Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword
- List of abbreviations
- 1 Introduction and overview
- 2 Delivery of oxygen
- 3 Airway assessment
- 4 Basic airway management techniques
- 5 Indications for intubation
- 6 Preparation for rapid sequence induction and tracheal intubation
- 7 Rapid sequence induction and tracheal intubation
- 8 Pharmacology of emergency airway drugs
- 9 Difficult and failed airway
- 10 Post-intubation management and preparation for transfer
- 11 Emergency airway management in special circumstances
- 12 Non-invasive ventilatory support
- 13 The interface between departments and hospitals
- 14 Audit and skills maintenance
- Appendix: Emergency airway algorithms
- Index
- References
6 - Preparation for rapid sequence induction and tracheal intubation
Published online by Cambridge University Press: 22 August 2009
- Frontmatter
- Contents
- List of contributors
- Foreword
- List of abbreviations
- 1 Introduction and overview
- 2 Delivery of oxygen
- 3 Airway assessment
- 4 Basic airway management techniques
- 5 Indications for intubation
- 6 Preparation for rapid sequence induction and tracheal intubation
- 7 Rapid sequence induction and tracheal intubation
- 8 Pharmacology of emergency airway drugs
- 9 Difficult and failed airway
- 10 Post-intubation management and preparation for transfer
- 11 Emergency airway management in special circumstances
- 12 Non-invasive ventilatory support
- 13 The interface between departments and hospitals
- 14 Audit and skills maintenance
- Appendix: Emergency airway algorithms
- Index
- References
Summary
Objectives
The objectives of this chapter are to understand how to:
prepare thoroughly for rapid sequence induction (RSI) and tracheal intubation
position patients optimally to maximize the success of laryngoscopy and intubation
assemble and check the equipment and drugs required for RSI and tracheal intubation
use appropriate monitoring and know its strengths and limitations
reassess the patient rapidly and ascertain all the required information before undertaking RSI
identify and use team resources appropriately to maximize team co-operation and understanding.
Introduction
Making the decision that a patient requires a rapid sequence induction (RSI) is the entry point to the sequence of preparation for this procedure. While there may be times when intubation of the patient needs to be achieved immediately, there are very few instances in which placement of the tracheal tube is so time critical that these basic preparatory steps cannot be followed. With a systematic approach and good team working, this will take only a few minutes and avoid many possible problems and complications.
The PEACH approach (Box 6.1) provides a useful mnemonic.
Positioning
Correct positioning of the patient's head and neck improves the view of the larynx at laryngoscopy and the likelihood of successful intubation. Alignment of the oral, pharyngeal and laryngeal axes during laryngoscopy provides a clear view from the incisors to the laryngeal inlet (see Chapter 4).
Approximately 20% of RSI undertaken in the emergency department require stabilization of the cervical spine: in almost all other cases the patient should be placed in the optimum intubating position, unless spinal deformity or arthritis makes this impractical or inadvisable.
- Type
- Chapter
- Information
- Emergency Airway Management , pp. 51 - 58Publisher: Cambridge University PressPrint publication year: 2008