Rapid intubation
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Rapid intubation, also known as rapid sequence intubation (RSI), is an emergency airway management technique used to quickly place an endotracheal tube. It involves preoxygenating the patient, administering induction medications to cause unconsciousness followed immediately by paralysis medications. This allows intubation to be performed without having to manually ventilate the patient first. Proper patient positioning, preparation of equipment, and verification of tube placement are important steps in the technique. Potential complications include esophageal intubation, hypotension, and dental trauma. RSI is the preferred method in emergency situations where immediate airway control is needed.
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3. Placement of the endotracheal tube once paralysis is achieved, confirmed by lack of muscle tone and ability to ventilate if oxygen saturation drops below 90%.
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Rapid intubation
- 1. Rapid Intubation Erica Corrao Oct. 19, 2012 Health Education for Allied Health Youngstown State University
- 2. What is Rapid Intubation ● The cornerstone for emergency airway management ● Results in rapid unconsciousness and paralysis in a patient ● Considered a “crash” airway
- 3. Indications ● Inability to maintain airway patency ● Inability to protect the airway against aspiration ● Ventilatory compromise ● Failure to adequately oxygenate pulmonary capillary blood ● Anticipation of a deteriorating course that will eventually lead to the inability to maintain airway patency or protection
- 4. Goal ● To intubate the trachea without having to use bag-valve-mask ventilation ● Without using sedative agents alone ● Administration of weight-based doses of an induction agent immediately followed by a paralytic agent to get the patient unconscious within 1 minute
- 5. Contraindications ● Absolute- total upper airway obstruction & total loss of facial/oropharyngeal landmarks ● Relative- anticipated difficult airway to achieve ● “Crash” airway- when the patient is in an arrest situation, unconscious and apneic
- 6. Anesthesia ● 3 phases of medication administration ● Pretreatment, induction, and paralysis
- 7. Preoxygenation ● Preoxygenation with nonrebreather mask for 5 minutes prior ● Allows the patient to maintain blood oxygen saturations during the apneic period of paralysis and allow for more time to intubate
- 8. Pretreatment ● Used to help the response to larygnoscopy and induction and paralysis ● Typically administered 2-3 minutes prior to induction and paralysis ● Examples are LOAD (lidocaine, opioid analgesic, atropine, defasciculating agents
- 9. Induction ● Provide rapid loss of consciousness that helps ease the intubation and avoids psychic harm to the patient ● Examples of meds are: Etomidate, Ketamine, Propofol & Midazolam
- 10. Paralysis ● Need to be administered immediately after the induction agent ● Neuromuscular blockade does not provide sedation so administering a right dose of the induction agent is important
- 11. Equipment Needed ● Laryngoscope ● Endotracheal tube ● Stylet ● 10 mL syringe ● Suction Catheter ● CO2 detector ● Oral and Nasal airway ● Ambu bag and mask
- 12. Positioning ● Place patient in sniffing position for adequate visualization. You will need to flex the neck and extend the head ● This position helps with visualization of the glottic opening
- 13. Technique ● Preparation – Confirm that equipment is functional – Assess for difficult airway – Establish Intravenous access – Draw up drug and determine sequence – Review contraindications to meds – Attach monitoring equipment – Check endotracheal tube for leak – Ensure function light bulb on laryngoscope blade
- 14. Technique ● Preoxygenation – Administer 100% oxygen through nonrebreather mask for 5 minutes for nitrogen washout – Assist ventilation with bag-valve-mask system only if needed to keep oxygen saturations greater than or equal to 90%
- 15. Technique ● Pretreatment – See Anesthesia slide for more information – Consider administration of drugs to mitigate the adverse effects of intubation
- 16. Technique ● Induction of Paralysis – Give a rapid acting induction medication to produce loss of consciousness – Administer neuromuscular blocking agent immediately after the induction agent – Should be given by intravenous push
- 17. Technique ● Protection and Positioning – Provide cricoid cartilage pressure – Maintain pressure until ETT is verified in position
- 18. Technique ● Placement with Proof – Visualize the ET tube passing through vocal cords – Confirm tube placement with a color change by CO2 dector and auscultation
- 19. Technique ● Postintubation Management – Secure ET tube in place – Initiate mechanical ventilator – Obtain chest x-ray – Administer proper meds for patient comfort and other factors
- 20. Complications ● Esophageal intubation ● Iatrogenic induction of an obstructive airway ● Right mainstem intubation ● Pneumothorax ● Dental trauma ● Postintubation pneumonia
- 21. Complications ● Vocal cord avulsion ● Failure to intubate ● Hypotension ● Aspiration
- 22. Conclusion ● Rapid Sequence Intubation (RSI) is the preferred technique in emergency departments. ● It is not indicated in a patient who is unconscious and apneic. ● Approach with caution in a difficult airway ● Proper technique is key
- 23. Reference ● Rapid Sequence Intubation – Medscape Reference – medicine.medscape.com/article/80222-overview