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Rapid Sequence Intubation

Equipment Checklist
Monitor with BP q1-3 min End tidal CO2 capnography and/or
Secure IV access x 2 colorimetric device
OP and NP airways Stethoscope
BVM with PEEP valve on O2 Tube securing device
Laryngoscope - blades & batteries OG tube
ETT - various sizes Personal protective equipment
10 cc syringe - check cuff Backup devices:
Stylet with tube straight, 30° bend at cuff Video laryngoscope (standard and
(stylet may vary with device) hyperangulated blades)
NRB & nasal cannula on O2 LMAs
Suction x 2 Cric kit - Scalpel, bougie, 6-0 ETT
Bougie

Basic Steps of RSI Post-Intubation Sedation Plan

1 Resuscitate (hypoxia, acidemia, BP) Analgesia options:

2 Preparation (check equipment, assess pt) Fentanyl, morphine, hydromorphone

3 Example: Fentanyl 0.7 to 10 mcg/kg/hr

Position patient
Sedation options:
4 Pre-oxygenate & setup NC for apneic O2
Propofol, benzodiazepines,
5 Push induction & paralytic agents
dexmedetomidine, ketamine
6 Placement with proof
Example: Propofol 5 to 10 mcg/kg/min
7 Post-intubation mgt (sedation, CXR, ABG)

This is for reference purposes only. EM:RAP and the authors assume no liability for use of the techniques described. Local practice, current guidelines, and
clinician experience should determine the exact procedural process in any individual patient.

© 2019 EM:RAP Inc.

 SMART
LINK TO EPISODE

SMART ™

Induction Agents for RSI

IV Dose Suggested IV Dose Onset Duration Pros Cons
Standard Dose 70 kg Shock
adult
Ketamine 1 to 2 mg/ 140 mg 1 mg/kg 60 to 90 5 to 15 min Good for: -Increases secretions
kg (2 mg/kg) sec -Hemodynamically -Caution in
unstable hypertensive patients
(3 to 4 mg/ -Bronchospasm -Nausea, vomiting
kg IM)*
Etomidate 0.2 to 0.6 20 mg 0.2 mg/kg 15 to 45 3 to 10 min Good for most -Myoclonus
mg/kg (0.3 mg/kg) sec intubations -Adrenal suppression
(unclear if clinically
relevant)
-Pain on injection
-Nausea, vomiting
Propofol 1 to 2 mg/ 105 mg 0.2 mg/ 15 to 45 5 to 10 min Good for: -Lowers BP
kg (1.5 mg/kg) kg starting sec -Bronchospasm -Caution in head injury
dose and -Seizures (drops MAP and CPP)
titrate -Allergy to egg or soy
-Pain on injection
*Intramuscular administration may significantly delay onset
Paralytic Agents for RSI
IV Dose Suggested Onset Duration Pros Cons
Standard Dose 70 kg
adult
Succinylcholine 1.5 mg/kg 105 mg 45 to 60 sec 5 to 10 Shorter duration Contraindications:
(2 mg/kg infants (1.5 mg/kg) (2 to 3 min IM) min allows return of HyperK, Guillain-
and small neuro exam Barre, malignant
children) hyperthermia, >3d post
(3 to 4 mg/kg burn or denervation,
IM)* neuromuscular disorders,
digitalis toxicity
-Bradycardia, transient
incr. in ICP & IOP
-Aminoglycosides may
prolong effects
Rocuronium 0.6 to 1.2 mg/kg 70 mg 60 to 120 sec 15 to 85 Good for most -Delays return of neuro
(1 mg/kg) min intubations exam
-Reversed by
sugammadex (costly, not
widely available)
*Intramuscular administration may significantly delay onset

This is for reference purposes only. EM:RAP and the authors assume no liability for use of the techniques described. Local practice, current guidelines, and
clinician experience should determine the exact procedural process in any individual patient.

© 2019 EM:RAP Inc.