RSI is the process of simultaneous administration of an induction and a neuromuscular blocking agent to Facilitate Tracheal Intubation And Is Preferred For Emergency intubation
2. Definition
RSI is the process of simultaneous administration of an
induction and a neuromuscular blocking agent to
Facilitate Tracheal Intubation And Is Preferred For
Emergency intubation
Aim: To intubate the trachea as quickly & safely as
possible
3. Indications for RSI
• airway protection and patency
• respiratory failure (hypercapnic or hypoxic),decrease
WOB.
• minimise oxygen consumption and optimize oxygen
delivery (e.g. sepsis)
• unresponsive patient, seizure, prevent secondary
brain injury.
• For humanitarian reasons (e.g. procedures) and for
safety during transport
4. Contraindications of RSI
Airway Obstruction
Allergy to Anaesthetic medications
Severe oral or mandible trauma
5.
6. 6 P’s of RSI
• Preparation
• Pre-Oxygenation with 100% oxygen
• Pre-treatment & Induction
• Paralysis +/- Cricoid pressure
• Placement of the tube
• Post intubation management
7. Preparation
Suction
— at least one working suction
Oxygen
— NRBM and BVM attached to 15 LPM of O2.
Airways
— 7.5 ET tube with stylet fits most adults, 7.0 for smaller
females, 8.0 for larger males, test balloon by filling with
10 cc of air with a syringe
8. — Stylet
—laryngoscope should be ready
— Backups – ALWAYS have a surgical cric. kit
available!
— have video laryngoscope if available & a LMA at
bedside
Pre-oxygenate – 15 LPM NRBM
Positioning
Monitoring equipment/Medications
— Cardiac monitor, pulse ox., BP cuff opposite arm with
IV ascess
— Medications for pre-treatment
End Tidal CO2
9. Pre-Oxygenation
Pre-Oxygenation
• Establish O2 reservoir
• Maximize time for intubation
• Prevent need for bag-mask ventilation
Methods:
• 3-5 minutes of 100% O2 via bag mask
• 5 Tidal capacity (5 Breaths)
12. Induction
Given as rapid IV push immediately before paralysing
agent
• Facilitate LOC in one-arm-brain circulation time
minimize the time from LOC to intubation
• Should provide a rapid onset & a rapid recovery from
anaesthesia with minimal CVS & Systemic side effect.
13.
14. Paralytics
Paralysis/NMB Agent
• Rapid onset of action to minimize risk of aspiration &
hypoxia
• Rapid recovery to facilitate the return of ventilation if
intubation fails
• Minimal hemodynamic & systemic effect
Wait for relaxation
- Do not bag unless hypoxic
- Insufflate air into the stomach & increase risk of
15.
16. Technique
Cricoid Pressure:
Techniques
• The oesophagus is occluded by extension of the neck
& application of pressure over the cricoid cartilage
against the body of 5 cervical vertebra to obliterate
oesophageal
lumen
• Applied an assistant with thumb & finger at either side
of cricoid cartilage
17.
18. Placement
Tube position is confirmed by:
• Direct visualization of ET tube between the vocal
cord
• Auscultation: equal air entry
• Capnometer: EtCO2
19. What if Intubation Failed???
What if the intubation attempt is not successful?
1st step = bagmask ventilation for support
Rescue Maneuvers
– The first rescue from failed intubation is bagging
– The first rescue from failed bagging is better bagging