Monday April 9, 2007
Revisiting RSI or Rapid Sequence Induction protocol

RSI protocol is aimed at quick, safe and organized emergent endotracheal intubation by using several medications. Very important consideration to remember is, unlike planned intubation for anesthesia, we should presume that patient’s stomach might be full and complication like aspiration can happen.

Medications fall into three categories:

1) Pretreatment agents:

• Oxygen, use 100% with reservoir mask, avoid positive pressure ventilation.
• Fentanyl (3mcg/kg)
• Lidocaine may suppress the cough reflex (1.5 mg/kg)
• Atropine may decrease the bradycardia

2) Induction agents:

• Pentothal (4 mg/kg)
• Etomidate (0.3 mg/kg) (may induce adrenocortical dysfunction)
• Ketamine (1-2 mg/kg)
• Midazolam (0.25 mg/kg)
• Propofol

3) Paralyzing agents:

• Succinylcholine (2mg/kg) - may induce hyperkalemia
• Vecuronium (0.15 mg/kg),
• Rocuronium (0.8 mg/kg)
  

Related previous link: Preventing sympathetic surge during head injury patient's intubation

2 great reviews

Airway Management of the Critically Ill Patient Rapid-Sequence Intubation, Chest. 2005;127:1397-1412

Rapid Sequence Induction (emdicine.com)

Other related link Quick dose calculator of drugs used in RSBI, by just entering weight


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