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Rapid Sequence InductionAka: Rapid Sequence Intubation
- Warnings
- High risk procedure
- Must be able to control airway after use
- Indications
- Preparation for intubating a conscious patient
- Alternatives
- Consider Nasotracheal intubation of a conscious patient
- Basic RSI Protocol
- Preparation and Preoxygenation
- Midazolam (Versed) 0.1 mg/kg IVP (5-6 mg)
- Apply cricoid pressure
- Succinylcholine 1 mg/kg IV (100 mg)
- Intubate
- RSI Protocol for Children under age 10 years
- Preparation and Preoxygenation
- Atropine 0.01 mg/kg IV (Minimum dose: 0.1 mg)
- Prevents vagally stimulated Bradycardia
- Midazolam (Versed) 0.1 mg/kg IVP
- Apply cricoid pressure
- Succinylcholine 2 mg/kg IV
- Intubate
- RSI protocol for high ICP or penetrating Eye Injuries
- Preparation and Preoxygenation
- Prevent ICP rise
- Lidocaine 1.5-2 mg/kg IV
- Vecuronium .01 mg/kg IV (defasciculating dose)
- Consider Fentanyl 3 ug/kg IVP
- Prevent Vagally stimulated Bradycardia
- Atropine 0.01 mg/kg IV (Minimum dose: 0.1 mg)
- Sedation
- Etomidate 0.3 mg/kg IVP OR
- Thiopental (Pentothal) 4 mg/kg IVP (IF BP stable)
- Apply cricoid pressure
- Muscle relaxants/Paralytic Agents
- Succinylcholine 1.5 mg/kg IV (2 mg/kg if <10 yo) OR
- Vecuronium 0.2 mg/kg IV
- Intubate
- General RSI Protocol (All Options)
- Atropine 0.01 mg/kg IV (Minimum dose: 0.1 mg)
- Prevents vagally stimulated Bradycardia
- Consider Increased Intracranial Pressure management
- Lidocaine 1 mg/kg IV (Prevents ICP rise)
- Fentanyl 3 ug/kg IVP
- Consider Vecuronium 1 mg (defasciculating dose)
- Sedation
- Preferred medications
- Etomidate 0.2-0.3 mg/kg IVP
- Midazolam (Versed) 0.1 mg/kg IVP
- Other options
- Thiopental (Pentothal) 3-5 mg/kg IVP
- Ketamine 1-2 mg/kg IV
- Muscle relaxants/Paralytic Agents
- Succinylcholine 1-1.5 mg/kg IV, 2-4 mg/kg IM
- Vecuronium (Norcuron) 0.1 mg/kg IV
- Pancuronium (Pavulon) 0.1 mg/kg IV
- Special Circumstances
- Status Asthmaticus
- Use Ketamine as the sedating agent
- Congestive Heart Failure
- Use Etomidate for Sedation
- Use Vecuronium for paralysis
- Avoid Thiopental, Succinylcholine
- Status Epilepticus
- Use Thiopental to sedate (raises Seizure threshold)
- Multiple trauma or hemorrhagic shock
- Use Etomidate for Sedation
- References
- Walker L. A. (1993) Emerg Med Rep 14(15):127
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