SimLabSolutions Rapid Sequence Intubation Training Bundle
SimLabSolutions Rapid Sequence Intubation Training Bundle
SimLabSolutions Rapid Sequence Intubation Training Bundle
The SimLabSolutions Rapid Sequence Intubation Training Bundle was designed by the DiaMedical USA Nurse Educator to help instructors teach students about RSI. RSI is important right now due to COVID. Lung damage from the COVID virus leaves the patient unable to breathe or maintain adequate oxygen levels. The sickest COVID patients require intubation and mechanical ventilation to survive. RSI is the procedure used to sedate the patient and quickly perform intubation.
The concept of Rapid Sequence Intubation (RSI) is that the patient is sedated and paralyzed in order to allow for intubation without constant artificial breaths via a bag valve mask (BVM). It is the fastest and most effective way to emergently secure the patient’s airway. RSI is particularly useful for patients with an intact gag reflex or a life-threatening illness or injury. Neuromuscular blocking agents that are used to relax the muscles will cause the patient to stop breathing. Hypoxia will develop rapidly if the patient is not intubated and ventilated in a timely manner.
Indications For Intubation & Mechanical Ventilation
- Airway protection, especially with impending obstruction (airway burn, penetrating neck injury)
- Respiratory failure (hypoxia, hypercapnia)
- Optimize oxygen delivery
- Unresponsiveness
- Terminate seizure (brain injury)
- Temperature control (serotonin syndrome)
- Upper cervical spine injury
Skills To Be Taught
- Administration of IV induction agents and neuromuscular blockers
- Dosage calculation based on body weight
- Ventilation with BVM
- Endotracheal intubation using laryngoscope
- Confirmation of ET tube placement
Items Included In The Bundle:
Simulated Medications
- Simulated Propofol/Diprivan
- Simulated Etomidate
- Simulated Midazolam
- Simulated Fentanyl
- Simulated Ketamine
- Simulated Succinylcholine
- Simulated Rocuronium
- Simulated Vecuronium
- Simulated Glycopyrrolate
Supplies
- Oral Airways
- Disposable Laryngoscope Kit
- Cuffed Endotracheal Tubes
- Intubation Stylet
- ET Tube Holder
- Colorimetric CO2 Indicator
- Luer Lock 10 mL Syringe
- Adult BVM Resuscitator
- Yankauer Suction with Tubing
- Open Suction Catheter Kit
Simulated medications are for educational use only. They are not to be used with humans or animals.
Student/Educator Resources
Basic RSI Pharmacology
Induction Agents
Etomidate: 0.3 mg/kg IV, quick onset, lasts 3-12 minutes. Has a long history of use in RSI and is a common “go-to” choice. There is some concern that it may cause adrenal suppression in septic patients, but this is up for debate.
Ketamine: 1.5 mg/kg IV or 4 mg/kg IM, onset in <1 minutes, lasts 10-20 minutes. Popular choice as it does triple duty as an anesthetic, amnestic, and analgesic. It causes bronchodilation and a catecholamine surge resulting in increased blood pressures and heart rate. Great in unstable sepsis patients and those with reactive airway disease. Avoid in cardiovascular disease. Rare report of laryngospasm.
Propofol: 1.5-2.5 mg/kg IV, onset in 45 seconds, lasts 5-10 minutes. Use in hemodynamically stable patients, status epilepticus, and reactive airway disease. Watch for hypotension and myocardial depression.
Neuromuscular Blockers
Succinylcholine: 1.5 mg/kg IV, onset in 45 seconds, lasts 5-10 minutes. Widely used but has many contraindications: hyperkalemia, recent crush or burn injury, and malignant hyperthermia.
Rocuronium: 1.2 mg/kg IV, onset 60 seconds, lasts 15-40 minutes. Frequently used in children.
Vecuronium: 0.15 mg/kg IV, onset 2-3 minutes, lasts 45-60 minutes. Generally avoided in RSI due to its duration of action.
Helpful RSI Mnemonics
Process Of RSI – 9 P’s To Remember
- Plan
- Preparation (drugs, equipment, staff)
- Protect the cervical spine
- Positioning
- Preoxygenation
- Pretreatment (optional)
- Paralysis & induction
- Placement with confirmation
- Postintubation management
SOAPME
- Suction – have ready at HOB
- Oxygen – Non-rebreather or BVM
- Airways
- 7.5 ETT fits most adults
- 7.0 ETT for smaller females
- 8.0 ETT for larger males
- Place stylet in ETT for rigidity
- Mac 3 or 4 curved blade for adults
- Miller 3 or 4 straight blade for adults
- Attach blade and confirm light works
- Pre-oxygenate at 15 LPM
- Monitoring & Medications – cardiac monitor, pulse ox, BP cuff, medications drawn up & ready
- End Tidal CO2
O2 MARBLES
- Oxygen
- Masks (NRB or BVM) & Monitoring
- Airway (OPA, NPA)
- RSI drugs
- BVM
- Laryngoscope
- ETT with ETCO2
- Suction
LEMON
- Look: Observe for possible complications
- Evaluate jaw and mouth for intubation
- Mallampati score: The more of the throat you can see, the easier it will be
- Obstruction: Possible foreign body, epiglottitis, edema, stridor, etc.
- Neck mobility: Anything that prevents ideal positioning of the neck, such as a c-collar, will make intubation more difficult