Rapid Sequence Induction

Question 1

Rapid Sequence Induction

Answer 1

—This technique is useful if there is worry that the patient may aspirate gastric contents.

—Obesity, pregnancy, an acute abdominal catastrophe, hiatus hernia or Class ‘E’ surgeries are all situations where aspiration must be a concern.

—The presence of an assistant is mandatory during rapid sequence induction.

Question 2

Rapid Sequence Induction Procedure

Answer 2

1. Check that all equipment is properly function and ready to go
2. Pre-Oxygenate
3. Position Patient
4. Pre-Treatment Analgesic
5. Administer a carefully calculated dose of Propofol (1-1.5 mg/kg) OR Etomidate (0.3 mg/kg)
6. Immediately give Succinylcholine or Rocuronium
7. Pre-sedation
8. Sellick’s Maneuver
9. Reconfirm position of the head and intubate the trachea at the onset of paralysis
10. Inflate the ETT cuff and confirm position
11. Record ETT position
12. Secure ETT

Question 3

Equitment for RSI

Answer 3

Resuscitation Gear (BVM, LMA, etc)

Extra ETT

One same size

One size smaller for in case of unexpected swelling

Suction

Question 4

How To Pre-Oxygenate For RSI

Answer 4

Use 100% oxygenation will face mask for 3-5 minutes

4-5 VCs minimum

When we are pre-oxygenating we are not bagging

Question 5

What Position Should The Patient Be In For Pre-Oxygenation

Answer 5

Place patient into the sniffing/intubation position

Question 6

PRe Treatment Anagesic

Answer 6

Should be done 3 min before induction

Ex. Fenatnyl

Question 7

Propofol And Etomidate

Answer 7

Propofol (1-1.5 mg/kg) or Etomidate (0.3 mg/kg) will be administer

Typically, Propofol will be used

With children however, we tend to use ketamine

Propofol may result in hypotension whereas etomidate has less of an effect on CVS and can be used on patient who are hypotensive

Question 8

Succinylcholine and Rocuronium

Answer 8

Succinylcholine (1.5 mg/kg) or Rocuronium (1.2 mg/kg)

Succinylcholine is a depolarizing paralytic, so we look at the twitches

Onset of action is 45 seconds

Rocuronium is polarizing and will last longer

Not to be used in predicted difficult intubation because duration is 40-60 min?

Question 9

Pre Sedation

Answer 9

This includes anti-anxiety and analgesic

This will reduce intra-gastric pressure and therefore reduce the chance of aspiration

Also can reduce the potency of Succinylcholine and delay its action

Question 10

Sellick’s Maneuver

Answer 10

As soon as the patient losses consciousness, the assistant should apply pressure to the cricoid cartilage

This will compress the esophagus and preclude aspiration

Sellick Maneuver is when you grab the sides of the airway and push down in order to make the airway visible and occlude the esophagus

IMPORTANT there is a big difference between cricoid pressure and laryngeal manipulation (BURP)

Question 11

Cricoid Pressure Big Take Away

Answer 11

Ask the doctor if they want cricoid pressure or laryngeal manipulation do not just do it, also make sure to clarify if it is cric pressure they want or laryngeal manipulation

Question 12

Cricoid Pressure Routine Use

Answer 12

The routine use of cricoid pressure in cardiac arrest is not recommended

Although cricoid pressure can prevent gastric inflation and reduce the risk of regurgitation and aspiration during bag-mask ventilation, it may also block ventilation.

Aspiration can still occur with the use of cricoid pressure

Question 13

What May Cricoid Pressure Delay

Answer 13

Some randomized studies have shown that cricoid pressure can delay or prevent the placement of advanced airway

Question 14

Cimplications of Cricoid PRessure

Answer 14

It can be difficult to properly train people how to do cricoid pressure

Keep in mind that esophageal rupture is a real possibility if cricoid pressure continues to be held firm while a patient is actively vomiting. The technique of CP is intended for profoundly obtunded or sedated patients at risk for passive regurg during resuscitation and many anesthesia texts support this view.