more than a recommendation. This practice includes routine administration of sedative and neuromuscular blocking agent nmba medications for pa. In other words, an advisory opinion is an official opinion of. Review of basic airway management, intubation, 14 hours and trauma assessment. Rapid sequence induction rsi is an established method of inducing anaesthesia in patients who are at risk of aspiration of gastric contents into the lungs. However, rsi as a practice is not without risk, particularly in the critically ill population. Rapid sequence intubation rsi is defined as an airway management technique in which a potent sedative or anesthetic induction agent is administered simultaneously with a paralyzing dose of a neuromuscular blocking agent to facilitate rapid tracheal intubation. In emergency medicine, rapid sequence intubation rsi comes into play when there is neither the time nor the luxury of adequately prepping a patient whose airway and breathing are compromised. Overview rsi is a method of intubating patients who have a gag reflex who would otherwise be difficult to intubate.
It differs from other forms of general anesthesia induction in. To complete an rsi, the patient should not be ventilated until the ett is in place. In the postsurgical patient this is often the case. He has a tense, rigid abdomen, bilateral femoral fractures and an unstable pelvis. Rapid sequence intubation is a stepwise process developed to assist health care providers in placing emergent arti. Current practice of rapid sequence induction of anaesthesia in the uk. Rapid sequence intubation, also known as rapid sequence induction, or medication enhanced intubation, is the use of sedating and muscle relaxing medications to aid in the intubation of conscious or struggling patients. Rapid sequence intubation is a stepwise process developed to assist health care providers in placing emergent artificial airways for patients requiring assisted ventilation. Rapidsequence intubation and the role of the emergency department pharmacist jeremy p. Techniques for improving patient care and minimizing infectious risks to care providers and spread of the virus during emergency intubation are summarized in the following table table 1 and discussed in greater detail separately. Rapid sequence induction and intubation request pdf. This prospective study, from the university of california, san diego, investigated the effect of rapid sequence intubation rsi on outcomes in adults with severe traumatic brain. His gcs is 6 and he is making gurgling sounds when he breathes.
To avoid such spread, certain practices used in standard rapid sequence intubation rsi must be modified. Rapid sequence induction medications soft physical restraints, as ordered crash cart prerequisite skills verbalizediscuss recognition, assessment, and history findings consistent with u upper airway obstruction and or need for rapid sequence intubation rsi 1 2 3 discuss potential complications and precautions dentures. Intubation is accomplished by sedating and paralyzing the patient, allowing for easier intubation. Thorough preparation, satisfactory preoxygenation, modified rapid sequence induction, and rapid intubation using a video laryngoscope are widely used intubation strategies in wuhan. The usual, nonrapid sequence of induction and intubation for anesthesia consists of administration of an induction agent, proof of the ability to mask ventilate. These include antacids, a group of drugs that react with hydrochloric acid to raise ph. This article will not be a complete or exhaustive resource for this topic, but it can serve as a starting point for medical students. Airway management of the critically ill patient rapidsequence intubation stuart f. An advisory opinion adopted by azbn is an interpretation of what the law requires. Rapid sequence induction rsi is an established airway management. Rapid sequence induction bja education oxford academic. Subscribe today and give the gift of knowledge to yourself or a friend rapid sequence intubation.
Rapid sequence induction agents for emergency intubation. Pharmacology for intubationrapid sequence inductionpages summary. No new skills are necessary, but decision making is crucial. In the event of a desaturation rapid sequence intubation optional assemble airway equipment. A presentation that discusses a pharmacists role and the medications used in rapid sequence intubation. Rapidsequence intubation airway management of the critically ill. The effect of paramedic rapid sequence intubation on outcome in patients with severe traumatic brain injury davis, d. The classical technique of rapid sequence induction rsi of. This course manual will discuss the recognition of airway. Definition rapid sequence intubation is indicated when concern for aspiration exists.
Lungprotective ventilation, prone position ventilation, and adequate sedation and analgesia are essential components of ventilation management. Rapid sequence intubation is a stepwise process developed to assist health care. These were collated by stept and safar in 1970 to describe a technique they called rapid sequence induction and intubation. In advanced airway management, rapid sequence induction rsi also referred to as rapid sequence intubation or as rapid sequence induction and intubation rsii is a special process for endotracheal intubation that is used where the patient is at a high risk of pulmonary aspiration or impending airway compromise. Rapid sequence intubation sharonelizabethmace,md, facep, faap a,b c d definitionoverview rapid sequence intubation rsi is a process whereby pharmacologic agents, specifically a sedative eg, induction agent and a neuromuscular blocking agent are admin. The technique includes specific protection against aspiration of. Rapidsequence intubation and the role of the emergency. The aim is to intubate the trachea as quickly and as safely as possible. Rapid sequence intubation course manual vermont department. Current controversy mohammad elorbany, md, and lois a. Management of your patient may require a more individualized approach. This practice includes routine administration of sedative and neuromuscular blocking agent nmba medications for patient comfort during endotracheal tube placement. Connolly, md the changing opinion regarding some of the traditional components of rapid sequence induction and intubation rsii creates wide practice variations that impede attempts to establish a standard rsii protocol.