Airway


INTRO TO RSI

Indications and Contraindications to Rapid Sequence Intubation and Induction

Indications for RSI are simply those patients who cannot ventilate, oxygenate or fail to protect their aiway. Contraindications are few and relative.

Seven P's of RSI - The Process of Rapid Sequence Intubation

RSI involves the use of an induction agent, followed immediately by a neuromuscular blocking agent to quickly create an optimal environment for intubation.


PHARMACOLOGY

INDUCTION AGENT

Etomidate

Dose: 0.3 mg/kg
Onset: 15 - 45 sec
Duration: 3 - 12 min
INDUCTION AGENT

Midazolam

Dose: 0.1 - 0.3 mg/kg
Onset: 30 - 60 sec
Duration: 15 - 30 min
INDUCTION AGENT

Ketamine

Dose: 1 - 2 mg/kg
Onset: 45 - 60 sec
Duration: 10 - 20 min
INDUCTION AGENT

Propofol

Dose: 1.5 - 3 mg/kg
Onset: 15 - 45 sec
Duration: 5 - 10 min
INDUCTION AGENT

Thiopental

Dose: 3 - 5 mg/kg
Onset: < 30 sec
Duration: 5 - 10 min
PARALYTIC

Rocuronium

Dose: 1 - 1.2 mg/kg
Onset: 45 - 60 sec
Duration: 45 min
PARALYTIC

Succinylcholine

Dose: 1.5 mg/kg
Onset: 45 - 60 sec
Duration: 6 - 10 min

CHOOSING YOUR MEDICATIONS

Choosing an Induction Agent

Induction agents used in rapid sequence intubation all lead to a similar endpoint which includes providing sedation and amnesia and can improve intubating conditions.

Rocuronium Versus Succinylcholine for Rapid Sequence Intubation

There are two neuromuscular blocking agents that have short enough onset times to be used in rapid sequence intubation and induction: succinylcholine and rocuronium.


CLINICAL CASES

QUESTION & ANSWER

Succinylcholine in RSI

In which of the following scenarios is succinylcholine a safe alternative to rocuronium during intubation?

Answer

CLINICAL SCENARIO

Shortness of breath after house fire

A 58-year-old male presents with shortness of breath and hoarseness following a house fire.

Answer