Rapid Sequence Induction and Front-of-neck Access - E Stewart



This on-demand teaching session is relevant to medical professionals and covers topics related to rapid sequence induction (RSI). It covers definitions of RSI, airway and circulatory causes, modifications of RSI for different patient types and populations, equipment, and when to use medications. Learn how to plan for RSI and understand best practices for the most challenging clinical scenarios. Come and learn how to work effectively in the hardest situations and create the best outcomes for your patients.
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Learning objectives

Learning Objectives for this session: 1. Identify the common steps and components of rapid sequence induction (RSI). 2. Explain when to initiate and how to safely administer RSI. 3. Outline the various indications for RSI. 4. Identify the appropriate medications to use when administering RSI. 5. Demonstrate how to correctly set up and use the necessary equipment for administering RSI.
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The following transcript was generated automatically from the content and has not been checked or corrected manually.

This is a really expected on rapid sequence induction in the eighties, so it's not gonna get able to do one a talk, and that's a purpose. It's just so it could be that I was working with the team, that we've got common language. You know what the plans are and so that we can just see very slick whenever it happens to. That sometimes is quite stressful thing to happen. Eso Month and Monseigneur 0.2 definitions and RSI is essentially just securing the Arab. I could gain a teaching high risk of expiration, so that's gonna be older patients in the day. The circus stations in the hospital that will probably had something that your drink and or listen they have on. And we need to get an airway and quick for some reason or another, and I'm trying to not make them vomit. In the meantime, especially an artist, I was style socks, a cracker pressure, and we've sort of moved on a we best and said, not sort of all the artists is that they are what we call a modified RSI and either bag in the patients that that may actually is we're not using credit could got some sort of adoption to it. And it's just be aware that there's just a slight change in the recent years and how you do these. So the question why we are side there's multiple things that you can sort of split them up into 80 s. So you're obviously airway obstructions or pending are exceptions to the top left Quarter your airway burns and we used to be sort of a GCS it and to be it's sort of thought, and but actually we're seeing a lot of people below decks. Escape always obstructed airway, and it's not vomiting. We can safely manages patient until and whatever called Swears off, and usually we're common and 80 having your allergy. CS. It's a struggle Bird dogs and things that that we've gone to are and be calls is There's a a recorded in United See picture there and ideally interview today and concern oxygenation and decrease your work of breathing in to take over for them. You can do bronchoscopy and all those sorts of things, and then say your circulatory reasons so and your post arrest when she got Roscoe and trying to get control of situation get an ongoing monitoring. And sepsis is, well, no other caveat to sepsis in that if you have a septic patient that shot buying, sometimes the worst thing you can do that in that moment is to try and interpret them. The best in today is property or substitute. Teaching first and proper fluid resuscitation, giving anywhere adrenaline and really the only and kid in this market already get recent change happened sort of results to go over these things. Every medic and then their D you're set left this your head injuries trying to fix a second your brain injury on, then everything else. So you're so called a patient that we can to get under control of the station that to protect them are ourselves. And then sometimes just for humanitarian reasons, we can integrate. People are moving, so you're sort of total surface body area burns where it's absolute, proves that person to be that way. And it's, um, a polyp and preached to just a lot of patients have account death with their family beside the minute it to you. So that's not on hard. All they actually multiple reasons why we can do it. Sometimes the biggest thing is asked lineup did it. And actually, the biggest thing is, if you don't have the right skills, actually don't have the right team. You shouldn't be doing in our say so if you don't know how what you're doing with the drugs, we don't know how to mountain area. If you're not ever confident. If you're not, I have not seen your support. Absolutely. Do not A You know, you're a patient with any drugs to prime it to get my That's the worst thing you could do and sort of the done in creditor effect. They but and we sort of climb. It's in that sort of margin. Your staff sometimes have more confidence in confidence. And don't be on that much. Dip it if you've no idea what you're doing. But they are up here on him dying level of this book that you shouldn't be using it on the same thing. If you don't have the right team with confident your team, Do you think you have the wrist? Is that they're doing that? And you don't want to be stationed in March? Last patient on Most things can do it the other is Is that on your patient reason? So very young child. Actually, Did you want a senior pediatric? Anything is there. Do you and one piece into that? Do you want the splints? What kind of the new needle And this is time to come and to the hospital on then for your obvious. If they're not going to make it the 80 you it's there so real and there's no point to sexually because you've integrated them. Bring it. But actually but know what to look after them on it. And also it is our job didn't buy. Those people are dying and indications of general not a part of a positive process. Then why is it more difficult any day? I would say that in dinars I needed more difficult anywhere else in the hospital. And you're happy preop patient this thing and expire And then I started in the morning. That's close. I have stopped zone is very different from our patient that comes in with a smashed in face and fill of drugs and alcohol and burgers. And we've also got and the benefits don't know that much trying. We've got not very much information. We often don't even know why. Our patient has a little GCS and we haven't had the CT scan yet. We haven't had a chance to look in them. Actually, no, absolutely nothing about the stations. And so we're against the time. Lots of nose. And then often we put things in place ourselves like and colors and blocks. And I'm actually physically maintaining in her eyes quite difficult. No, this thing is in a patient going to an emergency anesthetic left for appendix. They're they're only moderately a lot actually to create, continue them. They'll manage without oxygen for what, five minutes before they just treated Probably more than that. Spurs give are really shocked patient in the day. It probably is less in two minutes that you have before they start dropping their stats. When you make them at night, you can take away the option. And so we just have a lot more time fertilizations on our side. So I'm just gonna run three things going anywhere as a team. So before any education is 80 which they are, side check left. So they're over something that started a different department. It's just it's just the gas. And if you're in, the idea is if we keep doing this for every indication when you get that really, really difficult time that we need to quickly. Actually, everyone will be on board a new the plan and know what's happening next. So it is okay, something that being in the situations where it's hurting bad and you just need to get you. Then we say How to set up, have a lot of equipment. This is my plan A, B, C and D. Let's go. And actually, if you've got a great team and everyone's working together, that's okay. But generally we should be running to the next time someone has elected and give some drugs without any of these things, the country. So you absolutely don't stop mobility and our side checklist so going on to them and we bits. So prepare your patients Who have you got access? Do you want to central line or an arterial line? And there are signs of a bacterial last gotten on several patients. Generally a good idea. It can be helpful in special positions. Sometimes it needs to be after you've given some of your induction agent and because a you know where our patients are, like quite. Actually, it it We can't get them into the excision. It's been offered a base patient. For someone even gonna be a difficult airway. It can be a good idea to remember, to be honest at it for Officer Help pill, which is the Cialis 60 hum. And just sometimes help, actually, one of the back sensation to rolled up blanket that we have and the corner recess and quick a recessive. It's not going to be like what we'll do an anesthetic. So how quickly can then life is there, Help me stand trees are all these blood is your only something that's going to make your active little of this patient and a week injection is generally not a helpful for us in the day, and then oxygen. You tired really do that if it's a patient so that they don't speak proper and I keep them on it, that's okay. We can get of just taking out after a CM with their room, and but generally you want it least a period of oxygenation trying to get their stats on this high as you can, and then just tracking their allergies on them again. Just like I said earlier about your septic patient, the tree of often my status, much as you can given them some and NORAD fluids, antibiotic solutions and delayed seconds. Induction is often a really good thing that we, especially that really agitated patients and or especially asthmatics. And sometimes you need to give them with the kids, catching you before you get going to come and going so you can play oxygen year to him and get yourself. I have a twitch spot to make it. We bit safer. So then the next in today's prayer equipment and you got all your standard monitoring. But what is not a good stability? Definitely talk. Entire CT amitriptyline got working for you start, and I generally have the over on the anyway. Any situations going to check your trip so there's a cost to it or cuts in the quarter. There will generally and, uh, normal size man have a each and every woman have a 7.5 a size of a balloon between got one on the covers. The person is checking the show. You just need to inflate the blend make sure it's and went up and not popped, and it puts on the application on the bottom. Then we'll need some syringes cooks. So actually drink would have actually just going to be the one I just got. Still be very are lace of the graft there. And the idea is, we want her best. He correctly to try and get the job done quick as we can, and but definitely is there and the A one. That's a Miller believe the generally uses and Children. It's lovely in ST on, then the that scare sounded my control. Hopefully, someone adults would usually usually excuse that. Controlled for and the blue thing there. That's a big big and I love these actually, drink over tonight where I was working with the dealer indications with the chemo. Hold on just a little up. If they're so, you create a little the truth with GI. Stick the end of it into the Murphy's. I have a teacher that we call the bottom. I just stopped the staff that's really great in, but in it's just essentially a little tube to put in a slightly bigger chip. Before you passed your bigger trouble, but it's there's nothing fancy. It's just it's just essentially, that's what it is. And then your son, dirt working, suction your jail drink a lots and we have a flexible scope on them. Said it were. And we generally don't have any D and things in the catheter is probably having back for recess truly on then. Importantly, affective and access sets only really need is a size six chip busy on but, uh, scalpel, which will be in every. Surely this isn't a exhaustive list. Will need other things like here way to secure the chip, your oxygen, all the things. But it's something she absolutely need. And just that we picture the bottom of what the instigator is looking for. So a degree of use whenever you look dying, it's important that the teacher says, let me see so the rest of the team can activate the problems on board. Just one thing that chipped right in the middle of the cores, and she said, You should go along the pictures that's going to become a lot more difficult to school and going to talk a little bit. Not very much about drugs, and that's for up checking the reason, and I think you shouldn't be using the drugs on this. You really know what you're doing. And I'm not need to bed time and acidic. So 90 and because there's no right formula on day and every patient is so different and it's over and you know what you might be asked is to make up the drugs. But again, if you're not comfortable doing that, I do actually want you to do that. I want you to tell me I'm not controlled. Rather, take that million drugs and get it. Make sure it's right. Now I'm taking responsibility of giving those. So if you're not sure just asking, you been on three, it's, um, other time. And then I always make sure you know your emergency drugs are so your general and your appetite and your matter. Ah, middle. And sometimes it's very rare and the eating with reverse and then the induction. You start the in muscular agent, and but we're using your name in the rare occasion. Just know your sugammadex is in the department, because that's what we used to reverse on. There was a big mistake Coughing's from someone else's life stone, honey, and she's a doctor in our time. It's very famous. Salad diet. If you're still his idea of this school is beware if the junior, if it if it comes on and gets 80 patient, 200 mg of put full on his I have parenting. This is this Is labor the hippo that a needed to be castrated off to the vet today. It never worked before and the shot once. We can't me. It didn't work and the shot on the other two times and he said that was a couple of 200 mg of cat mean impair lever. The hippo had a party for an accident. Is, um didn't CPR boot Essentially be aware of people that don't know what they're doing? And if you think they didn't what you're doing, I'm got senior Vice. The next one is preparing the team, so this is probably the most important thing and knowing what your role is and we've got well, everyone still says you may have more than one a role in our society. Sometimes the team leader. It's first interview sure on the person to help telling what drug leaves. It's just Well, what we have still is what we have at the time. And but as long as everyone knows what your job is and that is fine, that a crack would pressure small a little bit out of fashion, really Haven't Virginia listen to talk with Crack Alone? By John Heinz It's all online, just stable left. And he had that surgery well, So there's actually no evidence that works, actually, shoes that we and cause more harm than good because more evidence off aspiration and on Dexter be harder. So the vast guidelines say that actually looked every departments decided we want to use crackers or not well, is really helpful. Loads instead of record is sometimes you may be asked to be what's called a birth maneuver, so I've got differently. I'll take your hand, put it over there. Tricks I remember and get you to push back up to the right to my concern has been a good for beauty into a beautiful view that will be able to treat it. And then I start. I was discussing your manual in my civilization effects needed for a formal patient if you like. But like a year and half ago were doing our size and 80 was actually just a pair of gloves on. My heart feels weird. Alien dust. Sometimes people that say Did you like the mask? If you tell, someone might potentially have meningitis, my real covered and goings and gloves and masks, advisers and older ass. So just make sure he are happy that your staff for all ppd dot the middle and see if, especially it's really difficult to medicate together, know in each other names, and it's really important to do this. First, it's sometimes it the minute the most important person is a runner right side. There is not. People use that booger about last kid that you forgot. And then, hey, do we call for help? It's always kind of a You take your GI are not changing 66 here, and I called and said, consulted Colon, the 80 consultant and making sure you got in some support. And I think fitness bottom picture and because it is an idea off perfect team. This is a team right within swollen jerk in 90 and this is on Christmas Day last year. It's just three R's after all of our shifts it. And then we did six our size up there, and suddenly three of our patients died. And both I completely dependent on that team. They were incredible. Will help the catheter we kept together. And there was just one moment in the day that that just made me know. Okay, Is that where is that? We had a really distant you should and my consult with another patient. I was only on the corner of my eyes were going through the steps, I could see the charge and I'm still putting search pill. And because I'd like to make it to start just in my head that I need to have my back that you will ever did. We were all working together and they were just getting a reasonable medicine got low. So just highlights to meet important solve it with perfect team with the cast keep going together. So this is probably that was important that right before we start on A is our plan and it's gonna be cm for every single patient essentially and are following the difficult every society guidelines. So questions tell me with the station of the patient feels that works and your contributors. It does not work in the day you for making a decision that so I'm off to sleep. It is incredibly rare that we can get him back up again, so you need the decision. But they need to be off to sleep and have a definitive area. So assembly being my every plan is a A Mac for blade with size, it shipped with a B J. That's not working. Maybe Tomo graph thought doesn't work. 100 more Senior educator. That can be a maximum 30 plus one attempts. The three kids. It's just sort of your books under their competent person. The one is a specialist in a seizure or an 80 consultant. So if he comes into the industry attempts and there's no one more senior there you go to the next steps Apply. B is always lead to be a lot of airway, like on I gel. If that doesn't work, you going to move to Plan C, which is face mask with two people and dilation, and if that doesn't work very sadly, we're going to plan D you just from doing that access. We need to be very clear on that. And I like that forever. Single one so that if people say that I'm struggling, then we don't need to get more senior person. And if that doesn't work and they're assistant knows that we're getting I just And that doesn't work sometimes of new fronted. Next trip for me on also gives you the confidence That's the team member. If you see that I'm getting and task the best you can see. And that's time to me before. And you can sort of How about companies that, you know, that should be the plan. So this is just a short video on front access. I mean, um, state. So if you can spot that you get a price on, it's not getting out of your consultant. And so the idea is, you get to the end of that. You say Okay, so can't into it would come into little bit different back access, usually the first time that that first it's set on the fish is just on. This is actually what you did. Okay, so this is not count interviewed confidently. Situation continue to manage Upper airway. We're going to set up from the neck access soon for the purpose of video that were wearing in house pee pee. And so we're gonna have to get a clean to the area and again. Scalpel. Stop by remembering twist. Pass a bougie into the trachea. Okay. 6 80 tip. Okay, inflate the cuff, and then we're gonna check. We have entitled. See you t in a bag. Got misting him in June. Three beats of a UTI. So we've successfully, so just aggressively keep it simple. Scalpel. Busy chip. That's always and I'm usually it's just having a conflict. So that was the next step. Usually the decision to do is the worst part. The actual in itself is a lot of field and slide is just highlight the importance of cup of milk a day. So if you've got no TriEst seminal place on last, you've got kids. You can't say it is Even if you've seen it should be going through the courts. You take it out, you go back to need to get them and follow that critical. And it's just important. So sweet seeing deaths happening. People say, definitely the boards, and that puts more of it. Wasn't there so and just absolutely gold standard used to have a choose the mustard dressing, sir, And securing ships. So ties for most people in the middle one is t generally do that for worried of light reason for your pressure, head injuries and third picture just crossed, which he can use it for. Anyone even go ahead and drink and your post up in our post education. Care to see him for just a well, very According Teo. What's wrong with your patient? But secure the chip. Get a chest X ray. Do you need to line them up? Do you need any further imaging? Continue Zetia assessment Getting your purposeful infusion, bowling Tonto and anesthesia organizing them to the I T. Or where they need to go to their defendant of care And it doesn't. Anderson. The Cipro is in just making sure you continue those things. If you can reach problems after even treated and you just need to follow that PSA stomach protocol each time. So you're 80 assessment and then specifically that I interviewed. So look, a chip has been displaced. Do you still have an title? See you to have your Children. You just step school. Um I have been pushed on it and the one month and then you pass a suction Catheters are Is there any muscle? Relax, taking over. So I'm going to get an X ray of your incompetent back. And is your equipment failures to go back to basics disconnect from your little put your and C circuit on trying? I've them tighter crypt, um, and minerals just stopped breast disconnection the ventilator. Sometimes you're a really severe asthmatics. Still little stuff, and you have to sort of press the the area of the lung. So I'm almost a seat you are, and so just keep calm, followed by a big sex. I'm going. You'll be fine. Eso That was just a really quick little stopped her into our size. It's not definitive, just Teo. Let's all know what sort of plan is to the rule, but I had so that will just work together is a better team whenever we get an association again. Any questions? Um, did anyone smoke the mistake create? I was gonna say it'll be a prize for whoever supposed to mistake. I don't have a price, so I let her sacral for you. You know that, not insulin. That's a nice and that's not not not a consultant. Okay, thanks. Um, any questions or any going off the heck are Thank you. Right. Great. Thanks much. So we're going to cut back to Sarah and I then?