References

Appiah-Ankam J, Hunter JM Pharmacology of neuromuscular blocking drugs.. Contin Educ Anaesth Crit Care Pain. 2004; 4:(1)2-7

London: AAGBI Safety Guideline. AAGBI; 2009

Bauer ST, Orio K, Adams BD Succinylcholine induced masseter spasm during rapid sequence induction may require a surgical airway: case report.. Emerg Med J. 2005; 22:(6)456-8

Bernard SA, Nguyen V, Cameron P Prehospital rapid sequence intubation improves functional outcome for patients with severe traumatic brain injury: a randomized controlled trial.. Ann Surg. 2010; 252:(6)959-65

Bochicchio GV, Ilahi O, Joshi M, Bochicchio K, Scalea TM Endotracheal intubation in the field does not improve outcome in trauma patients who present without an acutely lethal traumatic brain injury.. J Trauma. 2003; 54:(2)307-11

Bozeman WP, Kleiner DM, Huggett V A comparison of rapid-sequence intubation and etomidate-only intubation in the prehospital air medical setting.. Prehosp Emerg Care. 2006; 10:(1)8-13

Bulger EM, Nathens AB, Rivara FP, Moore M, MacKenzie EJ, Jurkovich GJ Management of severe head injury: institutional variations in care and effect on outcome.. Crit Care Med. 2002; 30:(8)1870-6

Caroline NLLondon: Jones and Bartlett Publishers; 2008

Carillo-Esper R, Vinay-Ramírez B, Bahena A The BURP maneuver.. Images in Anaesthesiology. 2008; 31:(1)63-5

Carroll D, Lowes T Great North Air Ambulance Service: prehospital anaesthesia course. Journal of Paramedic Practice. 2011; 3:(2)96-99

Chewter M Cricoid pressure: Are we doing it right?. J Perioper Pract. 2011; 21:(10)342-5

Derby: College of Paramedics; 2008

Cole CD, Wang HE, Abo BN, Yealy DM Drug-assisted effects on protective airway reflexes during out-of-hospital endotracheal intubation (preliminary report).. Prehosp Emerg Care. 2006; 10:(4)472-5

Davis DP, Fakhry SM, Wang HE Paramedic rapid sequence intubation for severe traumatic brain injury: perspectives from an expert panel.. Prehosp Emerg Care. 2007; 11:(1)1-8

Davis DP, Hwang JQ, Dunford JV Rate of decline in oxygen saturation at various pulse oximetry values with prehospital rapid sequence intubation.. Prehosp Emerg Care. 2008; 12:(1)46-51

Downie G, Mackenzie J, Williams A, Hind CLondon: Churchill Livingstone Elsevier; 2008

Eaton CJLondon: Churchill Livingstone; 1999

Ewart L The efficacy of cricoid pressure in preventing gastro-oesophageal reflux in rapid sequence induction in anaesthesia.. J Perioper Pract. 2008; 17:(9)432-5

Ezzat A, Fathi E, Zarour A, Singh R, Abusaeda MO, Hussien MM The optimal succinylcholine dose for intubating emergency patients: retrospective comparative study.. Libyan J Med. 2011; 6

Fitzpatrick L Masseter muscle rigidity, elevated creatine kinase and rhabdomyolosis following succinylcholine administration: a case report.. AANA J. 2005; 76:(5)349-54

Fuchs-Buder T, Sparr HJ, Ziegenfuss T Thiopental or etomidate for rapid sequence induction with rocuronium.. Br J Anaesth. 1998; 80:(4)504-6

Galbraith A, Bullock S, Manias E, Hunt B, Richards AHarlow: Pearson Education Limited; 2007

Genzwuerker HV Prehospital airway management: the patient needs oxygen!.. Scand J Trauma Resusc Emerg Med. 2008; 16

Grace RNew South Wales: A position statement of the NSW Therapeutic Assessment Group Inc. NSW Therapeutic Assessment Group Inc and NSW Health Department; 1998

Henderson JJ, Popat MT, Latto IP, Pearce AC Difficult Airway Society guidelines for management of the unanticipated difficult intubation.. Anaesthesia. 2004; 59:(7)675-94

Hiestand B, Cudnik MT, Thomson D, Werman HA Rocuronium versus succinylcholine in air medical rapid-sequence intubation.. Prehosp Emerg Care. 2011; 15:(4)57-63

Hodkinson M The future of paramedic intubation: who should be responsible?. Journal of Paramedic Practice. 2010; 2:(8)358-62

Holmes N, Martin D, Begley AM Cricoid pressure: A review of the literature.. J Perioper Pract. 2011; 21:(7)234-8

London: IHCD; 2007

London: BMJ Group and Pharmaceutical Press; 2010

Kahn S, Stannard N, Greijn J Precipitation of thiopental with muscle relaxants: a potential hazard.. JRSM Short Rep. 2011; 2:(7)

Karcioglu O Dilemma in rapid sequence intubation: succinylcholine vs rocuronium. Internet Journal of Emergency and Intensive Care Medicine. 2003; 7:(1)

Klemen P, Gremc S Effects of pre-hospital advanced life support with rapid sequence intubation on outcome of severe traumatic brain injury.. Acta Anaesthesiol Scand. 2006; 50:(10)1250-4

Ko HB, Lee DY, Lee YC Severe bradycardia during suspension laryngoscopy performed after tracheal intubation using a direct laryngoscope with a curved blade -A case report-.. Korean J Anaesthesiol. 2010; 59:(2)116-18

May P, Trethewy C Practice makes perfect? Evaluation of cricoid pressure task training for use within the algorithm for rapid sequence induction in critical care. Emerg Med Australas. 2007; 19:(3)207-12

Moppett IK Traumatic brain injury: assessment, resuscitation and early management. Br J Anaesth. 2007; 99:(1)18-31

London: NCEPOD; 2007

Oglesby AJ Should etomidate be the induction agent of choice for rapid sequence intubation in the emergency department. Emerg Med J. 2004; 21:(6)655-9

Perry JJ, Lee JS, Sillberg VAH, Wells GA Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev. 2008; 2

Porth CM, Matfin GPhiladelphia: Lippincott Williams and Wilkins; 2009

Richard-Hibbon A, Chollett C, Leroy C, Marty C Succinylcholine improves the time of performance of a tracheal intubation in the prehospital critical care medicine. Eur J Anaesthesiol. 2002; 19:(5)361-7

Schlesinger S, Blanchfield D Modified rapid-sequence induction of anesthesia: a survey of current clinical practice. AANA J. 2001; 69:(4)291-8

Scott WN, McGrath DLondon: Lippincott, Williams and Wilkins; 2009

Seeley RR, Stephens DT, Tate PBoston: McGraw-Hill; 2000

Singhal S Haemodynamic response to laryngoscopy and intubation: comparison of McCoy and Macintosh laryngoscope. The Internet. Journal of Anesthesiology. 2007; 17:(1)

Soliday FK, Conley YP, Henker R Pseudocholinesterase deficiency: a comprehensive review of genetic, acquired, and drug influences. AANA J. 2010; 78:(4)313-20

Steinbacher DM Propofol: A sedative-hypnotic anaesthetic agent for use in ambulatory procedures. Anesth Prog. 2001; 48:(2)66-71

Svenson J, Biedermann M Ketamine: a unique drug with several potential uses in the prehospital setting. Journal of Paramedic Practice. 2011; 3:(10)552-6

Tripathi SS, Hunter JM Neuromuscular blocking drugs in the critically ill. Contin Educ Anaesth Crit Care Pain. 2006; 6:(3)119-23

Wang HE, Peitzman AB, Cassidy LD, Adelson PD, Yealy DM Out-of-hospital endotracheal intubation and outcome after traumatic brain injury. Ann Emerg Med. 2004; 44:(5)439-50

Wierda JM, van den Broek L, Schiere S, Maestrone E Potency and onset of action of neuromuscular blocking drugs. Anesth Analg. 1995; 80:(6)1249-50

clinical skills
air ambulance
literature review
air ambulance

Rapid sequence induction and the paramedic

02 September 2014
Features
02 September 2014
Volume 6 · Issue 9

Abstract

It is usually the most obtund and critically ill of patients that receive paramedic pre-hospital endotracheal intubation. Without a patent airway, asphyxia will lead to death rapidly if not corrected. Pre-hospital endotracheal intubation is indicated in patients when there is—or a risk of—apnoea, upper airway blockage and a need for safeguarding against aspiration due to a decreased Glasgow Coma Scale. Endotracheal intubation is currently routinely performed on cardiac arrest patients and traumatic injury patients by paramedics. However, rapid sequence intubation induction, as an advanced paramedical procedure, is not currently advocated for UK paramedic practice. Rapid sequence intubation differs from the normal method of endotracheal intubation in that it can be performed on originally conscious and/or semi-conscious patients and that it uses sedation and paralytic pharmacological agents coupled with protective airway manoeuvres to induce a state of sedation suitable to facilitate endotracheal intubation. This paper explores some of the issues surrounding whether it is feasible for paramedics to routinely perform RSI in the future.

Rapid sequence intubation/induction (RSI) is an advanced procedure not currently advocated for UK paramedic practice although some paramedics attached to Helicopter Emergency Medical Services (HEMS) provide integral support for others practising RSI (Carrol and Lowes 2009). In the preh-ospital field within the UK, RSI is performed by doctors attached to HEMS or to The British Association for Immediate Care (BASICS), where it affords severely injured patients the possibility of a secure and patent airway (Hodkinson, 2010). RSI is routinely performed in operating theatres on patients deemed to have a high risk of regurgitation which could lead to aspiration (Schlesinger and Blanchfield, 2001).

RSI differs from the normal method of endotracheal intubation in that it can be performed on originally conscious and/or semi-conscious patients and that it uses sedation and paralytic pharmacological agents coupled with protective airway manoeuvres to induce a state of sedation suitable to facilitate endotracheal intubation (Bozeman et al, 2006).

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Airway management
Emergency care
Paramedic practice
RSI