RSI
RSI
RSI
• Useful in the patient with an intact gag re ex, a “full” stomach, and a life
threatening injury or illness requiring immediate airway control
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Indications
• A – airway protection and patency
• B – respiratory failure (hypercapnic or hypoxic), decrease WOB, secretion
management/ pulmonary toilet, to facilitate bronchoscopy
2. Non-cooperative patient
4. Impaired oxygenation
• airway proceduralist
• airway assistant
• drug administrator
Procedure
• Suction
— at least one working suction, place it between mattress and bed
• Oxygen
— NRBM and BVM attached to 15 LPM of O2, preferably with nasal prongs for apneic oxygenation
• Airways
— 7.5 ET tube with stylet ts most adults, 7.0 for smaller females, 8.0 for larger males, test balloon by lling with 10 cc of
air with a syringe
— Stylet – placed inside ET tube for rigidity, bend it 30 degrees starting at proximal end of cu (i.e. straight to cu , then
30 degree bend)
— Blade – Mac 3 or 4 for adults – curved blade
— Miller 3 or 4 for adults – straight blade
— Handle – attach blade and make sure light source works
— Backups – ALWAYS have a surgical cric kit available!
— have video laryngoscope, LMA and bougie at bedside
• provide analgesia
• maintain stable cerebral perfusion pressure and cardiovascular
haemodynamics
• be immediately reversible
• have few, if any, side e ects
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Induction Agent
• Ketamine 1.5-2 mg/kg IBW
• Etomidate 0.3-0.4 mg/kg TBW
• Fentanyl 2-10 mcg/kg TBW
• Midazolam 0.1-0.3 mg/kg TBW
• Propofol 1-2.5 mg/kg IBW + (0.4 x TBW) (others simply use 1.5 mg/kg x
TBW as the general guide)