Rapid sequence induction
Clinical Procedure
 
Aliases:
RSI

Topic aliases are alternate phrasings for a particular topic.


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Means of securing the patient's airway with an endotracheal tube in as shorter time as possible to minimise risk of aspiration of gastric contents as well as hypoxia.

Components traditionally include:

1. Rapid onset muscle relaxation with agents such as suxamethonium or rocuronium (at 1.5mg/kg)

2. Avoidance of mask ventilation where practical

3. Use of cricoid pressure to attempt to occlude the oesophagus and reduce risk of gastric regurgitation.
(Although the use of cricoid pressure varies significantly between countries and clinicians as evidence for its use is not strong)

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Mar 15, 2013
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If not using an intubating stylet, ensure that a gum-elastic bougie is handy & ready for use.

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Jun 13, 2011
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Alfentanil is a good choice for rapid onset opioid analgesia to blunt the sympathetic response to laryngoscopy during rapid sequence induction.

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Sep 16, 2012
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An effective method for delivering 100% oxygen to the patient (especially if they refuse to have a mask placed on their face for preoxygenation), or while monitoring is being attached, is to have patient hold the end of the circuit in their mouth and breathe through this. The liqorice stick is probably the most comfortable piece of the circuit. This does not replace having an adequately sized mask.

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Dec 05, 2012
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Consider preloading endotracheal tube with an intubating stylet. This will make it easier to guide the tube in patients with an anterior larynx.

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Ensure suction is working & place sucker under pillow for quick access

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Jun 13, 2011
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If a nasogastric tube is present prior to induction, aspirate this to empty the stomach and reduce the risk of regurgitation.

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Preoxygenation is more effective in the 25 degrees head-up position than in the supine position in severely obese patients. 25 degree head up provides 200 seconds oxygenation after 3 minute period of preoxygenation compared with 155 seconds in supine position. refl.in/35

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Jan 23, 2013
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Cricoid pressure in the sniffing position places pressure on the hypopharynx, not the oesophagus.
#spanza2011

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Nov 23, 2012
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Optimise positioning of patient to make the first attempt at laryngoscopy the best. Changing the position of the patient after induction consumes time while the patient consumes their reserve oxygen.

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Method of simulating the 20N force required for cricoid pressure. Obtain a luer lock 60ml syringe filled with 50ml of air. Cap syringe & place upright on flat surface. Place thumb, middle & first finger on the plunger & depress by 12ml to the 38ml mark to apply 20N of force.
refl.in/cx

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Dec 25, 2012
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