Episode 2 - Airway Management During the COVID-19 Pandemic: Rapid Sequence vs. “Protected” Intubation

(thank you https://jamanetwork.com/journals/jama/fullarticle/2763852 for the image)

Summary

RSI or rapid sequence intubation a method of achieving rapid control of the airway while minimizing the risk of regurgitation and aspiration of gastric contents. What this means is that RSI is almost universally required in situations calling for emergent endotracheal intubation and, If you’ve ever been in the trauma bay when a patient has required a definitive airway, RSI was almost certainly employed. Due to the nature of intubation (and extubation!) being an aerosol generating procedure, specific steps and preparation must be undertaken to minimize risks to not just patients during intubation but to us as well.

Learning Objectives

#1 Describe the sequence & steps involved in performing rapid sequence intubation.

#2 Appreciate COVI-19 specific considerations for safely securing a definitive airway

Take Home Points

Pause, think, and prepare BEFORE rushing into a patients’ room to secure a definitive airway

There ARE NO EMERGENCIES DURING A PANDEMIC!!!

Time Stamps

• 00:12 Introduction

• 01:36 Objectives

• 03:12 What is Rapid Sequence Intubation

• 04:27 Cricoid pressure: yay or nay?!

• 05:43 5 Steps & sequence of RSI

• 06:05 Preparation

• 14:04 Preoxygenation & Positioning

• 18:09 Medication administration

• 19:00 Insertion of ETT and balloon inflation

• 19:35 Confirmation of placement

Overview of RSI

1. Preparation for intubation

2. Pre-oxygenation

3. Induction of Drug administration

4. Application of cricoid pressure?

5. Paralytic administration

6. ETT insertion

7. Inflation of ETT balloon

8. Confirmation of ETT placement

9. Release of cricoid pressure?

STATICS Pnemonic for Intubation Preparation

Suction 

Tape

Airways

Tubes

Introducer

Circuit / CO2 detector

Scope / Syringe

Harbor-UCLA Protected Intubation Checklist (v4)

Adapted from Unity Health Protected Airway Checklist (3/20/20)

Standard RSI vs. “Protected” Intubation

Recommended Reading

The Australian and New Zealand Intensive Care Society (ANZICS) COVID-19 Guidelines Version 1

http://cec.health.nsw.gov.au/__data/assets/pdf_file/0004/572512/ANZICS-COVID-19-Guidelines-Version-1.pdf

Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19)

https://www.sccm.org/getattachment/Disaster/SSC-COVID19-Critical-Care-Guidelines.pdf?lang=en-US