2015 Trumbull Memorial Hospital Demo

Rapid Sequence Induction Preparation

Rapid Sequence Induction Preparation

Clinical Indications:  Paramedics approved by EMS Medical Director only.  Patient is in a hypoxic and combative state where implied consent would be utilized.

 Critical illness or injury that requires immediate control of the airway by intubation to prevent mortality or severe morbidity AND the airway cannot be controlled by conventional means of orotracheal intubation without sedation or paralysis (the patient is fighting away other airway techniques because of their hypoxic state).

Steps

Performed? Yes No

1. If patient is so hypoxic that they become combative to more basic airway techniques, this protocol is warranted under implied consent. This is NOT an elective procedure. Confirm DNR status when able.

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2. Confirm indications for the procedure.  Inadequate ventilatory effort, rate, or volume.

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 Oxygenation failure (such as CHF nonresponsive to CPAP and nitrates).  Patient fights away other airway techniques because of their hypoxic state.

3. Confirm no contraindications for the procedure.  Inadequate personnel on scene to manage the patient.  Allergies or contraindications to any of the RSI medications.  High likelihood of not being able to intubation due to physical, mechanical, or traumatic alterations of the anatomy.  Lack of patent, well secured IV access.  Lack of appropriate equipment or knowledgeable assistant.  Dangerous environment that may require moving the patient before the airway is secured.  Presence of a valid DNR order or refusal of procedure by the patient. 4. Perform assessment of the airway anatomy to determine difficulty (LEMON).  L ook at the patient’s neck for deformities, abnormal growths, adipose tissue, foreign objects, scars, stomas, height, and width. Can you effectively provide bag-mask ventilations?  E valuate with the 3-3-2 method. 3 fingers between the teeth, 3 fingers from the tip of the chin (mentum) to the hyoid, and 2 fingers from the hyoid to the thyroid cartilage indicates the potential for easier airway access.  M allampati and Cormack-Lehane grades.

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 O bstruction such as swelling, burns, foreign bodies, excessive adipose tissue.  N eck mobility assessment, such as ability to position the airway as needed.

5. Check equipment.  Functional laryngoscope, tube, bougie, and suction.  Bag- mask device and oxygen supply.  Oximeter and heart monitor. Continuous waveform capnography is strongly recommended .

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 Drug dosages calculated and drawn into syringes, labeled appropriately.  Back up device, surgical or fast cricothyroidotomy equipment available.

Mallampati Classes Cormack-Lehane Grades

148

EMR

EMT

AEMT

Paramedic

Extended