RSI Checklist
Indications :
- Patient requires immediate airway control and has a gag reflex or trismus
- Age 12 or greater
- 2 paramedics present - a minimum of one being RSI qualified
Procedure
- Complete an airway exam and collect an airway history - Intubation appears possible
- Bougie is easily accessible and ready for use
- Suction is ready for use
- Appropriately sized King LT easily accessible
- If possible, position patient at a 20-30 degree head-up position
- Place nasal cannula under CPAP or BVM mask and set for 15 lpm
- Hyperoxygenate patient (nasal cannula at 15 lpm and CPAP 5-10 cm/hg is preferred)
- Prepare Medications
Etomidate- maximum dose 30 mg (15cc)
- Under 100 lb < 45 kg 15 mg 7.5 cc
- 100-200 lb 45-91 kg 20 mg 10 cc
- Over 200 lb >91 kg 30 mg 15 cc
Etomidate - drawn up, labeled, and back in the RSI box
Succinylcholine - maximum dose 150 mg (7.5 cc)
- Under 100 lb < 45 kg 75 mg 3.75 cc
- 100-200 lb 45-91 kg 150 mg 7.5 cc
- Over 200 lb > 91 kg 150 mg 7.5 cc
Succinylcholine - drawn up, labeled, and back in the RSI box
- Valium - ready for use, labeled, and in the RSI box
- Reevaluate the patient is RSI necessary
- All medications verified by another paramedic
Conduct RSI
- Administer Etomidate Time: _____________
- Hold Cricoid Pressure and provide ventilations
- After 1 minute, administer succinylcholine [PARALYTIC] Time: _____________________
- Intubate Time: _______________________
- If unsuccessful after 3 attempts - place iGel verified by
- Auscultation of lung sounds and negative epigastric sounds
- Capnography - waveform when present
- Remove nasal cannula
Post intubation
- Monitor for signs sedation is wearing off (agitation, tearing, biting the tube, ↑ HR, ↑ B/P)
- If indicated, sedate - Valium 5mg or Ativan 2 mg Time: ____________
- Repeat if necessary to a total of Valium 10 mg or Ativan 4 mg Time: ______________
- Consider Vecuronium ONLY after sedation when necessary due to continued agitation
Vecuronium - maximum dose 10mg (10cc)
- Under 100 lb < 45 kg 5 mg 5 cc
- 100-200 lb 45-91 kg 8 mg 8 cc
- Over 200 lb > 91 kg 10 mg 10 cc
- Vecuronium - drawn up, labeled, and verified by a second paramedic
- Administer Vecuronium [PARALYTIC] Time:_____