RSI Checklist (And Other Checklists)

[Tigger]

Does your service use an RSI checklist? What's included? Would you mind sharing it?

I had an RSI as an intern that did not go particularly smoothly and am thinking a more organized process would have gone a long way. Paramedics from three different agencies (us, the vollie FD with a paramedic from our ambulance service, and flight) make for a bad time anyway, but there was a lot of "who does what and did we do this yet." type talking.

I also think that having document an airway assessment prior to the procedure would be helpeful.

 

[NomadicMedic]

In my case, the guy with the laryngoscope usually calls the shots. Working with a partner who knows the process can make things easier. For example, it was always two medics to perform a DFI in Delaware, and the process was always the same. Partner always drew up and administered the meds. When the intubation was in process, partner watched the monitor, called out saturation and times.

I know there are lots of RSI/DFI checklists out there, maybe you can create your own, or find one that's fits, vet it through your med director and QI and see if you can make it a systemwide thing.

 

[VentMonkey]

Does your service use an RSI checklist? What's included? Would you mind sharing it?

I had an RSI as an intern that did not go particularly smoothly and am thinking a more organized process would have gone a long way. Paramedics from three different agencies (us, the vollie FD with a paramedic from our ambulance service, and flight) make for a bad time anyway, but there was a lot of "who does what and did we do this yet." type talking.

I also think that having document an airway assessment prior to the procedure would be helpeful.

Here's a quick "down and dirty" version of ours. There are actually several pages to it which include meds, dosages, what's indicated when, etc.

Also, this form is slightly dated, though the sequence hasn't changed too much.

 

[WolfmanHarris]

I think checklists are a fantastic idea for any high risk, low incidence procedure. I haven't reviewed the research in a long time, but I think when it comes to procedures designed to limit error during high stress, can't do wrong taking cues from NASA.

 

[STXmedic]

I made one for us that's laminated in both our airway bag and by our meds in the ambulance. I'll try to remember to post it tomorrow

 

[Handsome Robb]

We have one that we're required to fill out and turn in. I'll try to get you a copy of it


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[DPM]

I think about this all the time, so I would love to collaberate on updating / making some. Our ETT protocol contains somewhat of a checklist, but as my agency refuses to every print a protocol book, you have to resort to using it on your phone if you want to have it. Granted, I could print it out, but it's also not a very good checklist...

 

[Carlos Danger]

I've never used an RSI checklist, but it is something I've thought about a lot. I think they are a fantastic idea, especially for use in the field where there are so many forces and variables at play on every intubation and you might have different people from different agencies involved.

While you obviously don't want a checklist that takes a long time to read, you do want it to contain enough detail to remember all the little things that you might forget. Something as seemingly small as the suction tubing not being hooked up, or the portable suction battery being dead because you didn't actually turn it on to check it, can have a big impact on the situation if you need that suction immediately.

I think this one covers everything and with practice, you could run down it in 30 seconds or less:

1. Clinician assignments:
- Intubator at head of patient and "in charge".
- First assistant at patient's shoulder to assist intubator with airway management (positioning, mask-ventilation, handing the intubator items, etc.)
- Second assistant operates monitor and pushes drugs

2. Patient positioning:
- Slight head-up position
- The patient should be "ramped" so that the earlobes are level with the sternal notch.

3. Pre-Oxygenation:
- NRB
- NC at 10 lpm
- CPAP

4. Monitors:
- Sp02
- EKG
- NIBP
- ETc02 attached to monitor and ready to attach to ETT immediately upon intubation

5. Check equipment:
- Ambu bag & mask: attached to oxygen at high flow rate. Within reach of intubator.
- Suction: on and working, tubing and yankauer attached; yankauer within reach of intubator
- Laryngoscope & blade: appropriate blade attached to handle & checked; other blades immediately available
- Bougie immediately available
- Backup airway device immediately available and visually inspected (as closely as possible without opening it's packaging)

6. Medications:
- Induction sedative and paralytic drawn up and labeled
- Post intubation medications drawn up and labeled
- Resuscitative medications immediately available

7. RSI sequence:
- Give sedative & paralytic
- ETT confirmation & securement
- Post-intubation management