Rapid sequence induction
From Wikipedia, the free encyclopedia
Rapid Sequence Induction (RSI) is an advanced medical protocol of advanced airway support designed for the expeditious intubation of the trachea of a patient. RSI is generally used for patients who are suspected of having an increased risk of aspirating stomach contents into the lungs. The technique is a quicker form of the process normally used to "induce" a state of general anesthesia. It uses drugs to rapidly allow an endotracheal tube to be placed between the vocal cords, by blocking the patient's involuntary reflexes and muscle tone in the oropharynx and larynx. Once the endotracheal tube has been passed between the vocal cords, a cuff is inflated around the tube in the trachea and the patient can then be artificially ventilated.
RSI involves pre-oxygenating the patient with a tightly-fitting oxygen mask, followed by the sequential administration of pre-determined doses of a hypnotic drug and a rapid-acting neuromuscular blocker. The difference between an RSI and standard anaesthetic induction is that the anaesthetist does not wait to see the effect of the drugs. Sedatives used include thiopental, propofol, midazolam and etomidate. Neuromuscular-blocking drugs used include suxamethonium (also called succinylcholine) and rocuronium.[1]
Other drugs may be used in a "modified" RSI. When performing endotracheal intubation, there are several adjunct medications available. No adjunctive medications, when given for their respective indications, have been proven to improve outcomes. [2] Opioids such as alfentanil or fentanyl may be given to attenuate the responses to the intubation process (tachycardia and raised intracranial pressure). This is supposed to have advantages in patients with ischemic heart disease and those with intra-cerebral haemorrhage (e.g. after traumatic head injury or stroke). Lidocaine is also theorized to possibly decrease a rise in intracranial pressure during laryngoscopy, although this remains controversial and its use varies greatly. Atropine may be used by many physicians to prevent a reflex bradycardia during laryngoscopy, especially in young children and infants.
This procedure is usually performed by doctors in operating theatres and in the emergency department, but is becoming increasingly more popular in the prehospital setting.[1]
[edit] References
- ^ a b Rapid Sequence Induction for Prehospital Providers
- ^ David T. Neilipovitz, Edward T. Crosby: No evidence for decreased incidence of aspiration after rapid sequence induction, in: Canadian Journal of Anesthesia 54, 9, 2007, S. 748-764 Abstract, http://www.cja-jca.org/cgi/content/full/54/9/748
[edit] External links
- Pousman, Robert M. (2000). "Rapid Sequence Induction for Prehospital Providers" (HTML). The Internet Journal of Emergency and Intensive Care Medicine Volume 4 (Number 1). Internet Scientific Publications, LLC. ISSN 1092-4051.
