Rapid sequence induction

Question 1

When is an RSI indicated

Answer 1

In patients with high risk of aspiration
Delayed gastric emptying
Abdo pathology
Incompetent lower oesophageal sphincter
Altered level of consciousness
Pregnancy
Neurological or neuromuscular disease
Inadequate fasting

Question 2

When is an RSI contraindicated

Answer 2

Suspected difficult airway - use awake techniques and airway adjuncts
Cases requiring premedication to stabilise - High ICP, severe asthma/COPD, hypovolaemic shock, Aortic emergencies, paediatrics
Pre-hospital
“Crash airway” - Unconscious, apnoeic pt

Question 3

Describe the classic RSI

Answer 3

Prepare as for a difficult airway - suction, BMV, “Plan B”, monitoring and assistance
Pre-oxygenate with 100% O2 for 3-5mins
Induction with pre-calculated doses (Thiopentone)
Immediately follow with NMB (Succinylcholine)
Cricoid applied on loss of consciousness 10N -> 30N
Intubation with ETT + stylet
Confirm correct tube placement
Remove cricoid

Question 4

What maneouvres can be trialled to improve view if initial laryngoscopy is poor

Answer 4

Check position and ensure neck flexion with head extension
External laryngeal manipulation
Reduce cricoid force
Introducer (bougie)
Trial different laryngoscope - straight, long, McCoy, C-MAC

Question 5

What is the recommended maximum number of intubation attempts prior to aborting

Answer 5

3

Question 6

What is the next step if intubation is unsuccessful

Answer 6

Use face mask to maintain oxygenation and ventilation
Attempt to wake pt while maintaining cricoid
If successful - postpone surgery if able, if unable to postpone surgery - continue anaesthesia with LMA

Question 7

Define failed oxygenation

Answer 7

SpO2

Question 8

What is the next step if unable to oxygenate the patient

Answer 8

LMA or facemask
Reduce cricoid force
Maintain maximum head extension and neck flexion
100% Oxygen
Declare CICO