Choosing the appropriate premedication, induction drug, and paralytic will maximize the success of tracheal intubation and minimize complications.Įtomidate induction agents ketamine neuromuscular blockers premedications propofol rapid-sequence intubation. Rapid Sequence Intubation (also known as Rapid Sequence Induction, or RSI) is a method of intubating patients who present with issues that make intubation. RSI is used to secure a definitive airway in often uncooperative, nonfasted, unstable, and/or critically ill patients. Rapid sequence intubation is an airway management technique that creates the optimal conditions the clinician needs for intubation. In advanced airway management, rapid sequence induction also referred to as rapid sequence intubation or as rapid sequence induction and intubation or as crash induction is a special process for endotracheal intubation that is used where the patient is at a high risk of pulmonary aspiration. ![]() Older children and trauma patients were more likely to be intubated with RSI compared to younger children and patients presenting with medical illnesses. Citations from publications were reviewed for additional references.ĭata were reviewed to support the use or avoidance of premedications, induction agents, and paralytics and combinations to consider when drug shortages occur. Initial intubation attempts were all oral, including rapid sequence intubation in 81, without medications (NOM) in 13, and sedation without neuromuscular blockade (SED) in 6. To summarize published data regarding the steps of rapid-sequence intubation (RSI) review premedications, induction agents, neuromuscular blockers (NMB), and studies supporting use or avoidance and discuss the benefits and deficits of combinations of induction agents and NMBs used when drug shortages occur.Ī search of Medline databases (1966-October 2013) was conducted.ĭatabases were searched using the terms rapid-sequence intubation, fentanyl, midazolam, atropine, lidocaine, phenylephrine, ketamine, propofol, etomidate thiopental, succinylcholine, vecuronium, atracurium, and rocuronium. Rapid sequence intubation (RSI) is an advanced airway skill commonly performed in the pre-hospital setting globally, by physician or non-physician providers 1, 2.
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