Rapid Sequence Intubation Made Short and Sweet

IntubationMade Short &

sweetby Melissa Yuan-Innes, MD, CCFP-EM

www.melissayuaninnes.com

Prepare• SOAPME: (Suction, oxygen, airway,

pharmacology, monitoring, equipment), or try• Suction

• Oxygen

• Airway set-up

• Pharmacology: “What do you want?”

• Mask yourself

• Elevate patient (positioning)

Preoxygenate

• 3 minutes at 100 percent

• 8 deep (vital capacity) breaths• http://journals.lww.com/em-news/Fulltext/2006/08000/

Preoxygenation,_Critical_in_RSI,_Often_Negates.24.aspx

Premedicate

LOA

• Lidocaine (?“tight head/lungs”)

• Opiates (“tight head/heart”)

• Atropine (tiny infants)

Or think ABCA: Asthma

B: brains & babiesC: cardiovascular

Pacify the patient

• Etomidate: good for trauma (? not in sepsis)

• Ketamine: asthma

• Midazolam: seizures

Paralyze

• Succinylcholine (or rocuronium)

• go big or go home

Pass the Tube

• get the epiglottis out of the way to see the vocal cords

Post-Intubation Check

• CO2 detector

• (visualization, condensation, auscultation)

• Secure the tube

• Chest X ray

• Sedate patient

Read Up

UpToDate Adults: http://www.uptodate.com/contents/rapid-sequence-intubation-in-adults?

UpToDate Children: http://www.uptodate.com/contents/rapid-sequence-intubation-rsi-in-children#H11 [gives error message if not logged in]