WEEKLY SCIENTIFIC DISCUSSIONS
101 :
Steps to Rapid
Sequence
Intubation
Auliya Rezki Ananda
Supervisors :
dr. Akhtar Fajar Muzakkir, [Link] (K)
dr. Fadillah Maricar, [Link] (K)
Introduction to
Intubation
The skill of endotracheal intubation to
secure an airway plays a critical role in many
settings such as pre hospital environments,
emergency room, critical care units and
perioperatives medicine
Rapid sequence intubation involves the
simultaneous rapid administration of a
person with paralysis and induction agent to
create optimal conditions to provide rapid
control of the airway.
Indication Hypoxemic Respiratory Failure, especially when it is
persistent despite 100% oxygen or non invasive
positive ventilator support
Hypercapnic respiratory failure causing respiratory
acidosis and increased work of breathing indicative
of impending respiratory failure
Upper airway obstruction or injury (e.g burns or
caustic inhalation) requiring early and rapid
stabilization of airway
Shock/haemodynamic instability when associated
with altered mentation and increased work of
breathing
Clinical conditions associated with risk for airway
compromises such as stroke, drug overdose or coma
01
The 7Ps Rapid
Sequence of
Intubation
The 7Ps
01 Preparation
02 Preoxygenation
03 Pretreatment
04 Paralysis and Induction
05 Positioning
06 Placement and Confirmation
07 Post-intubation management
Preparation
Includes assessing the degree of difficulty of a patient’s
airway and establishing adequate intravenous access and
continuous monitoring (telemetry, blood pressure, and pulse
oximetry)
ETT’s size measurement, Understanding
The Anatomy of Respiratory system
Preparation
Includes assessing the degree of difficulty of a patient’s
airway and establishing adequate intravenous access and
continuous monitoring (telemetry, blood pressure, and pulse
oximetry)
Assess for difficult airway.
Preparation L – Look for Externally
E – Evaluate 3-3-2
O – Obstruction and Obesity
N – The Neck Mobility
M – Mallampati Score
Assess for difficult airway.
Preparation L – Look for Externally
E – Evaluate 3-3-2
O – Obstruction and Obesity
N – The Neck Mobility
M – Mallampati Score
Preoxygenation
Pre-oxygenation involves providing the highest
possible oxygen concentration at high flows for 3-
5 minutes
Pre-Treatment
Pre-treatment is an additional step
involving administering medications
that may optimize the clinical setting
where intubation is being done.
Typically short acting opioid such as
intravenous fentanyl is administered for
pre-treatment
In patients with reactive airway disease,
a short-acting-beta-agonist (albuterol)
may be administered during this step to
minimize airway resistence.
Pre-Treatment
Paralysis and Induction
Paralysis with induction involves the simultaneous
administration of the medications for sedation and
paralysis that have been decided earlier in preparation
phase based on clinical status, allergies, and potential
contraindications.
During rapid sequence intubation, the dose of the
drugs should be precalculated and administered
intravenously as a bolus and never titrated
Positioning The protection and positioning phase is vital, as the
patient is now paralysed, and the airway must be
protected from aspiration
1
Positioning The protection and positioning phase is vital, as the
patient is now paralysed, and the airway must be
protected from aspiration
2
Positioning The protection and positioning phase is vital, as the
patient is now paralysed, and the airway must be
protected from aspiration
3
Placement and Confirmation
Placement should occur once adequate sedation and paralysis have
been obtained. Direct laryngoscopy should be performed, and once
glottis is visualized definitively, and appropriately sized ETT with
stylet should be placed
Post-Intubation
Management
Post intubation management involves
securing the endotracheal tube, connecting
the endotracheal tube to a mechanical
ventilator, and evaluating and managing
potential post-intubation complications
SUMMARY
THANK
YOU
RSI Failure
