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RAPID SEQUENCE INTUBATION

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Cricoid pressure is started (Sellick maneuver)...the cricoid is the ring just ... don't stop cricoid pressure until you know the tube is placed correctly ... – PowerPoint PPT presentation

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Title: RAPID SEQUENCE INTUBATION


1
RAPID SEQUENCE INTUBATION
2
Definition
  • Rapid sequence intubation is a technique used to
    secure the airway rapidly
  • Indications emergency surgeries or other
    situations where the stomach might be full
    (recent meal / delayed gastric emptying d/t
    trauma, acute abdomen, morphine / incomplete
    lower esophageal sphincter (obesity, hiatal
    hernia, pregnancy)

3
Overview of the process
  • The patient is put to sleep with an IV agent such
    as thiopentone or propofolthese cause hyponosis
    and amnesia
  • Then the patient is paralyzed and rapidly
    intubated
  • Before you start this process, you need to be
    sure everything is set-up and ready to gothe
    patient wont be able to breathe once they are
    paralyzed, so you need to be sure you can intubate

4
Before Paralysis
  • Preoxygenate the patient for at least 3 min
  • Start an IV if there isnt one
  • Attach monitor, oximeter
  • Set-up equipmenthave emergency trach tray ready
  • Several sizes of ETTsopened with cuff checked
  • Suctionon and under the pillow
  • Laryngoscopescheck lightsseveral blades/sizes

5
Induction
  • Cricoid pressure is started (Sellick
    maneuver)the cricoid is the ring just below the
    larynx (Adams apple)if it is pushed
    posteriorly, because it is circular and solid, it
    compresses and closes the esophagus which is
    behind it preventing regurgitation of gastric
    contents
  • Induction agent is given

6
Induction agents used
  • Succinylcholine
  • A depolarizing neuromuscular relaxant causes the
    muscles to depolarize (they contract) then keeps
    them depolarized so they cant contract again
  • Can cause fatal hyperkalemia in 24 hrs to up to 2
    years later in some patientsdont use with
    burns, strokes, spinal cord injuries, MS, ALS, or
    crushed muscle
  • Onset is within 1 minute and duration is about 5
    minutes

7
Induction agents, cont
  • Vecuronium onset is within 1 minute with max
    onset at 3-5 minutes and duration of 25-40
    minutes
  • Rocuronium onset is within 2 minutes with max
    onset at 3 minutes and duration of 30 minutes

8
After paralysis
  • The patient is paralyzed when the eyelash reflex
    is lost and when fasciculation (muscle twitching)
    stops
  • Patient is intubated, cuff is inflated, tube
    secured, and tube placement is verified dont
    stop cricoid pressure until you know the tube is
    placed correctly

9
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10
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