GuidelinesOther guideline
Rapid Sequence Intubation - Adult
Adult Rapid Sequence Intubation Algorithm
Treatment algorithm
Equipment checklist
Induction agent
Paralytic agent
Initial ventilator settings
Treatment Algorithm
Equipment Checklist
- Suction
- 100 % NRB Oxygen Mask
- Bag Valve Mask
- Sats Probe
- Cardiac Monitor
- Capnography
- BP cuff
- IV access
- Oropharyngeal Airway (OPA)
- Laryngoscope
- ETT: 3 sizes
- Rescue Device (LMA)
- Introducer
- Bougie
- Induction and Paralytic Agents
- Atropine
ETT Measurements
| Patient | Size | Depth |
| Small Medium Large | 6-7mm 7.-8mm 8-8.5mm | 19-21 21-23 23-25 |
LMA Size
| Patient Size | Size |
| Small Female Large Female or Average Male large Male | 3 4 5 |
DRUGS CHECKLIST:
- Induction Agent
- Paralytic Agent
- Atropine
- Ephedrine or Phenylephrine
Induction Agent
| ETOMIDATE | KETAMINE | MIDAZOLAM | PROPOFOL | THIOPENTONE | |
| DOSE | 0.2 – 0.4 mg/kg | 1 – 4 mg/kg | 0.2-0.3 mg/kg | 2 – 2.5 mg/kg | 3 – 5 mg/kg |
| 70 kg patient | 20 mg | 140 mg | 15 – 20 mg | 140 mg | 210 mg |
| AVOID IN | Sepsis | Seizures | Use only if no other agent available | Hypotension Elderly | Hypotension |
| GOOD IN | CVS unstable | Asthma Hypotensive | Head Injury Intracranial Pathology |
Paralytic Agents
| AGENT | SUXAMETHONIUM | ROCURONIUM |
| DOSE | 1.5 - 2 mg/kg | 0.6 - 1.2 mg/kg |
| ONSET TIME | 30 - 60 sec | 2 min |
| DURATION OF ACTION | 5 - 10 min | 45 min |
| CAUTION and CONTRAINDICATIONS | > 24 hrs Major Burns > 5 day Spinal Cord Injury or Muscle Disease Hyperkalaemia Malignant Hyperthermia | Hypersensitivity to Non-Depolarisers USE CAUTIOUSLY IN RSI |
Initial Ventilator Settings
(Adjust according to ABG/Capnography/Clinical Condition)
Normal Lungs | COAD | Asthma | Pneumonia/ARDS | |
RR | 8-10 | 8-10 | 6-8 | High <20 |
TV (ml/kg) | 6mls/kg (6-10) | 6mls/kg (6-8) | 6mls/kg (6-8) | 6mls/kg (6-8) |
Peak P | <35 | <35 | <35 | <35 ideally |
PEEP | 3-5 | 3 | 3 | 5-10 |
I:E | 1:2 | 1:4 | 1:4 | 1:2 |
MAINTAIN SEDATION
- 45 mg Midazolam
- 30 mg Morphine
- in 200 mls N/S
- Start at 1ml/hr
CONSIDER LONG ACTING PARALYTIC
- Vecuronium 0.1 mg/kg IF
- Patient is fighting ventilation
- As long as ETT is well-placed and
- Sedation is adequate
IF DETERIORATION OCCURS, CHECK
- Displacement of Tube
- Obstruction of Tube
- Pneumothorax
- Equipment Failure
- Sedation