RAPID SEQUENCE INTUBATION

1
RAPID SEQUENCE INTUBATION
2
Definition

• Rapid sequence intubation is a technique used to
  secure the airway rapidly
• Indications emergency surgeries or other
  situations where the stomach might be full
  (recent meal / delayed gastric emptying d/t
  trauma, acute abdomen, morphine / incomplete
  lower esophageal sphincter (obesity, hiatal
  hernia, pregnancy)

3
Overview of the process

• The patient is put to sleep with an IV agent such
  as thiopentone or propofolthese cause hyponosis
  and amnesia
• Then the patient is paralyzed and rapidly
  intubated
• Before you start this process, you need to be
  sure everything is set-up and ready to gothe
  patient wont be able to breathe once they are
  paralyzed, so you need to be sure you can intubate

4
Before Paralysis

• Preoxygenate the patient for at least 3 min
• Start an IV if there isnt one
• Attach monitor, oximeter
• Set-up equipmenthave emergency trach tray ready
• Several sizes of ETTsopened with cuff checked
• Suctionon and under the pillow
• Laryngoscopescheck lightsseveral blades/sizes

5
Induction

• Cricoid pressure is started (Sellick
  maneuver)the cricoid is the ring just below the
  larynx (Adams apple)if it is pushed
  posteriorly, because it is circular and solid, it
  compresses and closes the esophagus which is
  behind it preventing regurgitation of gastric
  contents
• Induction agent is given

6
Induction agents used

• Succinylcholine
• A depolarizing neuromuscular relaxant causes the
  muscles to depolarize (they contract) then keeps
  them depolarized so they cant contract again
• Can cause fatal hyperkalemia in 24 hrs to up to 2
  years later in some patientsdont use with
  burns, strokes, spinal cord injuries, MS, ALS, or
  crushed muscle
• Onset is within 1 minute and duration is about 5
  minutes

7
Induction agents, cont

• Vecuronium onset is within 1 minute with max
  onset at 3-5 minutes and duration of 25-40
  minutes
• Rocuronium onset is within 2 minutes with max
  onset at 3 minutes and duration of 30 minutes

8
After paralysis

• The patient is paralyzed when the eyelash reflex
  is lost and when fasciculation (muscle twitching)
  stops
• Patient is intubated, cuff is inflated, tube
  secured, and tube placement is verified dont
  stop cricoid pressure until you know the tube is
  placed correctly

9
(No Transcript)
10
(No Transcript)