![]() ![]() ![]() The goal of this step during RSI is to achieve sedation and paralysis 45 to 60 seconds after the administration of the medications via IV push. Your induction agent and paralytic of choice should have been chosen prior to this point and after optimizing your patient’s conditions, the induction agent and paralytic are administered almost simultaneously. This may include intravenous fluids, blood products, and vasopressors as necessary in cases of septic shock, or the placement of chest tubes in cases of hemopneumothorax in trauma and the continued preoxygenation for all patients. This includes the identification of the underlying pathology and attempting to treat and manage the patient accordingly. Unless the need for intubation is immediate, patients should be physiologically optimized prior to the procedure. Pre-intubation optimizationĭuring the preparation phase, the provider should have recognized any anatomical features or physiological derangements that would make RSI more difficult. Women at near full-term pregnancy: Adults with chronic illness or obesity: For example, a study demonstrated the time to desaturation less than 90 percent after apnea during RSI for preoxygenated patients of different ages and conditions: Keep in mind that the time to desaturation can vary depending on age, gender and most importantly those who are critically ill. In certain clinical scenarios, you may even consider the use of non-invasive ventilation to achieve a desirable oxygen reserve in order to facilitate a longer period of apnea without desaturation. This can be achieved with flush-flow oxygen for at least three minutes and passive oxygenation via high-flow nasal cannula thereafter is recommended for all patients being intubated with RSI. Preoxygenation creates an oxygen reservoir in the lungs, blood, and tissues that enables patients to tolerate a longer period of apnea without desaturation. Remember that the goal of preparation is to maximize the chances for successful intubation on the first attempt. Have a backup plan to account for any potential difficulties or complications resulting from RSI. This would include gathering the necessary equipment and medications, in addition to formulating a plan to correct physiologic derangements, such as intravenous fluids in septic shock, and optimizing positioning in cases of difficult anatomically airways. Have an airway management plan in place from the very beginning. Having a plan to correct these derragement prior to intubation may prevent these poor outcomes, further increasing the chance of a successful intubation on the first attempt. These anatomically difficult patients and physiologic derangements may lead to complications that may prolong the time to successful intubation, thus prolonging the patient’s apneic time. Also consider physiological derangements such as hypotension or shock as these clinical scenarios may put patients at risk for post-intubation hypotension or cardiac arrest. For example, obese patients are classically presumed to be difficult intubations because of their body habitus often making it difficult to maneuver the laryngoscope in order to locate your anatomical landmarks. Start by assessing the patient for anatomical features or physiologic findings that would potentially make them difficult to intubate or ventilate using a bag-valve-mask. It involves the use of an induction agent to induce unconsciousness, followed immediately by a neuromuscular blocking agent for paralysis so that the clinician can safely intubate the patient by minimizing the time the patient’s airway is unprotected. Rapid sequence intubation (RSI) is an emergent procedure used to secure the airway in acutely unstable patients. Seven P's of RSI - The Process of Rapid Sequence Induction and Intubation ![]()
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