RSI Flashcards
When preparing for an RSI, what do you need to get ready?
RSI equipment and checklist
RSI drugs from fridge
Difficulty airway trolley
What is plan A for RSI?
Initial intubation strategy e.g. direct laryngoscopy
What is plan B for RSI?
Alternative intubation strategy e.g. using camera assistance
What is plan C for RSI?
Maintenance of oxygenation and ventilations e.g. BVM, LMA, iGel
What is plan D for RSI?
Rescue techniques e.g.
surgical airway
What are the steps of an RSI?
- Have a plan on the event of failure
- Suction needs to be available and working
- Preoxygenate
- Apply cricoid pressure
- Administer induction drug or sedation
- Administer muscle relaxant
- Intubate patient
- Inflate the cuff and confirm placement by auscultating chest and ensuring presence of end tidal CO2
- Release cricoid pressure
- Ventilate
Can the 3,2,1 formula be adapted?
Yes, it can be adapted to suit individual patients and in gross haemodynamic instability. A ratio of 1,1,1 can be used of drugs removed completely, normally fentanyl first
What is the 3,2,1 formula?
Refers to doses of fentanyl (3mcg/kg), ketamine (2mg/kg) and rocuronium (1mg/kg) developed by anaesthetist in trauma
What are the main drugs used in RSI?
Fentanyl-induction/pre med
Ketamine - induction
Rocuronium-paralytic
What are the indications for
RSI?
A - airway protection and patency
B-respiration failure
C- minimise oxygen consumption and optimise oxygen delivery
D- low GCS, non terminating seizures, prevention of secondary brain injury
E- temperature control
F- humanitarian reasons, predicted clinical course, patient safety
Why use RSI?
It minimises the time between loss of airway reflexes and placement of ETT in the trachea.
It minimises the risk of aspiration in patients who are inadequately starved, have impaired gastric emptying or gastric reflux
What is the reversal for rocuronium?
Sugammadex
