Rapid Sequence Intubation PDF
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University of Arizona
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Summary
This document provides an overview of Rapid Sequence Intubation (RSI). It covers learning objectives, indications for intubation, physiological responses, steps in the procedure, preparation, induction agents, paralytic agents, and post-intubation considerations. Important details about the duration of action for different medications are discussed, highlighting the critical need for proper sedation and analgesia concurrently with paralytic agents.
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Rapid Sequence Intubation Learning Objectives Describe the body’s physiologic response to laryngeal manipulation Explain the role of sedatives in rapid sequence intubation Compare and contrast neuromuscular blocking agents used in rapid sequence intubation When given a patient care scenario, design...
Rapid Sequence Intubation Learning Objectives Describe the body’s physiologic response to laryngeal manipulation Explain the role of sedatives in rapid sequence intubation Compare and contrast neuromuscular blocking agents used in rapid sequence intubation When given a patient care scenario, design an appropriate regimen for rapid sequence intubation Compare the duration of action of commonly used sedatives and neuromuscular blockers and describe the implication of these differences on post intubation sedation and analgesia Indications for Intubation Inability to protect airway Altered mental status Current or impending respiratory failure Pneumonia, COPD/asthma exacerbation, anaphylaxis, etc. Facilitation Perform procedures or surgery Pain control Physiologi c Response Sympathetic stimulation (“fight or flight” response) Increased catecholamine release ↑HR; ↑MAP ↑ICP ↑IOP Parasympathetic stimulation (“vagal response”) Hepatic Warnings, side effects, additional information, and contraindications No absolute contraindications The Airway is Secured Now what? Post-Intubation Sedation and Analgesia When does pain occur in these patients? Events prior to intubation Intubation itself Procedures afterwards Negative Effects of Poor Pain Control Higher incidence of chronic pain, PTSD, and lower QOL Increased catecholamine release, impaired tissue perfusion Negative effects on immune function Paralysis without Analgesia/Sedati on This should never occur Need to keep in mind the duration of action of our NMBA's Succinylcholine ~5-7 min Rocuronium ~30-60 min Be Proactive! Conclusion s Sedation and paralytic agent should be chosen based on patient-specific factors and drug characteristics Mismatches between induction and paralytic durations of action Etomidate (5-7 min) vs rocuronium (3060 min) Risk of paralysis without appropriate sedation/analgesia Be prepared for early post-intubation management
