1. Rapid Sequence Induction

2. 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

3. 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

4. Aspiration is a serious complication that causes:
Increased length of stay
Increased cost of treatment
Increased chance of morbidity

5. 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

6. The goal of RSI is to rapidly secure and control the airway
The goal of RSI is to rapidly secure and control the airway. Its all about TIME.

7. 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

8. Supplies Establish IV Access Cardiac Monitor Oxygen Pulse Oximetry
Suction- Wall and Yankauer
Crash Cart
Ventilator Prepared for Attachment
Medications

9. 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

10. Patient Preparation Brief history and assessment
Use the mnemonic AMPLE
A= Allergies
M= Medications
P= Past Medical History
L= Last Meal
E= Existing Circumstances

11. 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

12. 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)

13. 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.

14. 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