Rapid Sequence Induction

Equipment...

Tilting trolley or operating table
Suction apparatus
Breathing circuit and oxygen
Selection of different sized laryngoscopes and blades
Selection of different sized endotracheal tubes
Bougie, cuff syringe, filter
Monitoring equipment
Range of oral airways
Anaesthetic drugs - induction agent, Atropine, and Suxamethonium
Have available a nasogastric tube

RSI shadow board

Preparation...

A tube tie should be positioned under the patient's neck
Suction turned on and placed under the pillow
Bougies/suction catheters at hand
Various sized airways at hand
Attach a primed syringe to the inflation port of the e.t. tube
Ensure laryngoscope blades are at hand

Method...

Pre-oxygenate for 3-5 minutes (6-8 litres/min)
Find cricoid cartilage (inform patient)
Give Thiopentone, or Etomidate if CV problems
As patient closes eyes, and lash reflex decreases, gradually...
Apply cricoid pressure - release if patient tries to vomit*
When blinking stops, give Suxamethonium**
Intubate
Only release cricoid pressure when Anaesthetist says so

Note:

* Cricoid pressure

Used to prevent passive regurgitation, NOT to prevent active vomitting. Maintaining cricoid pressure when the patient is trying to vomit could rupture the oesophagus, so pressure should be released if the patient appears about to vomit.

If regurgitated fluid leaks past the Cricoid pressure point, the table should be tilted head down, and suction applied.

When difficulties occur during Rapid Sequence Induction, the Difficult Airway Society algorithm should be followed.

** Dose

Dose: 1-2 mg/kg (ampoule = 100 mg/2ml)
Therefore: 0.02 - 0.04 ml/kg
Example: a 16kg patient needs 0.32 to 0.64 mls