Pharmacology-Assisted Intubation Quiz

Pharmacology-Assisted Intubation (RSI)

• RSI is a rapid sequence intubation technique for airway management
• It quickly induces unconsciousness (using an agent) and muscle relaxation (using a blocking agent)
• It's the fastest and most effective method for controlling a critical airway
• Spontaneous ventilation cessation carries significant risk if not managed promptly by intubation or ventilation
• RSI is helpful for patients with: an intact gag reflex, a full stomach, and life-threatening injuries/illnesses needing immediate airway control

Indications for Intubation and Mechanical Ventilation

• Airway protection and patency: Ensuring the airway is open and protected
• Respiratory failure: Hypercapnic or hypoxic failure, needing to increase functional residual capacity (FRC) and decrease work of breathing
• Secretion management/pulmonary toilet: Clearing secretions for bronchoscopy
• Minimizing oxygen consumption and optimizing delivery: Efficient O2 handling, seizure termination, and secondary brain injury prevention
• Unresponsive to pain: Severe pain management or seizure termination
• Temperature control: Managing conditions like serotonin syndrome
• Humanitarian or safety reasons: Procedures, transport (like psychosis)

Process of RSI (9Ps)

• Plan: Outline the procedure
• Preparation: Gathering drugs, equipment, personnel, and location
• Protect the cervical spine: Preventing injury
• Positioning: Positioning the patient (sometimes after paralysis and induction)
• Preoxygenation: Ensuring adequate oxygen levels to mitigate potential hypoxia
• Pretreatment: Administering drugs like atropine, fentanyl, or lignocaine (optional)
• Paralysis and Induction: Administering paralysis and induction drugs
• Placement with proof: Correct placement confirmation of the ET tube
• Post-intubation management: Ongoing care after insertion and monitoring

Roles During RSI

• A minimum of three people for the airway team
• Airway proceduralist
• Airway assistant (e.g., MILS), and
• Drug administrator (A separate role ideal for the team leader)

Preparation for RSI

• Self-control: Ensure preparation is handled correctly
• Patient-control: The patient will be prepared for the procedure
• Others-control: Other team members to be managed appropriately
• Environment: A sterile environment during communication of airway plan to the team. Ideally through SOAPME or O2 MARBLES mnemonics

SOAPME and O2 MARBLES Mnemonics

• SOAPME : Suction, Oxygen, Airways, Blade, Back-ups, and Monitoring

• O2 MARBLES : Oxygen, Masks (NP, NRM, BVM), Airway adjuncts (OPA, NPA, LMA), RSI Drugs, Resuscitation drugs, Bougie, Laryngoscopes, LMAs, ET tubes, ETCO2, and Suction.

Induction Agents (02 MARBLES)

• Ketamine: (1.5-2 mg/kg)
• Etomidate: (0.3-0.4 mg/kg)
• Fentanyl: (2-10 mcg/kg)
• Midazolam: (0.1-0.3 mg/kg)
• Propofol: (1-2.5 mg/kg)
• Thiopental: (3-5 mg/kg)

Neuromuscular Blockers (02 MARBLES)

• Suxamethonium: (1-2 mg/kg)
• Rocuronium: (0.6-1.2 mg/kg)
• Vecuronium: (0.15-0.25 mg/kg)

Complications

• Unrecognized esophageal intubation
• Malposition
• Aspiration
• Hypoxia
• Laryngospasm
• Oropharyngeal trauma
• Vagal stimulation

Pre-oxygenation (15 lpm NRM)

• Adequately oxygenate patient prior to the procedure

Supplies/ Equipment for RSI

• BVM, PEEP valve, and EtCO2 in circuit
• 10 mL syringe, and Manometer
• Laryngoscope, NPA and OPA
• Suction catheter, Supraglottic airway, and Surgical airway kit
• ECG, NIBP, SpO2 and EtCO2
• Patient positioning optimized for C-spine considerations
• Medications (induction agents, relaxants and pressors)

Test your knowledge on the rapid sequence intubation (RSI) technique and its indications for intubation and mechanical ventilation. This quiz covers essential aspects of airway management, including unconsciousness induction and challenges in respiratory failure. Perfect for healthcare professionals looking to enhance their skills in emergency situations.