RSI

[Scott]

Our service is looking at working RSI into the protocols. I am looking or anyone that might be willing to share their protocols for RSI so we can see how and what other services with experiences in this method work it. Anyone willing to share their RSI protocols???

[Ridryder 911]

Here is web site; containing critical care paramedic protocols from Dr. Bledsoe.

www.ssgfx.com/CP2020/medtech/procedures/proto_app.htm#rsi

Be safe,

Ridryder 911

[JohnClark]

Never seen a facial burns, head trauma with the patient clamped down ?

CHF compensating ? Remember the old saying Glasgow < than 8 : intubate ?

Don't get me wrong, RSI can be neccesary in the field. I think that it should be a last resort because of the complications involved, but advanced airway procedures can be neccesary. For example, the madison medics are trained to do surgial airways, and though there use is vanishingly small, I've seen them save people who would've died prior to arrival at the ED without that intervention. Still, it shouldn't be the first club out of the bag, and should be reserved only for those cases where no other treatment is effective.

[Ridryder 911]

I do agree John; however, so many medics wait until the patient is exacerbated. Many, try treating the pulse oximetry not the patient. If the patient is compromised, airway control is essential. Why make a patient suffer (V-Q shut-down, S/E acidosis, etc) when the patient is going to be on a vent anyway ?

I try to teach ....think ahead & be the patient advocate & do no further harm to the patient.

Be safe,

Ridryder 911

[Copperhead24]

While not new to EMS I am new to this forum, so I apologize if I step on anyone's toes! :wink:

Rid, you brought up an interesting point earlier that I think should be re-visited. You brought up a point about people treating the Pulse Ox and not there patient. A friend of mine [who occasionally visits this site] reviewed ETT stats from the state where I work. There was a marked increase in the number of ETT's put down in service's the year after they added RSI to there bag of tricks. [sorry I don't have the exact numbers but it was a BIG increase!]

Did that mean that all of those patient's needed to be tubed OR that they could be tubed.

We need to remember that we are clinician's and not technician's. We need to treat our pt.'s and not the cool new procedure that we have available. Am I against RSI - No! We need every tool available for our patients. I am against RSI for the sake of RSI, though. If you need practice, do it in a controlled enviroment [the hospital that supports your local training entity for one]. Practice makes perfect, but practice is for guinea pigs, not for patients. Having been involved in training and QI I am a firm believer that every skill should routinely be reviewed and practiced, especially the invasive ones!

My point is - don't perform a skill because you can, do it because you need to do it. While it may sound preachy the old adage of "treat your patient, not the algorithim" always hold true.

[Ace844]

Hi All,

I have no idea what the address is or if it's possible but once again I ask the MODERATOR/OWNER to please post a link or repost the verysame discussion we had on the old board before switching here as it has some great info on this subject!!!!!

For everyone that is interested and would like to learn the "proper RSI principles/phys, and Airway Management techniques" I would recommend you read the following items. 1.) The old posts if ever resurrected by the Owner/moderator. 2.) Walls: Emergency Airway Managemant. 3.) Mosby's Respiratory Physiology. 4.) Some of the studies I posted in the 60% Esophageal Entubation thread on this board.

out here,

Ace844

[rdenman26]

Hello

I'm Glad that this topic is being talked about, as this is quite a hot topic in the UK. At this time RSI is only done pre hospitaly by Docs who turn out the incidents t o assist us. But will soon be introduced to paramedics as soon as the powers to be stop arguing about it.

Its a particular interest of mine. Can people tell me what sort of training and education you have for this procedure, what are the protocols for its use over there, do you need medical orders to do it etc.

Cheers Guys :shock:

[1EMT-P]

I believe that RSI has it's place in the field, but I do not believe that every EMS system should be doing RSI. I believe that Patient Assisted Intubation is a much better choice in some areas.

[Ace844]

The only reason to use succs is if you think the case needs to be a little more challenging. I think for the most part RSI is unnecesary in the field, and should be reserved for the ED.

Dear "John,"

You should perhaps read a previous thread that was posted, here's the "link"http://www.emtcity.com/phpBB2/viewtopic.ph...&highlight=...It should also be noted that there has 0 studies showing RSi's efficacy in an ER as well, so by your own logic they shouldn't do it there either....

Hope this helps...

Ace

[ReD]

i have assisted or observed about half a dozen RSI's. all the ones in the ER went horribly. too many cooks in the kitchen, and the nurses got very excited and fumbled everything. the MD took too long to get the tube....just a cluster all around.

all of the successful ones were in the field, with 2-4 personell on scene, they went smoothly and quickly.

i am VERY firm in my opinion that hospitals cluster situations like this because they cram too many people in the room, too many nurses and MD and techs trying to get in and do it their way, or just trying to do something.