RAPID SEQUENCE

INTUBATION
Michael Bennett
AEMT-CC

RAPID SEQ U EN CE IN TU BATIO N

(RSI)
What Is RSI?
An advanced airway maneuver used to

secure the airway characterized by its

use of pharmacological agents.

RSI has been around for over 30

years
In competent hands, RSI is an
invaluable tool to secure a difficult
airway

RSI
INDICATIONS

CONTRAINDICATIONS

Inability to effectively

oxygenate the patient

Inability to effectively
ventilate the patient
Patient unable to protect
their own airway
Ex. OD, Burns, ect.

Suspected loss of airway

control before definitive

care is reached

Neck immobility or

increased risk of neck

trauma
Inability to open
mouth

EQ U IPM EN T
EKG
IV access
O2
Meds
Blades/ET Tubes/Securing devices
BVM
ET CO2
Backup Method

TIM ELIN E

T -1O M IN U TES
PREPARATION
Assemble all equipment
Properly position patient
Calculate doses and draw up

medications
Re-evaluate IV patency

Consent
Explain the procedure to the patient

Call for orders if necessary

TIM ELIN E

T -5 M IN U TES
Pre-oxygenate
Re-check all equipment
Assemble back-up equipment
Combi-tube
Needle cric

Re-confirm indications

TIM ELIN E

T -2 M IN U TES
PRE-MEDICATION
Defasciculating drug (for patients who

will get succinylcholine, but may not

tolerate fasciculation, e.g. elevated
intracranial or intraocular pressure)
Succinylcholine 0.15 mg/kg (10% of
paralyzing dose)
Vecuronium 0.01 mg/kg (10% of
paralyzing dose)
Prevention of a vagal response
Atropine 0.02 mg/kg

T -2 M IN U TES
PRE-MEDICATION (CONT)
Prevention of worsening intracranial

pressure or bronchospasm
Lidocaine 1.5 mg/kg
Prevention of hypertensive response in

patients with elevated intracranial

pressure, heart disease or aneurysm
Fentanyl 3 mcg/kg

TIM ELIN E

IN D U CTIO N
Administer Induction Agent
Etomidate 0.3mg/kg
Ketamine 1.5mg/kg
Propofol 2.0-2.5mg/kg
Thiopental 3-5mg/kg

IN D U CTIO N
Administer a Paralytic Agent
Succinylcholine 1.0-1.5mg/kg
Rocuronium 0.6-1.2mg/kg
Vecuronium 0.08-0.1mg/kg
Atracurium 0.4-0.5mg/kg

TIM ELIN E

DROP THE TUBE!!!

RSIvs.EO I
STUDIES SHOW

THAT 92% OF ALL

PATIENTS WERE
SUCESSFULLY
INTUBATED USING
RSI

ONLY 25% OF

ETOMIDATE ONLY
INTUBATIONS
WERE
SUCCESSFUL

FYI

SO U RCES
Bozeman, William P., Douglas M. Kleiner, and Vicki

Huggett. "A Comparison of Rapid-Sequence Intubation and

Etomidate-Only Intubation in the Pre-Hospital Air Medical
Setting." BioInfoBankLibrary. Wake Forest University. 5
Sept. 2008 <http://lib.bioinfo.pl/pmid:16418085>.
Jackson, Rendell W., and Christopher M. Burkle.
"Endotracheal Intubation by Direct Laryngoscopy." May
04. American Thoracic Society. 03 Sept. 08
<http://www.thoracic.org>.
Pousman, Robert M. "Rapid Sequence Induction for
Prehospital Providers." The Internet Journal of Emergency
and Intensive Care Medicine. 2000. 5 Sept. 2008
<http://www.ispub.com/ostia/index.php?
xmlfilepath=index.xml>.