This is supposed to have advantages in patients with ischemic heart disease and those with brain injury (e.g. Opioids such as fentanyl may be given to attenuate the responses to the intubation process ( accelerated heart rate and increased intracranial pressure). The neuromuscular blocking agents paralyze all of the skeletal muscles, most notably and importantly in the oropharynx, larynx, and diaphragm. Commonly used neuromuscular blocking agents used include succinylcholine and rocuronium. Commonly used hypnotics include thiopental, propofol and etomidate. This procedure involves preoxygenating the lungs with a tightly-fitting oxygen mask, followed by the sequential intravenous administration of predetermined doses of a sleep-inducing drug and a rapid-acting neuromuscular blocking agent. Once the endotracheal tube has been passed between the vocal cords, a cuff is inflated around the tube in the trachea and the patient can then be artificially ventilated. Medications are utilized to allow rapid placement of an endotracheal tube between the vocal cords, while the cords are being visualized with the aid of a laryngoscope. In either case, the endotracheal tube is placed shortly after onset of action of the blocking agent. However, the difference lies in the fact that the induction drug and blocking agent are administered in rapid succession with no time allowed for manual ventilation. During rapid sequence induction, the person still receives an IV opioid. Generally a person undergoing will be manually ventilated for a short period of time before a neuromuscular blocking agent (for example succinylcholine or rocuronium) is administered and the patient is intubated. With standard intravenous induction of general anesthesia, the patient typically receives an opioid, such as fentanyl, and then a drug to induce unconsciousness (commonly propofol). The technique is a quicker form of the process normally used to induce general anesthesia. Rapid sequence intubation refers to the pharmacologically induced sedation and neuromuscular paralysis prior to intubation of the trachea. Metaraminol or ephedrine, where hypotension (low blood pressure) may occur secondary to the sedating drugs.Atropine - For patients where bradycardia is a concern.Having evolved from procedures used to "induce" a coma-state in preparation for surgery, RSI is now often used in emergency settings also.Ĭommonly used medications during a rapid sequence induction: Rapid sequence induction, when performed in an Emergency Department or pre-hospital setting is an advanced medical protocol which permits the intubation of conscious patients who require advanced airway support. Synonyms and keywords: Rapid sequence intubation RSI List of terms related to Rapid sequence inductionĮditor-in-Chief: Santosh Patel M.D., FRCA Rapid sequence induction in the Marketplace Risk calculators and risk factors for Rapid sequence inductionĬauses & Risk Factors for Rapid sequence inductionĭiagnostic studies for Rapid sequence induction Patient Handouts on Rapid sequence inductionĭirections to Hospitals Treating Rapid sequence induction Patient resources on Rapid sequence inductionĭiscussion groups on Rapid sequence induction ![]() NICE Guidance on Rapid sequence inductionīe alerted to news on Rapid sequence induction ![]() US National Guidelines Clearinghouse on Rapid sequence induction Trial results on Rapid sequence inductionĬlinical Trials on Rapid sequence induction at Google Ongoing Trials on Rapid sequence induction at Clinical ![]() Podcasts & MP3s on Rapid sequence inductionĬochrane Collaboration on Rapid sequence induction Powerpoint slides on Rapid sequence induction Review articles on Rapid sequence inductionĪrticles on Rapid sequence induction in N Eng J Med, Lancet, BMJ Most cited articles on Rapid sequence induction Most recent articles on Rapid sequence induction WikiDoc Resources for Rapid sequence induction
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