Podcast
Questions and Answers
What is the primary purpose of rapid sequence intubation (RSI)?
What is the primary purpose of rapid sequence intubation (RSI)?
Which of the following is NOT an indication for intubation and mechanical ventilation?
Which of the following is NOT an indication for intubation and mechanical ventilation?
What does the 'Preoxygenation' step in the RSI process involve?
What does the 'Preoxygenation' step in the RSI process involve?
Which team member is typically NOT included in the minimum requirement for the airway team during RSI?
Which team member is typically NOT included in the minimum requirement for the airway team during RSI?
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What is a key risk associated with the cessation of spontaneous ventilation?
What is a key risk associated with the cessation of spontaneous ventilation?
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What is the purpose of the SOAPME mnemonic in preparation for RSI?
What is the purpose of the SOAPME mnemonic in preparation for RSI?
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Which type of laryngoscope blade is recommended for adults according to the SOAPME mnemonic?
Which type of laryngoscope blade is recommended for adults according to the SOAPME mnemonic?
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What should you use to pre-oxygenate a patient before RSI?
What should you use to pre-oxygenate a patient before RSI?
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What is one of the primary roles of neuromuscular-blocking agents during RSI?
What is one of the primary roles of neuromuscular-blocking agents during RSI?
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Which of the following is NOT listed as an RSI induction agent?
Which of the following is NOT listed as an RSI induction agent?
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Which complication is associated with the use of neuromuscular-blocking agents?
Which complication is associated with the use of neuromuscular-blocking agents?
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What is the recommended dosage range for Ketamine as an induction agent during RSI?
What is the recommended dosage range for Ketamine as an induction agent during RSI?
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In the context of environmental preparation for RSI, what does maintaining a sterile environment imply?
In the context of environmental preparation for RSI, what does maintaining a sterile environment imply?
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Study Notes
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
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SOAPME : Suction, Oxygen, Airways, Blade, Back-ups, and Monitoring
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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)
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Description
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.
