Management (general and specific)

Steps in RSI

1. Verbalise time out
2. Ensure designation of roles – intubator, drug delivery, managing equipment, monitoring patient’s vital signs
3. Check drugs, equipment
4. Ensure plan discussed
5. Give induction agent
6. Give paralytic agent
7. Wait 45-60 seconds after paralytic agent
8. Pass endotracheal tube
9. Move to plans B, C or D as needed
10. Confirm end-tidal CO₂, lung sounds, chest rise and misting of tube

The Difficult Airway Society, Intensive Care Society, FICM and the Royal College of Anaesthetists published a 2018 guideline on the management of tracheal intubations in critically ill adults.

As a minimum, the following personnel should be present during an intubation:

In the event of a failed or difficult airway, the following steps should be followed: