However, for most patients, a general anesthetic is required. Rapid sequence intubation also known as rapid sequence induction, or rsi is a method of intubating patients who present with issues that make intubation difficult e. Gcs dsi is procedural sedation, where the procedure is preoxygenation. Characterize medication practices during and immediately after rapid sequence intubation rsi by providerlocation and evaluate adverse drug events. It involves loss of consciousness during cricoid pressure followed by intubation without face mask ventilation. Preparation and planning including technique, medications, team member roles, and contingencies is desirable prior to every rsi. This was a multicenter, observational, crosssectional study of adult and pediatric intensive care unit and emergency department patients over a 24h period. Vermont ems rapid sequence intubation course manual. Appropriate rapidsequence intubation rsi with the use of neuromuscular blocking agents. Since no evidencebased guidelines support the challenge for anesthesiologists various practical recommendations exist in clinical practice for rapid sequence induction and intubation rsi.
Drug order in rapid sequence intubation driver 2019. Rapid sequence induction and intubation request pdf. One of the first choices to make for a rapid sequence intubation is which general anesthetic to use, if at all. Rapidsequence intubation involves the induction of general anesthesia and neuromuscular paralysis, followed promptly by endotracheal intubation. Rapid sequence intubation rsi is an airway management technique that produces inducing immediate unresponsiveness induction agent. Intravenous induction of anaesthesia, with the application of cricoid pressure, is swiftly followed by the placement of an endotracheal tube ett. The choice and dose of intravenous induction agent is crucial to ensure a balance between excellent intubating. The aim is to intubate the trachea as quickly and as safely as possible. Acquiring knowledge and skills that consider strategies for postintubation care andor failed and difficultintubations.
The development of this course has been supported by an educational grant from nhs education scotland. This guideline does not address indications for intubation. New hampshire prehospital rapid sequence intubation manual. Rapid sequence intubation rsi overview rapid sequence intubation 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. Objective we sought to determine if rsi drug order was associated with the time elapsed from administration of the first rsi drug to. Appropriate rapidsequence intubation rsi with the use of neuromuscular blocking agents, induction drugs. Administration of general anestheticsfor rapid sequence intubation. Rsi is an advanced airway continue reading rapid sequence intubation rsi.
Rapid sequence intubation rsi international emergency. Current practices and safety of medication use during rapid. The usual, nonrapid sequence of induction and intubation for anesthesia consists of administration of an induction agent, proof of the ability to mask ventilate. This protocol is only for use in patients with an age 12 or greater or patients longer than the broselowluten tape. G e n e r a l p r o t o c o l s pearls agencies must maintain a separate performance improvement program specific to rapid sequence intubation.
Rapid sequence intubation 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. Rsi procedure this short course aims to increase the confidence. Ketamine is the ideal dsi induction agent as it preserves airway reflexes and. New hampshire prehospital rapid sequence intubation manual requirements for each procedure each rsi procedure must be performed in a controlled fashion with an adequate number of providers present. There is a growing body of evidence particularly in trauma that prehospital rsi can be performed safely and with no greater. Current practices and safety of medication use during. Clinicians frequently use rapid sequence intubation rsi to secure the airway in an acutely unstable patient. Intubation is accomplished by sedating and paralyzing the patient, allowing for easier intubation. This document serves as a guide for rapid sequence intubation rsi for physicians to use in preparing to intubate a patient and for nurses who assist. In rsi, the simultaneous administration of an induction agent and a. 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. Rapid sequence induction the goal of a rapid sequence induction is to minimize the time when neither the patient nor you can protect the patients airway.
Rsi is a method of intubating patients who have a gag reflex who would otherwise be difficult to intubate. The risk of regurgitating and aspirating gastric contents is minimized by the application of cricoid pressure and avoiding bagmask ventilation. Rsi involves the administration of an induction agent followed quickly by a neuromuscular blocking agent to create optimal intubating conditions and minimize the time the airway is unprotected. Rapid sequence induction rsi is intended to reduce the risk of aspiration by minimising the duration of an unprotected airway. Rapid sequence induction bja education oxford academic. Pdf to summarize published data regarding the steps of rapidsequence intubation rsi. Gcs 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. Some patients may be comatose and a general anesthetic may not be needed.
This article will not be a complete or exhaustive resource for this topic, but it can serve as a starting point for medical students. In emergency medicine practice, the correct term is rapid sequence intubation rsi, and this term is used throughout this article 1. These steps also allow for any patient requiring advanced airway protection to be intubated with a decreased risk of. Mar 22, 2019 rapid sequence intubation 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. If the paramedic does not maintain this level of competency, then they shall not perform rsi. No new skills are necessary, but decision making is crucial. It consisted of preoxygenation, induction with a predetermined dose of thiopental followed by succinylcholine, application of cricoid pressure at loss of consciousness, avoidance of positive pressure ventilation, and finally tracheal intubation with a cuffed tube before removal of the cricoid pressure.
Rapidsequence intubation and the role of the emergency. Therefore, all junior doctors and trainees should be aware of this procedure in the early of their career. 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. Endotracheal intubation using rapid sequence intubation rsi is the cornerstone of emergency airway management. Acquiring knowledge and skills that consider strategies for post intubation care andor failed and difficultintubations.
The technique includes specific protection against aspiration of. Rsi is performed in order to reduce the risk of aspiration stomach contents entering the airway and lungs during the induction of anaesthesia. Intubation rsi program which offers an advanced technique using medications to facilitate intubation. Among these providers must be at least one rsi certified paramedic and one rsi assistant or non rsi paramedic. Rapid sequence induction wissen fur mediziner amboss. Rapidsequence intubation airway management of the critically ill. Rapid sequence intubation an overview sciencedirect topics. Rapid sequence induction in practice video traditional teaching of the rsi technique emphasizes not to bagmask ventilate after the administration of the muscle relaxant in order to avoid gastric insufflation and thereby further increase the risk of regurgitation aspiration. Rapid sequence induction an overview sciencedirect topics. Rapid sequence induction rsi for endotracheal intubation page 2 each paramedic that performs rsi must have a minimum of one successful, live or hps intubation per quarter to maintain competency in rsi. Dsi may be useful in the patient for whom rapid sequence intubation would inevitably result in significant hypoxaemia because they cannot be preoxygenated by other means. Rapid sequence induction rsi is the administration of an induction agent followed by a rapid acting neuromuscular blocking agent to induce unconsciousness and motor paralysis to facilitate endotracheal intubation. A known or presumed difficult airway is an absolute. Rapid sequence induction and intubation rsii is an anesthesia induction technique designed to facilitate rapid tracheal intubation in patients at high risk of aspiration.
This document serves as a guide for rapid sequence intubation rsi for. Schnelleinleitung, blitzeinleitung, blitzintubation, rapid. Guidelines for the management of tracheal intubation in. Appropriate rapid sequence intubation rsi with the use of neuromuscular blocking agents.
Rapid sequence intubation rsi is a method to achieve airway control that involves rapid administration of sedative and paralytic agents, followed by endotracheal intubation. Rapid sequence induction rsi is the administration of a potent intravenous anesthetic agent to induce unconsciousness followed by a rapidly acting neuromuscular blocking agent to achieve motor paralysis for tracheal intubation. Application of cricoid pressure cp for patients undergoing rapidsequence intubation is. The main objective of the technique is to minimize the time interval between loss of protective airway reflexes and tracheal intubation with a cuffed endotracheal tube. Among these providers must be at least one rsi certified.
Rapid sequence intubation and the role of the emergency department pharmacist jeremy p. 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. Overview rsi is a method of intubating patients who have a gag reflex who would otherwise be difficult to intubate. Rapid sequence induction or intubation rsi is a technique which was first described in 1970 and is now routinely used for many emergency intubations. Rapidsequence intubation is the preferred method to secure airway in patients who are at risk for aspiration because it results in rapid unconsciousness induction and neuromuscular blockade paralysis. Rapid sequence intubation rsi is a process whereby pharmacologic agents, specifically a sedative eg, induction agent and a neuromuscular blocking agent are administered in rapid succession to facilitate endotracheal intubation.
Rapid sequence induction and intubation rsii for anesthesia is a technique designed to minimize the chance of pulmonary aspiration in patients who are at higher than normal risk. Rapid sequence intubation scottish intensive care society. The optimal order of drug administration sedative first vs. 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.
102 1166 190 684 231 375 1238 964 782 1120 1188 294 1399 1178 1029 535 1339 725 543 1152 592 1081 1299 854 26 5 1388 1289 1114 1408 1174 1428 515 888 574 358 1323 1116 389