Rapid Sequence Induction HOWTO?

[Aprz]

Linuss, I am 2 chapters into the book, and enjoying it/it's excellent so far. Look forward to chapter 3, which is on RSI itself.

The book mentioned LEMONS, MOAN, SHORT, and RODS. It also mentioned the 7 Ps, which I don't know. I've heard of LEMON before, but haven't heard of the others yet. Does anybody know them? I may found out later in the book, or end up Googling. I forgot that I haven't added LEMONS to our acronym/abbreviation/mnemonic (makes me realize I forgot all the "5 Fs of cholecystitis" an the "6 Ps of compartment syndrome/neurovascular injuries" and stuff like that too) list either.

 

[Christopher]

Linuss, I am 2 chapters into the book, and enjoying it/it's excellent so far. Look forward to chapter 3, which is on RSI itself.

The book mentioned LEMONS, MOAN, SHORT, and RODS. I've heard of LEMON before, but haven't heard of the others yet. Does anybody know them? I may found out later in the book, or end up Googling. I forgot that I haven't added LEMONS to our acronym/abbreviation list either.

MOANS (should have an S, meant for predicting BVM success): Mask seal, obesity/obstruction, age (young/old), no teeth, stiff cervical spine

SHORT is cric success and RODS is supraglottic success, but I've not memorized those.

 

[Fish]

Lime

 

[Aprz]

What's lime?

I looked it up since I was curious.

S-H-O-R-T
Surgery (previous)
Hematoma (or neck swelling)
Obesity (this seems like a common factor)
Radiation distortion (I am guessing has to do with patient that get radiation treatment?)
Tumor

R-O-D-S
Restricted mouth opening
Obstructed upper airway
Distorted/disrupted upper airway
Stiff lungs

Oo.. You responded too quickly. I added the 7Ps also.

Preparation
Preoxygenate
Premedicate
Paralysis
Pressure on cricoid/protection
Placement of ETT
Post Intubation management

There were a ton of excellent resources online about this. I liked the link that showed up at the top for me when I Googled "MOANS airway mnemonic", lol.

http://emergencymedic.blogspot.com/2009/08/common-mnemonics-and-formula-in.html

 

[Fish]

Lime? Nothing, just saw people talking about Lemons so I said Lime, Lemon-Lime

 

[Aprz]

There's an another mnemonic similar to MOANS.

B-O-O-T-S
Beard
Obese
Old
Toothless
Snores

 

[recruiter1]

those are some great tips.

 

[ICU ALS]

Suxamethonium and thiopentone or ketamine, fentanyl and sux then depending on haemodynamics, maintain with rocuronium and midaz/fent or roc and propofol/fent. That's how we donut in Australia!

 

[ICU ALS]

Also, atropone us seldom needed. Mostly we would use it to limit secretions but you do often need a handy syringe of synthetic pressor like metaraminol. Especially if you instead choose propofol to induct.

 

[jwk]

Suxamethonium and thiopentone or ketamine, fentanyl and sux then depending on haemodynamics, maintain with rocuronium and midaz/fent or roc and propofol/fent. That's how we donut in Australia!

Also, atropone us seldom needed. Mostly we would use it to limit secretions but you do often need a handy syringe of synthetic pressor like metaraminol. Especially if you instead choose propofol to induct.

It's always interesting to see the different drugs used here in the US compared to elsewhere in the world.

Thiopentone (thiopental or pentothal in the US) is not commercially available in the US due to manufacturer concerns about it's use in capital punishment. It has simply been withdrawn from the market (not that it's been a big moneymaker anyway since the advent of propofol).

Metaraminol (Aramine) is a drug I haven't even heard mentioned in more than 30 years. It's a pretty old drug used to treat hypotension and has largely been replaced by newer and/or better drugs, in particular, ephedrine and phenylephrine.

 

[Veneficus]

Thiopentone (thiopental or pentothal in the US) is not commercially available in the US due to manufacturer concerns about it's use in capital punishment. It has simply been withdrawn from the market (not that it's been a big moneymaker anyway since the advent of propofol)..

Don't knock it until you have tried it.

 

[ICU ALS]

Wow. Ephedrine. We never use that! Metaraminol works well and is widely used.