MFI/RSI

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starzolife

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Now I'm a new ALS provider, but I've been part of the procedure as an ER Tech as well as being my OR rotation "final" (the anesthesiologist's makeshift exam on signing off on my rotation). I've never actually seen it done in field even though I rode with RSI providers. My question is how much is this used per provider? Is it a once in a while thing or is it like a needle cricothyrotomy where you could go a whole career never having to use it?
 
Where I'm at we do a lot of the intubations (RSI and otherwise) in the emergency department. We are authorized to RSI in the field. It isn't exactly a once in a career procedure, but it doesn't happen very often at all. I would imagine there are other places (Sussex, DE for example) where it happens much more often.
 
Haha, here in Sussex it is fairly frequent. I've been here slightly over a year and have personally performed ~5 RSIs. Some do more, some do less, but I'd say that the average medic does at least two per year. Waayyy more frequent than any kind of cric for sure.
 
I'd bet, on average, there is an RSI in our system every other day or so. I haven't seen the numbers for last year, however.
 
I think we had around 30-35 intubations last year between our ten medics. Half of them were arrests, the other half were almost all RSIs, I think we only had one non-RSI that was not on a cardiac arrest last year.
 
It's very dependent on where you work, and in what setting.

In some parts of the country it's standard to be part of a paramedic's skillset, in other parts, not so much. Some departments have the call volume and mindset that means they use it frequently, others not so much. A non-transporting paramedic will likely not be doing this, while a transporting paramedic would be more likely to. Completely variable, but if it's within your scope and protocols, I'd say it's something you can expect to be doing multiple times during your career...just maybe not multiple times in a year, depending on several variables. Not seeing it done during a limited internship doesn't really mean anything.

This ignores the whole arguement about whether or not paramedics should even be intubating in the first place (a big hell no for most paramedics), let alone doing an elective intubation.
 
Here in NM, a normal ground paramedic doesn't do it at all. But flight medics who respond to scene calls do it on a regular basis (it's one reason a rural provider might call for a rotor in this state). So it all depends on where you're talking about.
 
With an avg of 20 hours a week of work, I used to take part in 4 per year. Full-timers would typically take part in 4-8. There would also be a number of ETIs that would be done with etomidate only or with nothing at all if they were comatose enough.
 
I never did one as a ground paramedic.

Working the helicopter, I probably averaged around 3-4 a month. Some months I'd do more than that, some months only 1 or occasionally, none at all.
 
Drug assisted intubations- 2 a month
Other tubes (mostly arrests) another 2-4

How do you all define RSI?
 
I define it as having to use sedation and/or paralytics for a patient to accept intubation. Where I'm from paralytics are now only part of the process if there is still muscle resistance after sedation.
 
blindsideflank said:
Drug assisted intubations- 2 a month
Other tubes (mostly arrests) another 2-4

How do you all define RSI?
Click to expand...

Are those your individual numbers or system wide? Consider me surprised if one ground medic is intubating that frequently.
 
1 medic. Tiered system in a metro area.

I would like to know the numbers for a paramedic in surrey bc (Canada). I believe they run one ALS car for 500,000 people (that number seems to stick in my head) and once again, is a tiered system.

And I included calls like a stroke/od/sepsis that takes a little versed before a tube.
 
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We actually call it a DFI here. Word is Ketamine is coming, but right now it's a set cocktail of etomidate> sux >versed> vec. We can, with a Doc's okay, perform an etomidate only DFI.
 
chaz90 said:
Are those your individual numbers or system wide? Consider me surprised if one ground medic is intubating that frequently.
Click to expand...

Depending on the medic since they started allowing us to tube arrests that's an easily obtainable number here. My girlfriend and her partner had 6 working arrests last week.

We don't RSI here.
 
Usually did 1-2 a month working rural 911 and air and one every other month or so doing CCT.
 
blindsideflank said:
How do you all define RSI?
Click to expand...

RSI only has 1 definition:

Induction of anesthesia in order to optimize intubating conditions by rapid-sequence (or simultaneous) administration of both a potent sedative and a neuromuscular blocking drug.

Or something closely along those lines.
 
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Halothane said:
RSI only has 1 definition:

Induction of anesthesia in order to optimize intubating conditions by rapid-sequence (or simultaneous) administration of both a potent sedative and a neuromuscular blocking drug.

Or something closely along those lines.
Click to expand...

Right, but I think he was asking more about drug assisted intubations than only those with nmba use. (Maybe I'm wrong, sorry if I'm putting words in OP's mouth)

Edit: just read the original post again and I don't know why I felt he didn't strictly mean RSI. In that case, we don't have it and I know guys here that say they have had long careers and have never needed paralytics. But they don't take into account that paralytics generally improve your view by one grade in direct laryngoscopy. (Make your first try your best try).
 
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blindsideflank said:
Right, but I think he was asking more about drug assisted intubations than only those with nmba use. (Maybe I'm wrong, sorry if I'm putting words in OP's mouth)

Edit: just read the original post again and I don't know why I felt he didn't strictly mean RSI. In that case, we don't have it and I know guys here that say they have had long careers and have never needed paralytics. But they don't take into account that paralytics generally improve your view by one grade in direct laryngoscopy. (Make your first try your best try).
Click to expand...

No I think you were right - in the title he put "MFI/RSI", and I assume MFI = medication facilitated intubation, which would mean any sort of drug to help you out, not necessarily a NMB.

It's just a stupid peeve of mine when people say "RSI" when all they really did is use some sedation and Brutane. It wasn't directed towards you, just at the thought that some people have very different definitions for RSI :)

And you are right about paralytics - they make intubating much easier. I've never thought it made much sense to give a large dose of a sedative that causes apnea and blunts airway reflexes but does not guarantee good intubating conditions, yet be afraid of giving a NMB that causes apnea and abolishes airway reflexes, but guarantees optimal intubating conditions.
 
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