RSI Protocal

[firemankv]

My service is looking to add RSI back into our treatment plan. We had it for a short time but protocals were lacking and we discontinued. We are looing to add it back to our treatment plan and would like the help of others that use RSI. If anyone could give copies of there protocals or links to them, that would be great. Also any info you can give on your QI program reguarding RSI would be helpful. You can email them to me at firemankv@hotmail.com

Thanks

[ERDoc]

My service is looking to add RSI back into our treatment plan. We had it for a short time but protocals were lacking and we discontinued. We are looing to add it back to our treatment plan and would like the help of others that use RSI. If anyone could give copies of there protocals or links to them, that would be great. Also any info you can give on your QI program reguarding RSI would be helpful. You can email them to me at firemankv@hotmail.com

Thanks

Use the search function and you will find that this has been discussed ad nauseum.

[Doczilla]

MAKE.......IT.........STOP.............

'zilla

[FormerEMSLT297]

www.miemss.org then click on download complete 2007 protocols.

[paramedicmike]

RSI shouldn't be allowed as a procedure by someone who didn't pass second grade spelling.

Other than that, I'm with 'zilla.

MAKE.......IT.........STOP.............

-be safe

[cntrymedic]

I work for St. Johns Health Systems in Missouri and they are by far one of the more advanced in their protocols and training regarding RSI. Even our EMTs are encouraged to attend advanced airway classes, the powers that be think this makes an RSI go more smoothly and i'm inclined to agree. In the RSI kit we keep in our narc box there is a card with a dose chart for the use of the different RSI agents. Let's face it, it's hard to remember a protocol when you don't use it much or if you are new to using it...so the powers that be established that we need a cheat sheet to help things going smoothly in the event of an RSI. The RSI card in our kit is laminated. Our protocol reads as follows (we keep a binder in our ambulance with protocols in it so we can 'cheat' as needed):

Indications:

1. A critical need for airway control exists, such as:

a. persons with impending respiratory failure.

b. combative patients with compromised airway.

c. patients with depressed LOC. GCS less than or equal to 8.

d. patient with hypoxia refractory to oxygen.

e. multiple trauma patients who require an airway.

2. Any time risk of potential/actual airway compromise is suspected.

Relative Contraindications:

Benefit of airway control must be weighed against risk.

1. Hypersensitivity to drugs.

Absolute Contraindications:

1. Patients in whom cricothyrotomy would be difficult or impossible.

2. Massive neck trauma/swelling.

3. Patients who would be impossible to intubate or ventilate after paralysis.

4. Acute epiglotitis

5. Upper airway obstruction.

Procedure:

1. Assemble necessary equipment and personnel. (suction unit and catheter, BVM w/ correct mask, appropriate size ET tube, working laryngoscope, appropriate drugs drawn up in syringes, pulse ox, ETCO2 monitor, cardiac monitor, cricothyrotomy kit, and alternate airways). (Failed airways include OPA, NPA, combitube, LMA, cric kit, etc.).

2. Position patient properly.

3. Assure at least one secure well running IV line.

4. Pulse ox and monitor attached

5. Assign specific duties (bagging the pt, application of cricoid pressure, pushing of meds, etc.)

6. Allow pt to breath 100% O2 for 4-5 min if possible, or ventilate the pt with BVM at 100% for 1-2 min or 4 vital capacity breaths.

7. Premedicate patient as indicated:

a. lidocaine 1.5 mg/kg in pts with head injury or increased ICP.

b. atropine 0.5mg for bradycardic pts

c. atropine 0.02mg for pediatrics (min 0.1mg)

d. etomidate 0.3mg/kg for sedation

e. succinycholine 1-1.5mg/kg adult and 2.0mg/kg peds

f. vecuronium 0.1mg/kg (no med control is needed if used for primary paralytic, succs must be contraindicated)

8. Perform intubation and confirm placement while monitoring spo2, cardiac rate and rhythm.

9. Cricoid pressure should be maintained from time of sedation until ETT is secured to prevent aspiration.

10. Versed 0.1mg may be used for continued sedation, and may be repeated once.

11. Vecuronium 0.1mg/kg may be used for continued paralization. Make sure the pt is also sedated. (watch the heart rate) *Med control is required.

When utilizing RSI, even with adequate sedation, the patient may still be aware of the situation. Please inform the patient of any procedure you will be performing, just as you would with an awake and aware patient.

In the event that the patient cannot be intubated after paralysis is achieved:

1. Place an OPA, NPA, combitube, or other airway.

2. Assist ventilations with BVM.

3. If unable to ventilate patient place Quick Trach.

I hope this helps. If you have any questions about our protocol I'd be more than happy to try to answer them for you. Down here we are big believers in RSI and Capnometry and before i came to work here i had no clue about how it all worked....now, well, i'm a believer. i hope your search for a new protocol for your service is fruitful.

Cntrymedic

[flight-lp]

RSI shouldn't be allowed as a procedure by someone who didn't pass second grade spelling.

Other than that, I'm with 'zilla.

MAKE.......IT.........STOP.............

-be safe

Touche`

[VentMedic]

My service is looking to add RSI back into our treatment plan. We had it for a short time but protocals were lacking and we discontinued. We are looing to add it back to our treatment plan and would like the help of others that use RSI.

You did RSI without protocols?

And, where's your Medical Director? Doesn't he/she know how to get a protocol that he/she will be responsible for not to mention the medical oversight of your training and continued competency?

[tniuqs]

MAKE.......IT.........STOP.............

'zilla

Rounds of haloperidol for all, I will buy the first round ! :shock:

[Scaramedic]

You did RSI without protocols?

And, where's your Medical Director? Doesn't he/she know how to get a protocol that he/she will be responsible for not to mention the medical oversight of your training and continued competency?

They have protocols, this falls under protocals.