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Rapid Consequence Intubation (RSI)

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Bailey RSI Medication and intent Summary Rapid sequence intubation (RSI) is a standardized protocol that uses medications to facilitate endotracheal intubation of patients in emergency settings (Mason, Weant & Baker, 2013). Some indications for use of RSI include respiratory distress, trauma, or decreased airway patency (Mason et al., 2013). RSI medications include pretreatment medications such as fentanyl or lidocaine; acute paralytic agents and sedatives; and long term pain management, sedative or paralytic agents (Mason et al., 2013). Pretreatment medications in RSI are meant to mitigate effects of intubation and RSI. Atropine is typically used in pediatric patients to decrease the vagal response caused by use of the laryngoscope blade…show more content…
Etomidate is a short acting sedative that avoids affecting respiratory, cardiac and circulation centers, meaning less adverse reaction in the patient (Mason et al., 2013). Midazolam is a benzodiazepine sedative that can be used in RSI, but tends to cause hypotension in patients (Mason et al., 2013). Ketamine is another sedative that can be used, but it is usually a third choice after etomidate or midazolam because of its adverse affects (Mason et al., 2013). Propofol is the final sedative or hypnotic that is used in RSI, it has adverse effects including hypotension, and because of its short acting period is used primarily in conscious sedation procedures and not RSI (Mason et al.,…show more content…
Specifically using a sedative 1-2 minutes prior to a paralytic so that the patient does not wake up while paralyzed (Mason et al., 2013). Also the medications should be pushed through a patent IV line, and flushed with normal saline between medications to avoid adverse reactions (Mason et al., 2013). Additionally, all RSI patients should have cardiac and respiratory monitoring before, during and after the procedure (Mason et al., 2013). Other factors in selecting RSI medication should be addressed, including patient-specific factors. Finally, medication availability can be a factor in choosing medications as drug-shortages can cause limited supplies of certain medications (Mason et al.,
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