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:

DAS Difficult Intubation Guideline

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