Trauma ICU Rounds – Airway Management during the COVID-19 Pandemic: Rapid Sequence vs. “Protected” Intubation
- Apr 10th, 2020
- Dennis Kim
Originally posted on Trauma ICU Rounds on April 3, 2020. Follow Trauma ICU Rounds (@traumaicurounds) and Dr. Kim (@dennisyongkim) to learn more on simplifying trauma critical care together.
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RSI or rapid sequence intubation a method of achieving rapid control of the airway while minimizing the risk of regurgitation and aspiration of gastric contents. What this means is that RSI is almost universally required in situations calling for emergent endotracheal intubation and, if you’ve ever been in the trauma bay when a patient has required a definitive airway, RSI was almost certainly employed. Due to the nature of intubation (and extubation!) being an aerosol generating procedure, specific steps and preparation must be undertaken to minimize risks to not just patients during intubation but to us as well.
#1 Describe the sequence & steps involved in performing rapid sequence intubation.
#2 Appreciate COVID-19 specific considerations for safely securing a definitive airway
Take Home Points
Pause, think, and prepare BEFORE rushing into a patients’ room to secure a definitive airway
There ARE NO EMERGENCIES DURING A PANDEMIC!!!
03:12 What is Rapid Sequence Intubation
04:27 Cricoid pressure: yay or nay?!
05:43 5 Steps & sequence of RSI
14:04 Preoxygenation & Positioning
18:09 Medication administration
19:00 Insertion of ETT and balloon inflation
19:35 Confirmation of placement
Overview of RSI
Preparation for intubation
Induction of Drug administration
Application of cricoid pressure?
Inflation of ETT balloon
Confirmation of ETT placement
Release of cricoid pressure?
STATICS Mnemonic for Intubation Preparation
Circuit / CO2 detector
Scope / Syringe
- The Australian and New Zealand Intensive Care Society (ANZICS) COVID-19 Guidelines Version 1
- Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19)