RAPID SEQUENCE INDUCTION (RSI)/RSI IN SPECIAL CIRCUMSTANCES
Overview
• airway management technique
• used in emergency settings when it is assumed that the patient has not been fasted,
therefore has a “full stomach”; has an intact gag reflex - and carries risk of aspiration
• goal : to minimise the time between loss of consciousness and tracheal intubation
Indications
1. Airway protection
2. Respiratory failure (or impending respiratory failure)
• hypoxia
• failure in ventilation — hypercarbia
3. “Full stomachs”
4. Cerebral protection / resuscitation
• to keep normoxia / normocarbia
Contraindications
Absolute Relative
Total upper airway obstruction Difficult airway- awake intubation,
use of difficult airway adjuncts-
assess using LEMON
Cannot intubate, cannot ventilate Crash airway- if patient is
(CICO) situation unresponsive, unconscious, in an
arrest situation- no need for RSI
drugs- BVM is indicated
Total loss of facial landmarks
- Surgical airway is indicated
Complications
• Inability to secure the airway — oesophageal intubation, obstruction, inability to
visual vocal cords
• Inability to ventilate the apneic patient — laryngeal oedema, mass, obstruction,
distorted anatomy
• Alterations to blood pressure and heart rate
• Trauma to teeth, airway
• Increase risk of aspiration/regurgitation
Overview
• airway management technique
• used in emergency settings when it is assumed that the patient has not been fasted,
therefore has a “full stomach”; has an intact gag reflex - and carries risk of aspiration
• goal : to minimise the time between loss of consciousness and tracheal intubation
Indications
1. Airway protection
2. Respiratory failure (or impending respiratory failure)
• hypoxia
• failure in ventilation — hypercarbia
3. “Full stomachs”
4. Cerebral protection / resuscitation
• to keep normoxia / normocarbia
Contraindications
Absolute Relative
Total upper airway obstruction Difficult airway- awake intubation,
use of difficult airway adjuncts-
assess using LEMON
Cannot intubate, cannot ventilate Crash airway- if patient is
(CICO) situation unresponsive, unconscious, in an
arrest situation- no need for RSI
drugs- BVM is indicated
Total loss of facial landmarks
- Surgical airway is indicated
Complications
• Inability to secure the airway — oesophageal intubation, obstruction, inability to
visual vocal cords
• Inability to ventilate the apneic patient — laryngeal oedema, mass, obstruction,
distorted anatomy
• Alterations to blood pressure and heart rate
• Trauma to teeth, airway
• Increase risk of aspiration/regurgitation
