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Emergency Medicine Journal : EMJ logoLink to Emergency Medicine Journal : EMJ
. 2002 Mar;19(2):109–113. doi: 10.1136/emj.19.2.109

Rapid sequence induction in the emergency department: a strategy for failure

S Carley 1, C Gwinnutt 1, J Butler 1, I Sammy 1, P Driscoll 1
PMCID: PMC1725832  PMID: 11904254

Abstract

Background: Rapid sequence induction (RSI) is increasingly used by emergency physicians in the emergency department. A feared complication of the technique is the inability to intubate and subsequently ventilate the patient. Current drills based on anaesthetic practice may be unsuitable for use in the emergency department.

Objective: To construct a drill for failed adult intubation in the emergency department.

Methods: Literature review and consensus knowledge.

Results: A drill for failed adult intubation in the emergency department is given.

Summary: Failure to intubate following RSI in the emergency department is a feared complication. Practitioners must have a predetermined course of action to cope with this event. The guidelines presented here are tailored for use by the emergency physician.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ansermino J. M., Blogg C. E. Cricoid pressure may prevent insertion of the laryngeal mask airway. Br J Anaesth. 1992 Nov;69(5):465–467. doi: 10.1093/bja/69.5.465. [DOI] [PubMed] [Google Scholar]
  2. Asai T., Barclay K., McBeth C., Vaughan R. S. Cricoid pressure applied after placement of the laryngeal mask prevents gastric insufflation but inhibits ventilation. Br J Anaesth. 1996 Jun;76(6):772–776. doi: 10.1093/bja/76.6.772. [DOI] [PubMed] [Google Scholar]
  3. Asai T., Barclay K., Power I., Vaughan R. S. Cricoid pressure impedes placement of the laryngeal mask airway and subsequent tracheal intubation through the mask. Br J Anaesth. 1994 Jan;72(1):47–51. doi: 10.1093/bja/72.1.47. [DOI] [PubMed] [Google Scholar]
  4. Asai T., Barclay K., Power I., Vaughan R. S. Cricoid pressure impedes placement of the laryngeal mask airway. Br J Anaesth. 1995 May;74(5):521–525. doi: 10.1093/bja/74.5.521. [DOI] [PubMed] [Google Scholar]
  5. Asai T. Use of the laryngeal mask for tracheal intubation in patients at increased risk of aspiration of gastric contents. Anesthesiology. 1992 Nov;77(5):1029–1030. doi: 10.1097/00000542-199211000-00027. [DOI] [PubMed] [Google Scholar]
  6. Brimacombe J. R., Berry A. The incidence of aspiration associated with the laryngeal mask airway: a meta-analysis of published literature. J Clin Anesth. 1995 Jun;7(4):297–305. doi: 10.1016/0952-8180(95)00026-e. [DOI] [PubMed] [Google Scholar]
  7. Brimacombe J. Analysis of 1500 laryngeal mask uses by one anaesthetist in adults undergoing routine anaesthesia. Anaesthesia. 1996 Jan;51(1):76–80. doi: 10.1111/j.1365-2044.1996.tb07660.x. [DOI] [PubMed] [Google Scholar]
  8. Brimacombe J., Berry A. Mallampati classification and laryngeal mask airway insertion. Anaesthesia. 1993 Apr;48(4):347–347. doi: 10.1111/j.1365-2044.1993.tb06968.x. [DOI] [PubMed] [Google Scholar]
  9. Criswell J. C., Parr M. J., Nolan J. P. Emergency airway management in patients with cervical spine injuries. Anaesthesia. 1994 Oct;49(10):900–903. doi: 10.1111/j.1365-2044.1994.tb04271.x. [DOI] [PubMed] [Google Scholar]
  10. Gerardi M. J., Sacchetti A. D., Cantor R. M., Santamaria J. P., Gausche M., Lucid W., Foltin G. L. Rapid-sequence intubation of the pediatric patient. Pediatric Emergency Medicine Committee of the American College of Emergency Physicians. Ann Emerg Med. 1996 Jul;28(1):55–74. doi: 10.1016/s0196-0644(96)70140-3. [DOI] [PubMed] [Google Scholar]
  11. Gwinnutt C. L., Kishen R. The Combitube and cervical spine immobilisation. Anaesthesia. 1999 Mar;54(3):304–305. doi: 10.1046/j.1365-2044.1999.0811p.x. [DOI] [PubMed] [Google Scholar]
  12. Heath K. J. The effect of laryngoscopy of different cervical spine immobilisation techniques. Anaesthesia. 1994 Oct;49(10):843–845. doi: 10.1111/j.1365-2044.1994.tb04254.x. [DOI] [PubMed] [Google Scholar]
  13. Knill R. L. Difficult laryngoscopy made easy with a "BURP". Can J Anaesth. 1993 Mar;40(3):279–282. doi: 10.1007/BF03037041. [DOI] [PubMed] [Google Scholar]
  14. Laurent S. C., de Melo A. E., Alexander-Williams J. M. The use of the McCoy laryngoscope in patients with simulated cervical spine injuries. Anaesthesia. 1996 Jan;51(1):74–75. doi: 10.1111/j.1365-2044.1996.tb07659.x. [DOI] [PubMed] [Google Scholar]
  15. Levitan R. M., Kush S., Hollander J. E. Devices for difficult airway management in academic emergency departments: results of a national survey. Ann Emerg Med. 1999 Jun;33(6):694–698. [PubMed] [Google Scholar]
  16. Ma O. J., Bentley B., 2nd, Debehnke D. J. Airway management practices in emergency medicine residencies. Am J Emerg Med. 1995 Sep;13(5):501–504. doi: 10.1016/0735-6757(95)90156-6. [DOI] [PubMed] [Google Scholar]
  17. Mallampati S. R., Gatt S. P., Gugino L. D., Desai S. P., Waraksa B., Freiberger D., Liu P. L. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J. 1985 Jul;32(4):429–434. doi: 10.1007/BF03011357. [DOI] [PubMed] [Google Scholar]
  18. Martin P. D., Cyna A. M., Hunter W. A., Henry J., Ramayya G. P. Training nursing staff in airway management for resuscitation. A clinical comparison of the facemask and laryngeal mask. Anaesthesia. 1993 Jan;48(1):33–37. [PubMed] [Google Scholar]
  19. Nolan J. P., Wilson M. E. Orotracheal intubation in patients with potential cervical spine injuries. An indication for the gum elastic bougie. Anaesthesia. 1993 Jul;48(7):630–633. doi: 10.1111/j.1365-2044.1993.tb07133.x. [DOI] [PubMed] [Google Scholar]
  20. Rosenblatt W. H., Murphy M. The intubating laryngeal mask: use of a new ventilating-intubating device in the emergency department. Ann Emerg Med. 1999 Feb;33(2):234–238. doi: 10.1016/s0196-0644(99)70401-4. [DOI] [PubMed] [Google Scholar]
  21. Sakles J. C., Laurin E. G., Rantapaa A. A., Panacek E. A. Airway management in the emergency department: a one-year study of 610 tracheal intubations. Ann Emerg Med. 1998 Mar;31(3):325–332. doi: 10.1016/s0196-0644(98)70342-7. [DOI] [PubMed] [Google Scholar]
  22. Tayal V. S., Riggs R. W., Marx J. A., Tomaszewski C. A., Schneider R. E. Rapid-sequence intubation at an emergency medicine residency: success rate and adverse events during a two-year period. Acad Emerg Med. 1999 Jan;6(1):31–37. doi: 10.1111/j.1553-2712.1999.tb00091.x. [DOI] [PubMed] [Google Scholar]
  23. Walls R. M. Rapid-sequence intubation comes of age. Ann Emerg Med. 1996 Jul;28(1):79–81. [PubMed] [Google Scholar]
  24. Wilson M. E. Predicting difficult intubation. Br J Anaesth. 1993 Sep;71(3):333–334. doi: 10.1093/bja/71.3.333. [DOI] [PubMed] [Google Scholar]

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