RSI Cheat Sheet

Rapid sequence intubation requires a surprising amount of knowledge about drugs, from dosage to time to effect to half-life and duration of action. We've taken all that information and put it into two organized pages that will make a potentially intimidating topic surprisingly straight forward.

 Rapid Sequence Intubation Medications

Induction agents and paralytics...

Rapid Sequence Intubation Pharmacology

Emergency physicians have established expertise in the field of rapid sequence intubation (RSI). All emergency physicians must be facile not only with the skill of intubation, but also with the different pharmacologic agents appropriate for unique airway scenarios. Ultimately, by maximizing pharmacologic resources, the emergency physician will maximize the potential for success during RSI.

Emergency Airway Management: The Four Drugs That Matter

Lidocaine, Ketamine, Norepinephrine and Rocuronium.

International Emergency Medicine Education Project

First induction agent is given, then it is followed by a paralytic agent. The induction agents main aim is to induce rapid loss of consciousness to facilitate ease of intubation.

Rapid sequence induction/intubation controversies

Obviously, plenty still need to be done before establishing a more standardized protocol for RSI, preferably starting from evaluating these controversies using relevant studies.

Rapid sequence induction: where did the consensus go?

In many respects the conduct of RSI in current emergency practice is far removed from the original descriptions of the procedure. Despite this, the principles – rapid delivery of a definitive airway and avoiding aspiration, are still highly relevant and the indications for RSI remain relatively unchanged.

Rapid Sequence Intubation (RSI)

Rapid sequence intubation (RSI) is an airway management technique that produces inducing immediate unresponsiveness (induction agent) and muscular relaxation (neuromuscular blocking agent) and is the fastest and most effective means of controlling the emergency airway.

Rapid Sequence Intubation: Basics for Medical Students

There are a few induction agents, but the big ones to consider are etomidate, ketamine, and propofol. Etomidate: 0.3 mg/kg IV, quick onset, lasts 3-12 minutes. Has a long history of use in RSI and is a common “go-to” choice. There is some concern that it may cause adrenal suppression in septic patients, but this is up for debate. Ketamine: 1.5 mg/kg IV or 4 mg/kg IM, onset in <1 minutes, lasts 10-20 minutes. Popular choice as it does triple duty as an anesthetic, amnestic, and analgesic. It causes bronchodilation and a catecholamine surge resulting in increased blood pressures and heart rate. Great in unstable sepsis patients and those with reactive airway disease. Avoid in cardiovascular disease. Rare report of laryngospasm. Propofol: 1.5-2.5 mg/kg IV, onset in 45 seconds, lasts 5-10 minutes. Use in hemodynamically stable patients, status epilepticus, and reactive airway disease. Watch for hypotension and myocardial depression.

Selection of Paralytic and Induction Agents in RSI

Although RSI is associated with less rate of complications, however, patients who are critically ill may experience hypotension as a result of the rapid induction. Therefore, the choice of induction medication should be done carefully to minimize these risks and cardiovascular status should be optimized with crystalloids, blood products, vasopressors, or inotropes before beginning RSI.