Rapid Sequence Intubation

 

Indications:

 

  • Age greater than or equal to 12
  • Trauma with GCS <9 with gag reflex
  • Trauma with significant facial trauma and poor airway control
  • Closed head injury or major stroke with unconsciousness
  • Acute burn with airway involvement and inevitable airway loss
  • Respiratory exhaustion such as severe asthma, CHF or COPD with hypoxia
  • Overdose with AMS where loss of airway is inevitable

 

 

  • Look
  • Evaluate: 3-3-2
  • Mallampati score
  • Obstruction
  • Neck mobility

 

Difficult BIAD:

 

  • Restricted opening
  • Obstruction
  • Distorted airway
  • Stiff lungs or c-spine

 

Contraindications:

 

  • Significant burns greather than 4 days old
  • Known neuromuscular disease such as myasthenia gravis, amyotrophic lateral sclerosis, muscular dystrophy
  • Guillain-Barre syndrome
  • Chronic renal failure patients who have not had hemodialysis within the past 24 hours
  • Known hyperkalemia
  • Age less than 12
  • Patient or family history of malignant hyperthermia

 

A minimum of two paramedics on scene: a minimum of one being RSI qualified

 

 

 

 

 

 

  • Pre-oxygenate with 100% Oxygen via BVM or CPAP if possible

 

 

 

 

 

 

  • Place at 30⁰ - 45⁰ angle
  • Monitor O2 sat with pulse oximetry

 

 

 

 

 

 

  • Monitor heart rhythm with EKG

 

 

 

Etomidate (Amidate) IV/IO; max 30 mg;

 

OR

Ketamine IV/IO; max 200 mg

RSI Dosing Chart

 

  • Apply cricoid pressure

 

 

 

 

 

 

 

Successful ?

 

  • Yes

 

  • No

 

 

 

 

Successful ?

 

  • Yes

 

 

  • Notify receiving facility or contact Medical Control

 

PEARLS:

 

  • Etomidate is preferred over Ketamine for trauma patients.
  • Intubation equipment includes: intubation kit, bougie, BVM, suction, RSI medications, BIAD, waveform capnography.
  • All appropriate measures must be taken to attempt to increase O2 saturation to greater than or equal to 94 % prior to intubation.
  • Ketamine can cause a heightened sympathetic response that will increase heart rate and blood pressure.
  • Do not use CPAP on the trauma patient.
  • Waveform capnography and pulse oximetry must be utilized for a minimum of 5 minutes after tube placement prior to the administration of Vecuronium (Norcuron) and is required for intubation verification and ongoing patient monitoring.
  • Bradycardia after tube placement is a strong predictor of a misplaced endotracheal tube (ETT).
  • An airway evaluation form must be completed on every patient who receives

NRP

NREMR

NREMT

NREMR

NREMT-I

NRP

NRP

NREMT

NRP

NRP

NREMT