R.S.I. (RAPID SEQUENCE INTUBATION) PROTOCOLS
APPLIES TO: MCRS PARAMEDICS (R.S.I. Cleared)
1. Assess ABC’s.
2. Assure all possible airway control techniques have been exhausted and failed.
3. Protect C-spine during intubation if trauma is noted or suspected.
4. INDICATIONS for Rapid Sequence Induction (RSI).
a. Periodic apnea in trauma
b. Trauma patient with GCS < or = 9
c. Closed head injuries (unconscious, posturing)
d. Major CVA (unconscious, posturing)
e. Acute respiratory exhaustion in severe Asthma, COPD, or CHF with hypoxia
f. Overdoses with altered mental status and inevitable loss of airway
g. Respiratory/facial burns with inevitable loss of airway
h. Inability to maintain airway and/or oxygenation.
5. If patient meets criteria for RSI, contact on-line medical control for orders to induce and intubate patient. Order must be directly from on-line medical control. IF NOT FEASIBLE TO DELAY AIRWAY CONTROL MEASURES, PROCEED AND DOCUMENT CIRCUMSTANCES.
6. If conscious explain the procedure to the patient and obtain verbal consent. Assemble all equipment for intubation plus combitube or LMA to serve as a backup airway control device.
7. Insure that patient is attached to cardiac monitor and pulse oximetry.
8. Obtain Versed, and Succinylcholine. Draw medications into two (2) separate syringes and label with their respective medication.
9. Induction and airway control MUST be done with assistance.
10. Hyper-oxygenate for 4 minutes with 100% oxygen by bag valve mask.
11. Administer Versed 3-5mg IVP (Give 1mg if systolic BP 80-100mm/Hg). Have assistant apply Cricoid pressure and hold pressure until intubation placement confirmed.
12. After 30 – 60 seconds attempt to intubate.
13. Administer Lidocaine 1.5mg/kg IVP for head trauma and/or Atropine .5mg IVP for bradycardia.
14. If intubation with Versed alone fails, administer Succinylcholine 1.5mg/kg IVP Max dose 150mg.. After 30-60 seconds intubate.
15. If intubation fails, SpO2 falls <90%, or heart rate falls < 60 bpm – begin positive pressure ventilation (PPV) with 100% oxygen. Attempt intubation again. If unsuccessful, ventilate again and attempt a third time. If third intubation attempt fails secure airway with combitube or LMA.
16. If ET tube placement is successful, confirm bilateral breath sounds, chest rise, absence of gastric sounds, and an increasing SpO2.
17. Norcuron .1mg/kg IVP (Max Dose 10mg) should be considered for extended transport time ONLY. Contact on-line medical control for orders to give Norcuron or other sedation AFTER confirmed ET tube placement.
18. DO NOT DELAY TRANSPORT. IF AIRWAY CANNOT BE CONTROLLED, LOAD AND GO.
19. Notify on-line medical control of successful or unsuccessful RSI airway control.
Marlboro County Rescue Squad, Inc. ________________________
Advanced Life Support Protocols Dr. Shaukat Iftikhar
June 7, 2003 ________________________