But in general, patients who need assisted or positive pressure ventilation, in order to ventilate and oxygenate adequately, will likely require intubation, or at least it should be strongly considered. Sometimes these interventions may prevent a patient's deterioration. Temporary measures such as the delivery of oxygen through a nasal cannula, face mask, or even positive pressure ventilation can be used to stabilize the patient. Is their breathing labored and is there a concern that they will tire out from their breathing? If so, then consider early endotracheal intubation.Īdjuncts to your exam can also help determine a patient's ventilation and oxygenation status - pulse oximetry, continuous capnography, blood gases, etc. In the emergent setting, evaluating a patient's ability to ventilate or oxygenate is made on clinical grounds. CHF exacerbation, COPD, or asthma exacerbation). The failure to ventilate or oxygenate leading to hypercapnic or hypoxic respiratory failure is another indication for RSI (e.g. For example, the patient who is requiring frequent or continuous jaw thrust to maintain a patent airway should be intubated because of their risk of apnea from airway obstruction - the obtunded patient is discussed in more detail below - see the section on Consciousness. The patient who is obtunded or confused may be at risk for airway collapse. Aspiration events can lead to complications such as pneumonia or pneumonitis leading to respiratory failure which could be prevented with endotracheal intubation. Examples include upper GI bleeds, large strokes, traumatic intracranial hemorrhages, etc. The ABC’s of RSI Indications Airway protectionĪirway protection, or the lack of airway protection, refers to those patients who are altered or at risk for aspiration. In other words, it’s a way to quickly sedate and paralyze a person in order to perform endotracheal intubation or other airway management strategies.
Rapid sequence intubation is an airway management technique that creates the optimal conditions the clinician needs for intubation. Indications and Contraindications to Rapid Sequence Intubation and Induction