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38 - Induction Agents for Rapid Sequence Intubation of the Emergency Department Patient

from SECTION FIVE - SPECIAL CONSIDERATIONS FOR EMERGENCY PROCEDURAL SEDATION AND ANALGESIA

Published online by Cambridge University Press:  03 December 2009

John H. Burton
Affiliation:
Albany Medical College, New York
James Miner
Affiliation:
University of Minnesota
Joseph Clinton
Affiliation:
Professor of Emergency Medicine, Department of Emergency Medicine, University of Minnesota Medical School, Chief, Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
Arleigh Trainor
Affiliation:
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
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Summary

SCOPE OF THE PROBLEM

Rapid sequence intubation (RSI), a tool of anesthesiology for long, was rapidly adopted by the emergency physician. The emergency physician's approach necessarily differs owing to the circumstances of the most commonly encountered patients and environment. As stated by Dronen et al., “Whereas anesthesiologists use RSI to intubate patients requiring anesthesia, emergency physicians commonly use RSI to induce anesthesia in patients requiring intubation.”

Emergency physicians often do not know a patient's past medical history, medications, prior anesthetic complications, timing of the last meal, or even their clinical diagnosis. Emergency physicians must also confront emergent airway compromise with a goal to establish a stable airway in the fastest, most safe manner possible. Numerous studies support the use of sedation and paralytics in RSI to achieve a higher intubation success rate with fewer complications. Success is improved by a factor of 50–70% in some published reports when RSI methods are compared to non-RSI airway approaches.

PAIN/SEDATION CONSIDERATIONS

RSI

The process described as RSI refers to the rapid administration of medication designed to avert complications, sedate the patient, and relax the musculature to allow rapid control of the airway by tracheal intubation. The indications for airway control vary with the clinical circumstances. These agents range from the need for anesthesia for surgery to preservation of life in a respiratory emergency. The choice of RSI medications and techniques is dictated by the specific clinical scenario.

The RSI timeline varies with the individual patient circumstances.

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Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2008

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References

Dronen, S. Rapid-sequence intubation: A safe but ill–defined procedure. Acad Emerg Med 1999;6:1–2.CrossRefGoogle ScholarPubMed
Sakles, JC, Laurin, EG, Rantapaa, AA, Panecek, EA. Airway management in the emergency department: A one-year study of 610 tracheal intubations. Ann Emerg Med 1998;31:325–332.CrossRefGoogle ScholarPubMed
Thompson, JD, Fish, S, Ruiz, E.Succinylcholine for endotracheal intubationAnn Emerg Med 1982;11:526–528.CrossRefGoogle ScholarPubMed
Dufour, DG, Larose, DL, Clement, SC.Rapid-sequence intubation in the emergency department. J Emerg Med 1995;12:705–710.CrossRefGoogle Scholar
Sivilotti, MLA, Filbin, MR, Murray, HE, Slasor, P, Walls, RM.Does the sedative agent facilitate emergency rapid sequence intubation. Acad Emerg Med 2003;10:612–620.CrossRefGoogle ScholarPubMed
Miller, RD, Anesthesia, 5th edn. New York: Churchill Livingstone, 2000.Google ScholarPubMed
Robinson, N, Clancy, M. In patients with head injury undergoing rapid sequence intubation, does pretreatment with intravenous lignocaine/lidocaine lead to an improved neurological outcome? A review of the literature. Emerg Med J 2001;18:453–457.CrossRefGoogle Scholar
Levitt, MA, Dresden, GM. The efficacy of esmolol versus lidocaine to attenuate the hemodynamic response to intubation in isolated head trauma patients. Acad Emerg Med 2001;8:19–24.CrossRefGoogle ScholarPubMed
Clancy, M, Halford, S, Walls, R, Murphy, M. In patients with head injuries who undergo rapid sequence intubation using succinylcholine, does pretreatment with a competitive neuromuscular blocking agent improve outcome? A literature review. Emerg Med J 2001;18:373–375.CrossRefGoogle ScholarPubMed
Brucia, JJ, Owen, DC, Rudy, EB. The effects of lidocaine on intracranial hypertension. J Neurosci Nurs 1992;24:205–214.CrossRefGoogle ScholarPubMed
Koenig, KL. Rapid–sequence intubation of head trauma patients: Prevention of fasciculations with pancuronium versus minidose succinylcholine. Ann Emerg Med 1992;21:929–932.CrossRefGoogle ScholarPubMed
Bergen, JM, Smith, DC. A review of etomidate for rapid sequence intubation in the emergency department. J Emerg Med 1997;15:221–230.CrossRefGoogle ScholarPubMed
Perry, J, Lee, J, Wells, G. Are intubations conditions using rocuronium equivalent to those using succinylcholine?Acad Emerg Med 2002;9:813–823.CrossRefGoogle ScholarPubMed
Perry, J, Lee, J, Wells, G. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev 2003;1:CD002788.CrossRefGoogle Scholar

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