Rapid sequence intubation
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Rapid sequence intubation involves several key steps: 1. Preoxygenation of the patient with 100% oxygen for 3 minutes to establish an oxygen reserve before intubation. 2. Administration of sedatives and neuromuscular blocking agents (NMBAs) to gain control of the airway without risk of aspiration. 3. Placement of the endotracheal tube once paralysis is achieved, confirmed by lack of muscle tone and ability to ventilate if oxygen saturation drops below 90%. 4. Postintubation management including chest x-ray, use of long-acting NMBAs, and sedation to facilitate mechanical ventilation.
Rapid sequence intubation
- 1. Rapid Sequence Intubation Paleerat Jariyakanjana, MD Emergency Physician Naresuan University Hospital
- 2. Decision to Intubate 1) Failure to maintain or protect the airway 2) failure of ventilation or oxygenation 3) the patient’s anticipated clinical course and likelihood of deterioration
- 4. Administration of a potent sedative (induction) agent and an NMBA without interposed assisted ventilation positive-pressure ventilation air to pass into the stomach gastric distention risk of regurgitation & aspiration
- 5. Requires preoxygenation phase permits pharmacologic control of the physiologic responses to laryngoscopy and intubation, mitigating potential adverse effects Increase ICP sympathetic discharge
- 7. Preparation assessed for intubation difficulty determining dosages and sequence of drugs, tube size, and laryngoscope type, blade and size continuous cardiac monitoring and pulse oximetry ≥1 good-quality IV lines Redundancy is always desirable in case of equipment or IV access failure.
- 8. Preparation
- 9. Preoxygenation 100% oxygen for 3 minutes of normal, tidal volume breathing normal, healthy adult establishes an adequate oxygen reservoir to permit 8 minutes of apnea before oxygen desaturation to less than 90% occurs “no bagging” time is insufficient 8 vital capacity breaths using high-flow oxygen
- 10. Pretreatment drugs are before administration of the succinylcholine & induction agent mitigate the effects of laryngoscopy and intubation on the patient’s presenting or comorbid conditions Intubation sympathetic discharge elevation of ICP reactive bronchospasm Bradycardia: children
- 11. Pretreatment
- 12. Paralysis with Induction rapid IV push immediately followed by rapid administration of intubating dose of NMBA wait 45 s from the time the succinylcholine is given to allow sufficient paralysis to occur
- 13. Paralysis with Induction Tintinalli's Emergency Medicine, 7e
- 14. Paralysis with Induction Tintinalli's Emergency Medicine, 7e
- 15. Paralysis with Induction Tintinalli's Emergency Medicine, 7e
- 16. Positioning The patient should be positioned for intubation as consciousness is lost. Sniffing position: head extension, neck flexion
- 17. Positioning Sellick’s maneuver application of firm backward-directed pressure over the cricoid cartilage minimize the risk of passive regurgitation and, hence, aspiration after administration of the induction agent and NMBA BMV should not be initiated unless O2 sat ≤ 90%
- 18. Placement of Tube assessed most easily by moving the mandible to test for absence of muscle tone O2 sat is approaching 90%, the pt may be ventilated When BMV is performed, Sellick’s maneuver is advisable As soon as the ETT is placed, the cuff should be inflated and its position confirmed
- 19. Postintubation Management CXR use of long-acting NMBAs (e.g., pancuronium, vecuronium) toward optimal management using opioid analgesics and sedative agents to facilitate mechanical ventilation
- 21. ANY QUESTIONS?