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

 

  1. Administer Etomidate Time: _____________
  2. Hold Cricoid Pressure and provide ventilations
  3. After 1 minute, administer succinylcholine [PARALYTIC] Time: _____________________
  4. 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:_____