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Rapid Sequence Intubation Made Short and Sweet

  1. Intubation Made Short & sweet by Melissa Yuan-Innes, MD, CCFP-EM www.melissayuaninnes.com
  2. Prepare • SOAPME: (Suction, oxygen, airway, pharmacology, monitoring, equipment), or try • Suction • Oxygen • Airway set-up • Pharmacology: “What do you want?” • Mask yourself • Elevate patient (positioning)
  3. Preoxygenate • 3 minutes at 100 percent • 8 deep (vital capacity) breaths • http://journals.lww.com/em-news/Fulltext/2006/08000/ Preoxygenation,_Critical_in_RSI,_Often_Negates.24.aspx
  4. Premedicate LOA • Lidocaine (?“tight head/lungs”) • Opiates (“tight head/heart”) • Atropine (tiny infants) Or think ABC A: Asthma B: brains & babies C: cardiovascular
  5. Pacify the patient • Etomidate: good for trauma (? not in sepsis) • Ketamine: asthma • Midazolam: seizures
  6. Paralyze • Succinylcholine (or rocuronium) • go big or go home
  7. Pass the Tube • get the epiglottis out of the way to see the vocal cords
  8. Post-Intubation Check • CO2 detector • (visualization, condensation, auscultation) • Secure the tube • Chest X ray • Sedate patient
  9. Read Up UpToDate Adults: http://www.uptodate.com/contents/ rapid-sequence-intubation-in-adults? UpToDate Children: http://www.uptodate.com/contents/rapid- sequence-intubation-rsi-in-children#H11 [gives error message if not logged in]
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