Rapid sequence induction

Rapid sequence induction (RSI, also referred to as rapid sequence intubation when performed in an Emergency Department or pre-hospital setting) is an advanced medical protocol which permits the intubationof conscious patients who require advanced airway support. Having evolved from procedures used by anesthesiologiststo "induce" a coma-state in preparation for surgery, RSI is now used in an emergency setting by other physicians and paramedics.

RSI involves the use of a sedative/hypnotic medication to relax the patient followed by administration of a rapid-acting neuromuscular blocker (a paralytic) to disable the patient's involuntary reflex to fight the intubation. Sedatives typically used include midazolam, thiopental, fentanyl, ketamine, propofol, etomidateand methohexital. Paralyticstypically used include succinylcholine, atracurium, rocuronium, vecuroniumor pancuronium. The combination enables the insertion of an endotracheal tubeto ventilate patients requiring this type of advanced airway measure. Typically, lidocaineis given as well if increased intracranial pressure is suspected and atropineis given in patients less than 2 years old to block reflex bradycardia.

A similar procedure known as "pharmacologically assisted intubation" utilizes the sedative and hypnotic medications without the use of paralytics. This procedure is highly controversial and is usually performed where full RSI procedures are not legally allowed. RSI is the preferred procedure because it reduces the chance of developing harmful increased intracranial pressure or other injuries during intubation. These procedures are only to be performed by physicians, flight nurses and paramedicsproperly trained in the techniques.

de:Rapid Sequence Induction

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It uses material from the http://en.wikipedia.org/wiki/Rapid+sequence+induction Wikipedia article Rapid sequence induction.