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#Rapid sequence intubation process how to

Many organisations advocate the use of a checklist to ensure that all equipment is available and in working order, and that the planned sequence of events is shared with all team members. Anticipation of difficult airway and establishing oxygenation plans prior to conducting RSI are essential. Preparation is vital, both of equipment and team members – particularly if the team is unfamiliar with the environment or their colleagues. 2 Unstable cervical spine fractures will require caution in the application of cricoid pressure due to the possibility of exacerbating damage. A laryngeal injury contra-indicates cricoid pressure. Contraindications to suxamethonium such as allergy, susceptibility to malignant hyperthermia or hyperkalaemia should prompt usage of an alternative muscle relaxant such as high-dose rocuronium.

Patient factors may dictate the need for certain elements of the RSI to be modified or omitted. In fact, non-RSI intubation is almost exclusively the domain of the elective operating environment. This means that RSI is almost universally required in situations calling for emergent endotracheal intubation. RSI is indicated in patients who require endotracheal intubation and are at increased risk of reflux and aspiration of gastric contents. The term ‘ modified RSI’ is sometimes used to describe such variations but this term lacks a commonly accepted definition.įigure 2: Surface anatomy for cricoid pressure INDICATIONS In current clinical practice, a number of modifications have been made to the traditional RSI technique (Figure 1). The above classic method is now very rarely followed in full. Laryngoscopy and intubation of the trachea with a cuffed tube immediately following fasciculations.thiopentone) or volatile, and a rapid-acting muscle relaxant (e.g. Induction of anaesthesia with a barbiturate (e.g.Positioning the patient supine with a head-down tilt.Emptying of the stomach via a gastric tube which is then removed.RSI was originally described in 1961 by Sellick 1 as: In arrested or completely obtunded patients, an endotracheal tube can usually be placed without the use of medications. RSI is only required in patients with preserved airway reflexes. Performance of an RSI is a high priority in many emergency situations when the airway is at risk, and is usually an essential component of anaesthesia for emergency surgical interventions. Intravenous induction of anaesthesia, with the application of cricoid pressure, is swiftly followed by the placement of an endotracheal tube (ETT). Rapid sequence induction (RSI) is a method of achieving rapid control of the airway whilst minimising the risk of regurgitation and aspiration of gastric contents.

#Rapid sequence intubation process how to

Substantial variability in practice exists, therefore institutional factors and clinical circumstances should be considered when determining how to perform an RSI.

Preparation and planning – including technique, medications, team member roles, and contingencies – is desirable prior to every RSI.

Rapid sequence induction (RSI) is intended to reduce the risk of aspiration by minimising the duration of an unprotected airway.

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Risks of rapid sequence induction include:Ī.

can be performed by an untrained assistant reduces aspiration risk by preventing passage of vomited gastric contentsĮ. is safe in the presence of laryngeal injuryĭ. should be removed if a poor view is achieved with laryngoscopyĬ. requires a constant 30N of applied pressureī. is frequently modified to suit clinical circumstancesĪ. requires titration of anaesthetic agent until loss of consciousness is achievedĬ.

is always accompanied by an intravenous opioidī. The answers can be found at the end of the article, together with an explanation. Before continuing, try to answer the following questions.