1. Preoxygenation
Make sure you use your basic airway adjuncts as needed
Consider NODSAT
2. Preparation -
equipment - use a challenge and response checklist to make sure you have remembered everything, even capnography
position patient - find a pillow!
protect c-spine
3. Premedication
Fentanyl - onset 3 min, offset 20min
This can be useful in patients who have a head injury
4. Paralysis and Sedation
Paralysis -
Suxamethonium - depolarising. 1 - 1.5mg/kg bolus
10-20second onset with 3 - 5 minute offset
or Rocuronium - 1 - 1.5mg/kg
Hepatic and biliary excretion so longer offset time and longer onset time
Sedation
Propofol - 1.5 - 2.5mg/kg induction. Maintainence at 1-4 mg/kg/hr
15-20second onset, 5 - 10min offset
or Ketamine
We don't seem to use Thio or any of the others now.
5. Passage of the ETT - this is the very tricky bit that needs some theatre time!
6. Post intubation care
Complications of RSI
Failure to oxygenate - prevent by using checklist and DAS guidelines
Anaphylaxis - treat with anaphylaxis algorithm
Hypotension - turn down rate of sedation agent. Give small boluses of metaraminol or adrenaline IV to maintain BP.
Laryngospasm - oxygen, Larsens Notch
Apply PEEP
If this fails, paralyse and intubate (may be difficult)
Capnography
You need a good seal. If you have a poor trace this might be reflected in your capnography trace.
