Rapid sequence intubation neonatal full#
Rapid sequence intubation neonatal mac#

Drawbacks: increased secretions, caution in cardiovascular disease (hypertension, tachycardia), laryngospasm (rare), raised intra-ocular pressure.Use: any RSI, especially if hemodynamically unstable (OK in TBI, does not increase ICP despite traditional dogma) or if reactive airways disease (causes bronchodilation).Propofol 1-2.5 mg/kg IBW + (0.4 x TBW) (others simply use 1.5 mg/kg x TBW as the general guide).doses may need to be adjusted in the hypotensive or shocked patient (see Intubation, Hypotension and Shock).IBW = ideal body weight, TBW = total body weight.doses shown are for intravenous (IV) administration.maintain stable cerebral perfusion pressure and cardiovascular haemodynamics.smoothly and quickly render the patient unconscious, unresponsive and amnestic in one arm/heart/brain circulation time.OPA, NPA, LMA) Ask for help and difficult airway trolleyĭoes not exist (unfortunately!), but if it did it would: O2 MARBLES is an alternative for the equipment and planning: Medications drawn up and ready to be given Cardiac monitor, pulse ox, BP cuff opposite arm with IV have video laryngoscope, LMA and bougie at bedside Backups – ALWAYS have a surgical cric kit available!

Handle – attach blade and make sure light source works Miller 3 or 4 for adults – straight blade

Rapid sequence intubation neonatal mac#

Blade – Mac 3 or 4 for adults – curved blade Stylet – placed inside ET tube for rigidity, bend it 30 degrees starting at proximal end of cuff (i.e. 7.5 ET tube with stylet fits most adults, 7.0 for smaller females, 8.0 for larger males, test balloon by filling with 10 cc of air with a syringe NRBM and BVM attached to 15 LPM of O2, preferably with nasal prongs for apneic oxygenation at least one working suction, place it between mattress and bed Maintain a ‘sterile cockpit environment’ when communicating the airway plan to the team, ideally through use of a ‘call and response’ checklist- otherwise one of these two mnemonics will help: In the event of a failed airway, another person may take on the role of the airway proceduralist and role re-allocation must be clearly communicated to the team.

person to perform cricoid pressure (if deemed necessary).

The team leader may perform one of the above roles if necessary, but should ideally be a separate stand alone role. The airway team should be a minimum of 3 people: Ideally, minimise instrumentation and suctioning prior to intubation to avoid stimulation of the patient’s gag reflex. Some add a 10th P for (cricoid) pressure after pretreatment but this procedure is optional and has many drawbacks (see Cricoid Pressure)

Positioning (some do this after paralysis and induction).

Preparation (drugs, equipment, people, place).

Secretions, blood, vomitus, and distorted anatomy.

Rapid sequence intubation neonatal full#

Full stomach (increased risk of regurgitation, vomiting, aspiration).Dynamically deteriorating clinical situation, i.e., there is a real “need for speed”.RSI is useful if the following are present (from Richard Levitan’s ): neck trauma, tumour)įACTORS THAT MAKE EMERGENCY INTUBATION DIFFICULT emergency surgical airway is not possible (e.g.paediatric cases (especially congenital deformity, laryngeal fracture) urgent need to OT and theatre is available anatomically or pathologically difficult airway (e.g.cervical spine injury (diaphragmatic paralysis).major trauma requiring multiple interventions) Lack of airway protection despite patency (swallow, gag, cough, positioning, and tone)hypoxia.The decision to perform RSI in the ‘out of theatre’ setting involves weighing the pros and cons: procedures) and for safety during transport (e.g.

D – unresponsive to pain, terminate seizure, prevent secondary brain injury.

C – minimise oxygen consumption and optimize oxygen delivery (e.g.B – respiratory failure (hypercapnic or hypoxic), increase FRC, decrease WOB, secretion management/ pulmonary toilet, to facilitate bronchoscopy.INDICATIONS FOR INTUBATION AND MECHANICAL VENTILATION prevent respiratory acidosis due to apnea from compounding severe metabolic acidosis) ventilation during apnea, titration of induction agents) modified approaches tend to trade an increased risk of aspiration for other benefits (e.g. ‘modified’ RSI is a term sometimes used to describe variations on the ‘classic’ RSI approach (e.g.RSI is particularly useful in the patient with an intact gag reflex, a “full” stomach, and a life threatening injury or illness requiring immediate airway control.

the cessation of spontaneous ventilation involves considerable risk if the provider does not intubate or ventilate the patient in a timely manner.

Rapid sequence intubation (RSI) is an airway management technique that produces inducing immediate unresponsiveness (induction agent) and muscular relaxation (neuromuscular blocking agent) and is the fastest and most effective means of controlling the emergency airway.