2015 Trumbull Memorial Hospital Demo

Rapid Sequence Induction

Rapid Sequence Induction

Steps

Performed? Yes No

1. Follow Rapid Sequence Induction Preparation Procedure

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2. Pre-treatment  Pre-oxygenation via NRB, BVM, or CPAP (provider’s discretion). Attempt CPAP prior to RSI in any case where CPAP is not otherwise contraindicated.  Remove cervical collar if in place

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3. Apneic Oxygenation  Prior to laryngoscopy, place the patient on 15 lpm O 2

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via nasal cannula to maintain oxygen

saturation during the intubation attempt.

4. If elevated intracranial pressure is suspected, then:  Administer Lidocaine 1.5 mg/kg slow IVP over 1 minute prior to the intubation attempt.

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5. Administer Fentanyl 3 mcg/kg via IVP. Skip this step in shock patients.

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6. Administer Ketamine 2 mg/kg via IVP.

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7. Ensure effective sedation. Consider noxious stimulus to confirm. Continue talking to the patient as if they can hear you. 8. Once sedation is ensured, Succinylcholine 1 mg/kg via IVP.  Contraindications to succinylcholine include recent spine injury, thermal/multisystem trauma greater than 24 hours old, massive crush injury, penetrating eye injury, hyperkalemia, patients with neuromuscular disease (previous hemiplegic CVA, Parkinsons’s Disease, ALS (Lou Gehrig’s Disease). 9. Visualize the glottis with a laryngoscope, insert bougie device through the chords first , then perform Orotracheal Intubation, inflate cuff, confirm tube placement.  Continuous Waveform Capnography is the most accurate confirmation device.  Other methods include direct visualization, presence of bilateral lung sounds, absence of epigastric sounds, adequate tidal volume upon ventilation, condensation in the tube, change of colorimetric device from purple to yellow, pulse oximetry maintains. 10. In the setting of trauma, apply cervical collar. If collar was removed to intubate, reapply cervical collar at this point. 11. Consider the need for additional sedative if necessary. Ensure sedation throughout transport. Muscle movement in ketamine sedation is normal. The patient may need additional sedation if tachycardia presents. Consider:  Versed 5-10mg slow IVP if SBP > 90mmHg 12. Continuously assess patency of the patient’s airway. Recognize a dislodged tube IMMEDIATELY and provide corrective action.

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149

EMR

EMT

AEMT

Paramedic

Extended