RSI

[firemedic54]

We have it here in our county but it is closely monitored when it is used. There is criteria that must be met in order for RSI to be used, then there is post- care follow up. I don't think it should be the standard nationwide. Each dept. has to consider how many times it would be used based on run volume that includes the number of times where RSI would've been used. There is also the costs involved, not to mention the obvious trainings and cont ed. that goes along with RSI. As of now we use it only for trauma pt's. with a GCS <8 where we need to secure a patent airway ASAP. Bottom line...No for national standards but certainly should be looked at on an individual basis.

[fiznat]

PLEASE

LET

THIS

THREAD

DIE!!

:!:

[captainstandup]

Which is likely to kill the patient first, relative hypovolemia or a failed airway? I dont believe anyone would argue the fact that we are now discussing semantics. In a patient with an inadequate airway I submit their blood pressure is virtually inconsequential. We must correct airway compromise immediately and completely. This is in a manner of speaking like waiting for extrication to be completed before decompressing a tension pneumothorax. The patients are often far too injured to wait for this life saving therapy and I feel the ones meeting RSI criteria are as well. (NO I DONT MEAN RSI SHOULD BE ATTEMPTED PRIOR TO EXTRICATION)

This isn't to imply that hemodynamics are of no importance, but what good does it do to perfuse a brain with a soup of 50% or less sao2 blood and lactic acid? Of course we all work in areas with different protocols and vastly different scope of practice settings and we must work within those limitations, but if you are so restricted that you cant provide care to the minimum standard, I recommend moving to another town for the sake of those you love and for your mental health or at least carefully begin the political process of firing the medical director.

[CBEMT]

Of course we all work in areas with different protocols and vastly different scope of practice settings and we must work within those limitations, but if you are so restricted that you cant provide care to the minimum standard, I recommend moving to another town for the sake of those you love and for your mental health or at least carefully begin the political process of firing the medical director.

Like I said, "region." In this case, "The entire state."

My local medical director doesn't matter at all. The protocols are set by the state ambulance board. There is a state Medical Director, and he's doing what he can, but there's only so far he can rock the boat or the fire departments will throw him out.

That being said, the last 30 years of how this system has been run has created an environment where introducing RSI into the system as is would lead to nothing less than multiple incidents of manslaughter on a daily basis.

[captainstandup]

I feel your pain friend. Sometimes it seems like time and progress are at a standstill, but dont give up! Get the media involved, show them how care can be better, but do so carefully. Remember who pays your salary and the power behind the throne, as it were. I'll be the first to agree that RSI isn't for everyone and as others have stated it's probably not best considered the standard of care without a tremendous array of supporting components.

QA, QI, audit and review of each and every utilization of this skill. Someone in the industry simply must begin the task of "evidence based" data collection that includes a multitude of factors to determine if this is a useful procedure for the pre-hospital environment. This doesn't mean we need to stop using it, we need to honestly evaluate its usefulness.

To reiterate my earlier statements, the focus must be on adequate airway management and specific patient dynamics and NOT on tally sheet measurement of successes and failures of specific skills. Again, we cant ignore the need for skill proficiency, but there must be a balance that encourages providers to focus on the patients need for proper airway management instead of fearing being perceived as incompetent by his/her peers simply based on a number on a skills sheet.

This is not the time for cowboy recklessness. Our patients, our profession deserve an educated, articulate approach. Who knows, this may begin a process much larger than itself?

[medicv83]

I see a lot of "no" replies to this question. In reality, thinking solely on the medics ability to determine if in fact a patients mentation/condition is a viable one to maintain their own airway, then the understanding, and cognitive medic will have the ability to isolate the patients airway prior to the airway becoming impregnable. Such as in a burn patient with inhalation injuries where the airway is swollen, and ready to shut down. The medic, with an RSI protocol is the only thing that stands in the way of a warranted patients airway closing off.

[unknown]

No.

Too many things that are not standard:

Education

Training

Competencies

Certifications

Licensing

Leadership

Medical Oversight

It may work well in some areas that have excelled in the above listed factors.

I concur