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Rapid Sequence Intubation

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  1. Rapid Sequence Intubation Trigger 1

  2. Rapid Sequence IntubationDefinition Rapid Sequence Intubation (RSI, also known as Rapid Sequence Induction)

  3. Rapid Sequence IntubationDefinition Rapid Sequence Intubation (RSI, also known as Rapid Sequence Induction) • refers to a specific method of general anaesthesia that can be used in emergency situations.

  4. Rapid Sequence IntubationDefinition Rapid Sequence Intubation (RSI, also known as Rapid Sequence Induction) • refers to a specific method of general anaesthesia that can be used in emergency situations. • it facilitates intubation while preventing gastric aspiration and protecting against increased intracranial pressure.

  5. Rapid Sequence IntubationTRAUMA CHALLENGES Trauma presents special challenges to airway management. • The patient's cervical spine, for example, must be immobilized until a thorough assessment of its stability can be completed. • The ability to open the patient's jaw may be limited, and there may be upper airway oedema, penetrating neck injuries, facial or laryngeal trauma • Loss of integrity of the airway structure, and obscured visibility of the passageway.

  6. Rapid Sequence IntubationTRAUMA CHALLENGES • The team should be aware that restlessness or aggression can result from hypoxia or a patient's drug and alcohol use and should therefore assess for hemodynamic compromise and traumatic brain injury

  7. Rapid Sequence IntubationASPECTS OF INTUBATION RSI offers the trauma team the quickest way to secure and manage the patient's airway.

  8. Rapid Sequence IntubationASPECTS OF INTUBATION The essential aspects of intubation are: • Communication with the patient • Preoxygenation • Sedation (when appropriate)+analgisic • Application of cricoid pressure • Paralysis (muscle relaxation) • Placing the tube/confirming placement • Patient monitoring

  9. Rapid Sequence IntubationCommonly used Drugs – PREMEDICATION AGENTS

  10. Rapid Sequence IntubationCommonly used Drugs – INDUCTION AGENTS

  11. Rapid Sequence IntubationCommonly used Drugs – MUSCLE RELAXANTS

  12. Rapid Sequence IntubationASPECTS OF INTUBATION • After intubation an orogastric or nasogastric tube should be inserted and chest x-ray taken to confirm placement of the tube in the stomach. • The unconscious patient requires eye care, pressure area care, temperature control and catheterisation of the urinary bladder.

  13. Rapid Sequence IntubationHYPOTENSION FOLLOWING INTUBATION • causes include vasodilator and/or negative inotropic effects of the sedative drug and/or positive pressure ventilation decreasing venous return and cardiac output. • treatment consists of fluid challenge and/or inotrope administration depending on the clinical setting.

  14. Rapid Sequence IntubationHYPOTENSION FOLLOWING INTUBATION • Rarely hypotension may be due to tension pneumothorax occurring after the commencement of positive pressure ventilation.

  15. Rapid Sequence IntubationHYPERTENSION FOLLOWING INTUBATION • Hypertension usually indicates inadequate sedation • Should be treated with supplemental sedation.

  16. Rapid Sequence IntubationNURSING IMPLICATIONS Nurses are active participants in the assessments, diagnosis, planning, and interventions pertaining to airway management. As such, they must remember to:

  17. Rapid Sequence IntubationNURSING IMPLICATIONS * make a baseline assessment that includes information on the patient's level of consciousness and hemodynamic status (blood pressure, pulse, respirations, temperature, oxygen saturation, circulation status [including quality of pulse and skin color], and cardiac rhythm). * begin continuous cardiac monitoring and pulse oximetry.

  18. Rapid Sequence IntubationNURSING IMPLICATIONS * insert at least one large-bore iv catheter to deliver fluids (two large-bore iv catheters are recommended for trauma patients). * provide patient and family education and support. * ensure the availability of all intubation and resuscitation equipment.

  19. Rapid Sequence IntubationNURSING IMPLICATIONS * determine and document which drugs and interventions are used and note when the desired effect was obtained (for example, when muscle relaxation and intubation occurred). * assess the patient's response to each medication and intervention * consider inserting an arterial line or obtaining ABG measurements to provide accurate, continuous monitoring of oxygen saturation

  20. Rapid Sequence IntubationNURSING IMPLICATIONS Nurses can improve the efficiency with which airway management occurs by learning about the risks and complications of intubation, becoming familiar with the pharmaceutical agents used in RSI, as well as their potential side effects, and by learning how to assess and monitor the needs of each trauma patient.