RSI

[ccguido]

So, I'm a little confused by the last post.... are you saying that in some cases it is ok to use succs if it is < 48 hrs and the pt has the ability to maintain some mobility in the limbs to lessen the buildup of Ach?

[Ridryder 911]

Yes, most EMS consider, < than 48 hrs safe. I prefer to use another paralytic, such as Pavulon, etc..

Be safe,

Ridryde 911

[spgmedic]

Great responses. We use it our service as protocol. I feel it is a great procedure. Our medics are trained by our flight crews. I have personally assisted with 5 as an EMT-b and had 1 as a Medic so far . All very successful.

[ffpm41]

We premedicate with Atropine (kids) or Lido (head injuries) if indicated.

Then sedate with Etomidate (.3 mg/kg) in head injuries or hemodynamically compromised Pt's. The other option is Versed (.1-.3 mg/kg) in kids or hemodynamically stable Pt's.

Then use Succinycholine (1.5 mg/kg) if no contraindications or Rocuronium (.6 mg.kg) if you can't use succs.

Contraindications are hyperkalemia, head injury, massive crush injury, penetrating eye injuries, skeletal muscle myopathies or Hx of malignant hyperthermia.

For continued sedation we use Ativan or Versed, and for continues paralysis we use more Rocuronium.

RSI is a great tool if used by a properly trained and educated medic. I think it is necessary to maintain CE to make sure your ready. Remember the ABC's, AIRWAY, AIRWAY, AIRWAY.

[battlemedic345]

I think it can't be stressed enough that in order to RSI someone you have to have taken part in a very rigorous RSI training program. This isn't just something you would want to talk about in class and have someone doing the next day.

How do you grade the airway?

On what scale?

When do you not RSI someone who doesn't meet the other contraindications?

All questions you have to be able to answer before you push the meds.

If you make a mistake, they are worse than they were before. You have to know that everytime you think about RSIing someone.

[JohnClark]

The only reason to use succs is if you think the case needs to be a little more challenging. I think for the most part RSI is unnecesary in the field, and should be reserved for the ED.

[Ridryder 911]

Never seen a facial burns, head trauma with the patient clamped down ?

CHF compensating ? Remember the old saying Glasgow < than 8 : intubate ?

Versed is only a sedative, it does not prevent laryngeospams, movement, etc..

Be safe,

Ridryder 911

[ffpm41]

I agree with Ryder, RSI is an important tool that is needed in certain cases. It all comes down to training and volume. If you don't use it you loose it; meaning if you work in a low call volume system and always need to go to the OR to recert, maybe RSI isn't a good choice.

I think the main problem in EMS is people in other medical fields (i.e. MD's, RN's PA's, etc) don't think we are compitent. How many times have you been called an ambulance driver? EMS needs to be more vocal both with the public and other professionals about our real role. Pre-hospital care is a technical field, we have some of the same responsibilities as a doctor and a nurse. It's time to step up boys and girls and next time you get called an ambulance driver, professionally educate the person, just don't be an ass about it.

The Gospel according to me. Stay safe brothers and sisters.

[Ace844]

can the moderator please bring back a link or copy of the discussion we had about this on the old board (just before we switched to this one) where this was discussed in detail as it has some good info in it from Rid, WPM, and USAF. Thanks,

Ace844

[Ace844]

can the moderator please bring back a link or copy of the discussion we had about this on the old board (just before we switched to this one) where this was discussed in detail as it has some good info in it from Rid, WPM, and USAF. Thanks,

Ace844