What is Rapid Sequence Intubation?

Rapid sequence intubation or rapid sequence induction are the terms used when a clinician such as a doctor or paramedic intubates a previously conscious patient by providing an induction agent (anaesthetic) to make the patient unconscious, followed by a rapidly acting neuromuscular blocking agent (muscle relaxant) so that that patient becomes both unconscious and muscular paralysis occurs allowing for the insertion of an endotracheal tube (ETT).

When should you Rapid Sequence Intubate a patient?

RSI is another relatively new concept in paramedics, with ambulance services such as those in the UK, Melbourne (Australia) and in many parts of the US embracing it for use in the following circumstances:

1. Rapidly declining patients, who are likely to require intubation soon;

2. Patients with severe burns to the upper airway who are likely to develop laryngeal oedema and occlude their airway later;

3. Trauma patients, with head injuries who are deteriorating or unable to be managed;

4. Acute Pulmonary Oedema/ severe airway problems that are unable to be managed in the conscious patient to the patient’s cerebral agitation.

Rapid Sequence Intubation requires confidence on the paramedic’s behalf that he or she is capable is capable of intubating the patient and if intubation fails that there is an alternative airway solutions, such as LMA, Bag valve Mask Ventilation, and Cricothyrotomy (in desperately extreme cases).

How do you perform a rapid sequence intubation?

The following mnemonic for performing RSI should be followed when performing rapid sequence intubation:

1. Preparation — prepare all necessary equipment, drugs and back-up plans;

2. Preoxygenation — with 100% oxygen to remove excess nitrogen and allow greater time and safer intubation;

3.Premedication — this should induce unconsciousness, such as midazolam

4. Paralyze — this makes it physically possible to pass a tube through the vocal cords (such as suxamethonium or rocuronium)

5. Pass the tube —visualize the tube going through the vocal cords

6. Proof of placement — using a reliable confirmation method, such as auscultation, end title CO2 monitoring (where you can confirm placement of the ETT by showing an ETCO2 waveform;

7. Post intubation care — secure the tube, ventilate, and regularly monitor