What is fast sequence induction

Disruption of the airways can lead to the death of a patient. So rapid sequence induction may be the key to saving many lives.

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Rapid sequence induction refers to orotracheal intubation and is usually performed in the emergency department . However, to be successful it is necessary to follow a series of ordered steps that, if skipped, can put the patient’s life at risk.

As a study well points out “for the doctor specializing in emergency medicine, airway management in Prehospital Care Units and Emergency Services constitutes a fundamental part of their basic competencies.”

Therefore, that doctors know how to perform a rapid sequence induction is essential to reduce the risk of pulmonary aspiration that some patients may have.

When does rapid sequence induction take place?

Health professionals should know this technique to apply in situations of maximum urgency.

Rapid sequence induction occurs when a patient comes to the emergency room with an imminent risk of ventilatory failure . A prompt and agile assessment will prevent this procedure from being carried out accurately.

The consequences of performing a rapid sequence induction can range from hypoxemia to causing injury to the airway when the orotracheal tube is inserted. Therefore, keeping calm and being clear about the steps to follow is very important.

Although in some cases it is not very clear when orotracheal intubation should be performed, which allows rapid sequence induction, when there are suspicions that the patient will not be able to keep the airways open, it should be performed.

However, the following symptoms can be taken into account that can clearly indicate the need for a fast sequence induction:

  • Suffocating bruise on the neck.
  • Chest trauma with hypotension.
  • Extensive burns.
  • Obstruction of the airway.
  • Heart attack.

If, in addition to all this, the patient is agitated because he is not able to breathe normally and requires immediate sedation. Rapid sequence induction should be practiced as soon as possible.

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Correct way to proceed

The performance should be quick but with the utmost caution to avoid damage to the patient’s windpipe.

To perform a successful intubation , a series of steps must be followed that will be performed in an agile, fast and precise manner . In this way, some of the consequences mentioned above will be avoided.

Pre-intubation actions

  • Raise the patient’s head by putting a pillow underneath.
  • Raise the jaw by pushing it up and forward.
  • Remove any foreign bodiesfrom the oropharyngeal cavity.
  • Aspirate all secretions (blood, vomit).

Fast sequence induction maneuvers

  • Hold the laryngoscope with one hand and insert it through the corner of the mouth, moving the tongue and bringing the laryngoscope forward and up.
  • Place the tip of this instrument on the epiglottis.
  • To reduce the risk of bronchoaspiration or regurgitation, another professional should perform the Sellick maneuver. This should be done for the duration of intubation.
  • In the event that the glottis or vocal cords do not look good, someone else must do the BURP maneuver to expose it. This will allow the laryngoscope to be inserted properly and avoid injury to the airway.
  • When the tube is properly inserted, the laryngoscopeis removed without moving the tube. This will be fixed and connected to the oxygen source.

Despite the fact that we have recommended the Sellick and BURP maneuvers, these should never be carried out in the event that the patient suffers trauma or has a foreign body in the trachea. This needs to be kept in mind.

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Drugs in rapid sequence induction

In general, the use of no drug is necessary when performing rapid sequence induction . However, there are cases in which, without the supply of these drugs, it would be impossible to intubate the patient.

When a patient is restless, it is necessary to provide a sedative medication. In other cases, when you suffer from severe pain, in addition to the sedative, you should be given a pain reliever .

There are few circumstances in which emergency physicians have to provide the patient with a micro-relaxant . This is essential when the tube fails to pass through the trachea due to stress.

As we have seen, induction is a procedure that all professionals in the emergency department must know how to carry out in a correct way to generate the least possible damage to the airways.

Also, it is important that they know the medicines that they must supply in certain situations. We could certainly consider rapid sequence induction an essential first aid measure .


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