Rapid Sequence Intubation
- 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
- Evaluate: 3-3-2
- Mallampati score
- Neck mobility
- Restricted opening
- Distorted airway
- Stiff lungs or c-spine
- 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;
Ketamine IV/IO; max 200 mg
RSI Dosing Chart
- May repeat two times for a total of 3 attempts
- Notify receiving facility or contact Medical Control
- 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