Beruflich Dokumente
Kultur Dokumente
in Emergency
• Alternatives exist such as awake nasal intubation with local anaesthesia and
sedation by a specialist Anaesthetist
The Seven P’s of RSI
• Preparation
• Pre oxygenation
• Pre treatment
• Paralysis with induction
• Positioning + Protection
• Placement with proof
• Post-Intubation Management
1: Preparation – Intubation Equipment
• Bag and mask (check size) • Stylet + Bougie
• 2 laryngoscope handles
• Syringe (10 ml)
• 2 laryngoscope blades
• OP/NP airway
(Test light bulb)
• Airway
+ Assistant
• Laryngoscope
+ Lubrication
• Endotracheal tube
+ ETC02
• Stylet (Bougie)
+ Syringe
+ Suction !
1: Preparation Airway Assessment
(You don’t want to be a L.E.M.O.N)
• Look externally
• Evaluate 3-3-2
• Mallampati
• Obstruction
• Neck
Look Externally
Is this patient likely to be a …
• Abscess
• Burn
• Trauma
• Tumor
Neck
• Possible cervical spine injury
• Rheumatoid arthritis
• Ankylosing spondylitis
Prepare Yourself and Staff
and Establish a Plan
2: Pre oxygenation
A. 60 - 90 seconds
B. 91 - 180 seconds
C. 181 - 360 seconds
D. > 360 seconds
Brainteaser 2:
3: Pre treatment
Laryngoscopy causes stimulation of afferent
receptors in the posterior pharynx, hypopharynx
and larynx
• “tight brain”
Cardiovascular disease
• “tight heart”
• “tight lungs”
FENTANYL
FENTANYL 1 - 3 mcg/kg given slowly over 1 minute
No contraindications
• Contraindication
- Elderly patients ( reduce dose to 0.5 mg/kg )
- Hypovolaemic patients ( preload with fluids )
- Risk of Awareness !
• Contraindication
- Closed head injury (elevated ICP)
- Ischaemic heart disease
Hypotensive patient
– Ketamine, Midazolam
NEUROMUSCULAR
BLOCKING AGENTS
Depolarizing
Suxamethonium
Non-depolarizing
Rocuronium
Vecuronium
Suxamethonium
NMBA best suited for RSI in emergency
due to its rapid onset and quick recovery time
Contraindications
Myopathic Processes
Mortality30%
Muscular dystrophy
Rare idiopathic
SUXAMETHONIUM
Dosage
– Duration: 30 – 60 min
– Duration: 60 – 75 min
• 5:Positioning
Time Zero + 45 seconds
– Direct visualisation
– ETCO2 / capnography
– Bilateral breath sounds
– Absent epigastric sounds
Failed Attempt = oxygenate
1st step = can I bag/mask ventilate this patient ?
» – Operator
» – Optimum patient position
» – BURP
» – Paralysis
» – Length of blade
» – Type of blade
Rescue Manoeuvres
7: Post-intubation Management
Secure tube / ‘bite block’
Monitor ETCO2 continuously
Arrange Chest x-ray