12/15/2007 1 Rapid Sequence Intubation (RSI) in Emergency Room Siriporn Pitimana-aree, MD Dept. of Anesthesiology, Faculty of Medicine Siriraj hospital. (The Royal College of Anesthesiologists of Thailand) RSI in Emergency Department • Indications for intubation • Considerations in Emergency intubation • Rapid Sequence Intubation (RSI) • The Failed Airway • Defining the Difficult Airway • Rescue Devices Outline Indications for ETT intubation • Absent or inadequate respiration • Impending airway obstruction • Inability to protect airway Emergency ETT intubation: • Time pressure • Unstable patient • Possibly difficult situation • Uncooperative / combative • Not fasted • Difficult airway Considerations • Physiologic responses Emergency ETT intubation: Physiologic responses to intubation •Gagging •Rise in ICP •Rise in BP •Tachycardia / Bradycardia •Dysrhythmias • Incidence of difficult & failed intubation: 8% • Frequency of esophageal intubation: 8% 40% of these - difficult intubation almost all recognized by clinical criteria but 3, decrease saturation detected by SpO 2 • Incidence of pulmonary aspiration: 4% • Hemodynamic consequences: 3% died during or within 30 min. of intubation
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12/15/2007
1
Rapid Sequence Intubation (RSI)
in Emergency Room
Siriporn Pitimana-aree, MD
Dept. of Anesthesiology,
Faculty of Medicine Siriraj hospital.(The Royal College of Anesthesiologists of Thailand)
RSI in Emergency Department
• Indications for intubation• Considerations in Emergency intubation• Rapid Sequence Intubation (RSI) • The Failed Airway• Defining the Difficult Airway• Rescue Devices
Outline
Indications for ETT intubation
• Absent or inadequate respiration
• Impending airway obstruction
• Inability to protect airway
Emergency ETT intubation:
• Time pressure
• Unstable patient
• Possibly difficult situation
• Uncooperative / combative
• Not fasted• Difficult airway
Considerations
• Physiologic responses
Emergency ETT intubation:
Physiologic responses to intubation
•Gagging•Rise in ICP•Rise in BP•Tachycardia / Bradycardia•Dysrhythmias
• Incidence of difficult & failed intubation: 8%
• Frequency of esophageal intubation: 8% 40% of these - difficult intubation
almost all recognized by clinical criteria
but 3, decrease saturation detected by SpO2
• Incidence of pulmonary aspiration: 4%
• Hemodynamic consequences: 3% died during or within 30 min. of intubation
12/15/2007
2
Definition
The virtually simultaneous administration of a potent sedative agent
& a neuromuscular blocking agent to induce unconsciousness
& motor paralysis for tracheal intubation.
Rapid Sequence Intubation (RSI)
Definition Incorporates:
• Every patient has a full stomach• Preoxygenation• No interposed ventilations• Sellick’s maneuver
Rapid Sequence Intubation (RSI)
Advantages of RSI
•Minimizes risk of aspiration•Facilitate intubation•Blunt untoward physiologic responses•Avoid awake intubation
Rapid Sequence Intubation (RSI)
Contraindications:
Anticipate of difficult airway& intubation
Staff inexperienced in RSI
Patients allergic or contraindication todrugs used in RSI