Which patient needs rapid sequence induction?

RSI is only required in patients with preserved airway reflexes. In arrested or completely obtunded patients, an endotracheal tube can usually be placed without the use of medications. 3.

When do you use rapid sequence induction?

Rapid sequence induction (RSI) is performed to prevent aspiration of gastric contents in patients who are inadequately starved, have impaired gastric emptying or are known to have a history of gastric reflux.

When do you apply cricoid pressure in RSI?

Prehospital Airway Management Cricoid pressure (Sellick’s maneuver) should always be applied after the patient loses consciousness in RSI.

When should RSI be performed?

RSI should be approached with caution in a patient with a suspected difficult airway. If difficulty is anticipated, then an awake technique or the use of airway adjuncts (eg, fiberoptic intubation) is recommended.

What are the steps of rapid sequence induction?

PROCESS OF RSI

• Plan.
• Preparation (drugs, equipment, people, place)
• Protect the cervical spine.
• Positioning (some do this after paralysis and induction)
• Preoxygenation.
• Pretreatment (optional; e.g. atropine, fentanyl and lignocaine)
• Paralysis and Induction.
• Placement with proof.

Which 2 drugs are used for rapid sequence induction?

[4] Common sedative agents used during rapid sequence intubation include etomidate, ketamine, and propofol. Commonly used neuromuscular blocking agents are succinylcholine and rocuronium. Certain induction agents and paralytic drugs may be more beneficial than others in certain clinical situations.

Why is it called rapid sequence intubation?

Technique. Rapid sequence intubation refers to the pharmacologically induced sedation and neuromuscular paralysis prior to intubation of the trachea. The technique is a quicker form of the process normally used to induce general anesthesia.

When do you release cricoid pressure during intubation?

– Release cricoid pressure once a cuffed tracheal tube protects the airway, if the patient actively vomits or on the anaesthetist’s request. – If lung inflation is not possible, either reduce the pressure that is being applied or release the pressure completely (Nolan et al, 2005).

Is cricoid pressure still recommended?

Cricoid pressure is a technique that has become part of rapid sequence intubation to prevent aspiration of gastric contents. The technique has limited evidence to support its utility; however, it is still recommended in select populations.

What is the difference between RSI and intubation?

One important difference between RSI and routine tracheal intubation is that the practitioner does not typically manually assist the ventilation of the lungs after the onset of general anesthesia and cessation of breathing, until the trachea has been intubated and the cuff has been inflated.

What happens during rapid sequence intubation?

This entails gathering and testing the supplies needed (endotracheal tubes, stylet, blades, handles, drugs, alternate airway methods) as well as planning for a surgical airway if orotracheal intubation ultimately fails. This step also involves stratifying the difficulty level of the patient’s airway.

What is modified rapid sequence induction?

Modified rapid-sequence induction (RSI) techniques Standard components of RSI are preoxygenation, cricoid pressure and the avoidance of positive pressure ventilation via face mask until an endotracheal tube is placed. In some circumstances, a modification of this rapid-sequence technique may be warranted.

When to use cricoid pressure or rapid sequence intubation?

Rapid-sequence 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). Application of cricoid pressure (CP) for patients undergoing rapid-sequence intubation is controversial.

What are the guidelines for rapid sequence induction?

Cricoid cartilage identified before induction by assistant. Light pressure (no more than 10 N force) on the cricoid cartilage prior to loss of consciousness. 30 N cricoid force (equivalent to registering 3 kg on a weighing machine) after loss of consciousness. Direct laryngsocopy undertaken.

How are randomised controlled trials for cricoid pressure used?

Randomised controlled trials (RCTs) comparing cricoid pressure to a control group as part of an intubation were included. In order to be included, studies had to report on aspiration or intubation conditions. Studies performed on animals, cadavers and models, or without a randomised control group were excluded.

When to use Rapid Sequence Intubation ( RSI )?

RAPID SEQUENCE INTUBATION AT A GLANCE In clinical practice, it is generally understood that RSI is used when tracheal intubation must be performed in a patient who is suspected of having a full stomach or is at risk for pulmonary aspiration of gastric contents.