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EMR
EMT
AEMT
Paramedic
Extended
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
via nasal cannula to maintain oxygen
saturation during the intubation attempt.
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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.
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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).
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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.
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10.
In the setting of trauma, apply cervical collar. If collar was removed to intubate,
reapply cervical collar at this point.
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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
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12. Continuously assess patency of the patient’s airway.
Recognize a dislodged tube
IMMEDIATELY
and provide corrective action.
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Rapid Sequence Induction