Airway - Rapid Sequence Induction

Airway - Rapid Sequence Induct= ion

Clinical Indications:<= /o:p>

= ______ 1. Need= for airway control in a patient who has a gag reflex or trismus.

Clinical Contraindications:

= ______ 1. Sign= ificant burns between 24 hours and 2 weeks old.

= ______ 2. Known neuromuscular disease such as myasthenia gravis, amyotrophic lateral sclero= sis, muscular dystrophy, or Guillian-Barre syndrome.

= ______ 3. Pati= ent or family history of malignant hyperthermia.

= ______ 4. At n= o time should RSI be attempted if the patient cannot be adequately ventilated with= a BVM.

Procedure:

= ______ 1.      Preo= xygenate patient with 100% oxygen via NRB or BVM.

= ______ 2.      If t= rauma or spinal injury is suspected, 2^nd caregiver will hold manual stabilization.

= ______ 3.      Moni= tor patient with pulse oximetry and cardiac monitor.

= ______ 4.      Acce= ss and ensure a patent IV line.

= ______ 5.      Eval= uate for difficulty of airway (LEMON)-see appendix

= ______ 6.      Prep= are equipment (intubation kit, BVM, suction, RSI meds, combi-tube, cricothyroto= my kit, CO2 detection devices.)

= ______ 7.      If p= atient is <8 years old, administer atropine (minimum dose of 0.1 mg/kg not to exceed a total single dose of 0.5mg.)

= ______ 8.      If p= atient is > 8 years old, consider atropine at 1 mg to prevent a vagal stimulati= on.

= ______ 9.      Admi= nister Lidocaine 1.5 mg/kg IVP as necessary for patient condition.

= ______ 10. Apply cricoid pressure (Selleck’s maneuver) by a 3^rd caregiver.<= o:p>

= ______ 11. Preo= xygenate patient for at least 2 minutes.

= ______ 12. Admi= nister Etomidate (0.2-0.6mg/kg){alternative Midazolam (2-5mg)}
= ______ 13. Admi= nister Succinylcholine (1mg/kg) {alternative Norcuron (0.1 mg/kg)}

= ______ 14. (Ped= iatric dose of Succinylcholine is 1.5 mg/kg)

= ______ 15. Intu= bate patient and verify tube placement.

= ______ 16. Rele= ase cricoid pressure and secure tube placement.

= ______ 17. Reas= sess tube placement often especially when moving patient.

= ______ 18. Docu= ment procedure, time, and results in the electronic PCR.

Certification Requirements:

·      =    Successfully complete an in-house annual training session including the essentials of Rapid Sequence Induction, Advanced Airw= ay Management, and Surgical Airways.

·      =    Obtain at least 1-year field experience with Cata= wba County Emergency Medical Services as an Emergency Medical Technician - Paramedic.

·      =    Obtain at least 6 successful intubations, 3 of wh= ich must be in the field setting.

·      =    Successfully complete a biannual evaluation inclu= ding the indications, contraindications, technique, and possible complications of the procedure.