Fentanyl and midazolam and sux to induce then pancuronium afterwards with a morphine/midazolam infusion to maintain the sedation.
The fentanyl can be swapped out if the patient is likely or has recieved IV amiodarone or the morph/midaz infusion can be changed to fent/midaz if an allergy exists
Im told the fent/midaz pe-med will be ditched for ketamine soon
Currently RSI is for the post ROSC management and traumatic head injuries. Respiratory patients are tubed by sedation with fent/midaz and then paralysed, but im told this is under review and will be swapped for RSI protocol sooner or later.
We don't seem to have any issues with missed oesephegeal placements like is reported in the states, facilitiated untubation MUST have waveform capnography available.
The intubation algorithm here is backed by a comprehensive failed intubation drill which basically goes 1 attempt with or without bougie (based on grade view), missed tube, pre-oxygenated with OPA/NPA, attempt with bougie, miss, LMA, if unable to ventilated adequately, and cricothyrotomy at the end (its a bit more to it than that but its the general gist of it)
I understand RSI is contentious. Basically it was supported by in house data that said there was a significant reduction in the number of patients with severe neurological impairment at 6 months (i think) in the setting of traumatci head injury. Also, RSI enabled therapeutic cooling post ROSC which contributes to the 30% + survival to discharge for cardiac arrest we currently have.