Rapid Sequence Intubation

[medic3401]

I was wondering how many of you work for services that use RSI in the field and if you do, what meds do you use for the procedure and what kind of training did you get prior to initiating the protocol.

Thanks,

Matt Sulentic, EMT-P

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If a fire is an emergency to the fire dept., who do they call?

[jpurdom]

Both services I work for use RSI. One service uses Versed and Etomidate. The other service uses Norcuron and Versed. Prior to implementation we had numerous inservice meetings and written testing.

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James Purdom NREMT-P

[Trauma_Dog]

We have been doing rapid seqence intubations in the field for aprox. 6-yrs now and have good success with the protocol. Our training included background and adminstration of the meds and also emergency cric incase the airway cannot be managed. The follow is a list of our meds in the order they are given.

100mg lidocaine
100mcg fentanyl
20mg etomadate
200mg succinylcholine
intubate
maintenance
5mg of versed
.01 mg/kg of norcuron

Our protocol states that you have to have to least 2 medics present durring the procedure, which basicaly means pull over or take an extra first resonder with you.

Also use caution when giving the succinylcholine to CHF pts, it can produce asytole(ask me how I know).

IF you have any other questions let me know.

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Kent Simon
Paramedic Incharge
MCHD EMS,
Montgomery Co.,TX

[medic3401]

Thank you two for the info. We are slowly working toward RSI here and I just was curious as to how long others have been doing it and what they did for a procedure. I can't tell you how many times I have had patients that I said, "If I only had RSI!!!!" Thanks again for the info.

One other thing...who taught the classes before the protocol was implemented?

Anyone else!?!?!?

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If a fire is an emergency to the fire dept., who do they call?

[This message has been edited by medic3401 (edited August 24, 2000).]

[Boothby]

Man I would love to have RSI, but unfortunatly we don't, and it doesn't look like we will get it anytime soon. We have been in a transition since firefighting and ems merged into one, and we still have alot of hurdles to clear before we will ever see RSI. Getting the department to come up with more money for better continuing education is a big one.

We did get a cool new toy though. Portable, disposable, oxygen powered ventilators. These things are great, and they can be used with a mask in demand mode with PEEP. I am looking forward to using this function on a bad CHF pt(should act as a poor mans CPAP if we can keep the mask tight). Hopefully it will aleviate the need for intubating some of these folks, which is better for the pt long term anyway.

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Larry Boothby
Firefighter/Paramedic
Truck 3 A-shift
Local 1784
Memphis.

[jpurdom]

Both services I work for had RSI inplace when I started. I was given inservice training by our training officers. One service changed meds for RSI and we recieved training from our medical control physician.

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James Purdom NREMT-P

[MaryAnn329]

Our flight program has been using RSI for a couple of years now. We premedicate with Lidocaine for head injuries and Atropine for pediatrics. We use weight-based dosages of succinylcholine and etomidate for intubation. All personnel went through extensive classroom training, did a rotation through OR to insure competency, and had to pass a written test. We also have an ongoing QA monitor and must do a yearly update. We were well prepared prior to implementation of the RSI protocol, and have had no major problems.

[MedicResQ]

Being from NC like yourself we went online as soon as the state approved our protocol. I think about October of 1999. We have a PA-C who works at a level 1 trauma center who works part time for us he and myself taught the class. Drugs Lidocaine in presence of head injuries Atropine in peds. Then we use Etomidate sucks for the short term and Vecuronium and Fentanyl e mail me at medicresq@aol.com and I'll send you a copy of the protocol

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MedicResQ

[Throwfoam]

I work for a very rural coastal agency that transports and we use Sux as an initial induction agent and Vecuronium as our longer acting agent. Atropine to counter vasovagal brady in peds and Lidocaine for any potential head injuries. doses are

LOTS OF VERSED
1.0 MG/KG Sux
0.1 MG/KG Vec
0.02 MG/KG Atropine
1.5 MG/KG Lidocaine

We have a new paralytic that our Sup. Phys is really gung ho for called Rapalon because it doesn't increase ICP as much as Sux but I hate it because it has a 5-7 min effect onset and a 15 duration and in my opinion a bad drug to use on someone unless they already have a tube in place. In both the coast and Portland Metropolitan area RSI really has not seemed to be a big deal. Our sup. phys. taught the 4 hour class and watched us do it (where I vol). I was grandfathered in at my Job because of this.
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Yugo Wego

[This message has been edited by Throwfoam (edited September 08, 2000).]

[This message has been edited by Throwfoam (edited September 08, 2000).]

[This message has been edited by Throwfoam (edited September 08, 2000).]