RE: Fw: RE: International SOS

January 10, 2009

Ian,

Forgive my ignorance but what is RSI?

Cheers

Geoff

Fw: RE: International SOS

Gents & amp; Ladies,Please see below from Diane at ISOS.ISOS Have a requirement

for RSI competent Flight Medics. CV's to the address in the mail.Best WishesIan

----- Original Message -----From: " Diane HUTCHINSON "

>;diane.hutchinson@...

January 10, 2009

RSI = Rapid Sequence Intubation.

Googled and found on wiki see

http://en.wikipedia.org/wiki/Rapid_Sequence_Intubation

Rgs

----- Original Message -----From: " " >;gmed1c@...

January 10, 2009

Geoff;

Rapid Sequence Intubation = the use of benzos and narcotics and/or other

agents including etomidate, some times propofol, then Anectine/Suxccinylcholine,

to successfully intubate then use longer acting paralytic agents, moreover

elective airway control and ventilation management.

I suspect managing ventilators and interactions with invasive and non

invasive monitors, chest tube management and experience with blood (and other

products) would be beneficial.

Cheers

Hope that helps

Wilf

Re: Fw: RE: International SOS

Ian,

Forgive my ignorance but what is RSI?

Cheers

Geoff

.

January 10, 2009

it's Rapis Sequence Intubation... i wish i cAN apply for this yet im having a

new contract for my work (renewal). i cant leave this.. Good luck for you all

Guys!greetings from bahrain

From: Gmed1c@... <Gmed1c@...>

Subject: Re: Fw: RE: International SOS

Date: Saturday, 10 January, 2009, 5:20 PM

Ian,

Forgive my ignorance but what is RSI?

Cheers

Geoff

[Remotemedics. co.uk] Fw: RE: International SOS

Gents & amp; Ladies,Please see below from Diane at ISOS.ISOS Have a requirement

for RSI competent Flight Medics. CV's to the address in the mail.Best WishesIan

----- Original Message -----From: " Diane HUTCHINSON " >;diane.hutchinson@

internationalsos .com

January 18, 2009

Rapid Sequence Induction?

[Remotemedics. co.uk] Fw: RE: International SOS

>

> Gents & amp; Ladies,Please see below from Diane at ISOS.ISOS Have a

> requirement for RSI competent Flight Medics. CV's to the address in the

> mail.Best WishesIan

>

> ----- Original Message -----From: " Diane HUTCHINSON " >;diane.hutchinson@

> internationalsos .com

>

January 18, 2009

Rod is right of course it's Induction, not Intubation. You heavily sedate, and

then induce the stoppage of muscle movement and loss of tone with drugs in order

to Intubate a person that, for what ever reason, can not protect their airway

but is still conscious enough, or simply combative enough or still has a gag

reflex and will fight you. In the end, it's all the same (hopefully), an

inubated patient with you in control of the airway.

Mike S.

Wm. M. (Mike) Spurgeon, NREMT-P

DynCorp Medical

Herat, Afghanistan

> From: Gmed1c@... <Gmed1c@...>

> Subject: Re: Fw: RE: International SOS

>

> Date: Saturday, 10 January, 2009, 5:20 PM

>

> Ian,

>

> Forgive my ignorance but what is RSI?

>

> Cheers

>

> Geoff

>

> [Remotemedics. co.uk] Fw: RE: International SOS

>

> Gents & amp; Ladies,Please see below from Diane at ISOS.ISOS Have a

> requirement for RSI competent Flight Medics. CV's to the address in

the

> mail.Best WishesIan

>

> ----- Original Message -----From: " Diane HUTCHINSON "

>;diane.hutchinson@

> internationalsos .com

>

January 18, 2009

I've heard both 'I's used by just about everyone. In my RSI experience I have

seldom needed to go as far as paralysis. I have vecuronium or succinylcholine

standing by, but etomidate usually makes the pt sufficiently loose and gag-free.

The real benefit of RSI is in it's ability to help you decide when and how the

intubation is going to happen. Without induction you're pretty much relegated to

having your supplies out and waiting for the pt to crump. I like being able to

discuss the matter w/ my patient and have them tell me if they think they are

too tired to continue. Then they know there is a pain/anxiety free option.

It just makes the whole intubation experience a lot more controlled and

orchestrated. Just be sure you know what you're getting into. There is no ideal

paralytic. The ones that don't cause hyperkalemia tend to hang around a while

and have vasoactive effects. It's bad form to paralyze someone and then NOT

secure the airway.

Later,

Guy

> From: Gmed1c@... <Gmed1c@...>

> Subject: Re: [Remotemedics. co.uk] Fw: RE: International SOS

> @groups. com

> Date: Saturday, 10 January, 2009, 5:20 PM

>

> Ian,

>

> Forgive my ignorance but what is RSI?

>

> Cheers

>

> Geoff

>

> [Remotemedics. co.uk] Fw: RE: International SOS

>

> Gents & amp; Ladies,Please see below from Diane at ISOS.ISOS Have a

> requirement for RSI competent Flight Medics. CV's to the address in the

> mail.Best WishesIan

>

> ----- Original Message -----From: " Diane HUTCHINSON " >;diane.hutchinson@

> internationalsos .com

>

January 18, 2009

Dont want to seem a pedant here - but Ill say it anyway!!

RSI - stands for Rapid Sequence Induction (of anaesthesia) and refers to

giving Sux and a rapidly acting sedation agent to get the patient off to

sleep and paralysed quickly so intubation can occur - the primary goal

is anaesthetising someone who isnt fasted or is unstable. This contrasts

with the tradtitional slower (non-rapid) classical induction of

anaesthesia, where both induction and paralysis can occur over 3-4

minutes.

In the mid 90's the Emergency Medicine community in the US - primarily

Ron Walls hijacked the term from the Anaesthetists, and used RSI to

refer to Rapid Sequence Intubation - which is what was the goal of the

exercise was - rapid intubation as opposed to rapid induction of

anaesthesia - although clearly they overlap to a great degree. This

second term is generally how RSI is referred to in the Emergency

Medicine and Prehospital fields - but not universally.

If your seldom needing to go as far as paralysis are you not doing RSI

regardless of which " I " you use and the evidence suggests views are

worse, intubation itself is harder and failure more likely. Paralysis is

the conerstone of RSI, what you are doing if you are not giving

paralysis is " drug assisted " intubation and it falls a poor second to

proper RSI. The distinction is important IMO. The sedation and paralysis

go together in RSI.

cheers

Craig

________________________________

From:

[mailto: ] On Behalf Of Guy

Sent: Monday, 19 January 2009 6:57 AM

Subject: Re: Fw: RE: International SOS

I've heard both 'I's used by just about everyone. In my RSI experience I

have seldom needed to go as far as paralysis. I have vecuronium or

succinylcholine standing by, but etomidate usually makes the pt

sufficiently loose and gag-free.

The real benefit of RSI is in it's ability to help you decide when and

how the intubation is going to happen. Without induction you're pretty

much relegated to having your supplies out and waiting for the pt to

crump. I like being able to discuss the matter w/ my patient and have

them tell me if they think they are too tired to continue. Then they

know there is a pain/anxiety free option.

It just makes the whole intubation experience a lot more controlled and

orchestrated. Just be sure you know what you're getting into. There is

no ideal paralytic. The ones that don't cause hyperkalemia tend to hang

around a while and have vasoactive effects. It's bad form to paralyze

someone and then NOT secure the airway.

Later,

Guy

> From: Gmed1c@... <mailto:Gmed1c%40aol.com> <Gmed1c@...

<mailto:Gmed1c%40aol.com> >

> Subject: Re: [Remotemedics. co.uk] Fw: RE: International SOS

> @groups. com

> Date: Saturday, 10 January, 2009, 5:20 PM

>

> Ian,

>

> Forgive my ignorance but what is RSI?

>

> Cheers

>

> Geoff

>

> [Remotemedics. co.uk] Fw: RE: International SOS

>

> Gents & amp; Ladies,Please see below from Diane at ISOS.ISOS Have a

> requirement for RSI competent Flight Medics. CV's to the address in

the

> mail.Best WishesIan

>

> ----- Original Message -----From: " Diane HUTCHINSON "

>;diane.hutchinson@

> internationalsos .com

>

January 19, 2009

>

> Dont want to seem a pedant here - but Ill say it anyway!!

>

> RSI - stands for Rapid Sequence Induction (of anaesthesia) and refers to

> giving Sux and a rapidly acting sedation agent to get the patient off to

> sleep and paralysed quickly so intubation can occur - the primary goal

> is anaesthetising someone who isnt fasted or is unstable. This contrasts

> with the tradtitional slower (non-rapid) classical induction of

> anaesthesia, where both induction and paralysis can occur over 3-4

> minutes.

>

> In the mid 90's the Emergency Medicine community in the US - primarily

> Ron Walls hijacked the term from the Anaesthetists, and used RSI to

> refer to Rapid Sequence Intubation - which is what was the goal of the

> exercise was - rapid intubation as opposed to rapid induction of

> anaesthesia - although clearly they overlap to a great degree. This

> second term is generally how RSI is referred to in the Emergency

> Medicine and Prehospital fields - but not universally.

>

> If your seldom needing to go as far as paralysis are you not doing RSI

> regardless of which " I " you use and the evidence suggests views are

> worse, intubation itself is harder and failure more likely. Paralysis is

> the conerstone of RSI, what you are doing if you are not giving

> paralysis is " drug assisted " intubation and it falls a poor second to

> proper RSI. The distinction is important IMO. The sedation and paralysis

> go together in RSI.

>

> cheers

>

> Craig

Craig,

I'm with you on this one. Rosen's Emergency Medicine is highly

critical of midazolam-only " RSI " (chapter one). I think it is fair to

extend that criticism to etomidate-only " RSI " .

A couple of bits of news, Rocuronium, which nearly parallels Sux in

its onset time, is now generic. I think Roc is the best paralytic for

the procedure for that reason, as well as the potassium issues, and

malignant hyperthermia that is associated with Sux. Unfortunately,

Roc also requires refrigeration.

Suggamadex is a fairly new drug, and it's even a new class of drug.

It encapsulates non-depolarizing muscle relaxers in a sugar matrix,

deactivating the NDMR very quickly. Roc-On,...Roc-Off. So if there is

any debate about the duration of Roc, compared with Sux, Suggamadex

provides additional strength to the argument for Roc.

Tyler Cascade

January 19, 2009

Before I initiate the process of rapid sequence induction (yes, induction) I

draw up a weight appropriate dose of Etomidate (or other fast acting, short half

life sedative) and the APPROPRIATE paralytic given the disease process.

Paralysis IS NOT anesthesia. A paralyzed patient can indeed feel and experience

the entire, god awful process of intubation. I realize you were not suggesting

otherwise, but I just wanted to clear that up.

If I have a decompensating CHF or COPD pt who is not responding to

pharmacological interventions and cannot tolerate (or fails to improve with)

simple pressure support (i.e. C-Pap) and we all agree that RSI is indicated, I

of course would draw up all of the necessary medications for the sequence.

However . . .

If after etomidate, the patient becomes completely unconscious and apneic with

no gag reflex, why not drop the tube right then? Long term sedation will follow

momentarily with versed or propofol, so what benefit do we derive from paralysis

in this instance? If one fails to assess a malampati score and fails to make the

necessary plan B accomodations and fails to secure the airway, how is paralysis

helping us then? Don't get me wrong, i'm not saying a good paralytic isn't

necessary on the whole, I'm just saying why introduce a pharmacological agent to

produce a change in the patient if they already manifest the condition needed to

secure the airway? Textbook? If we find someone apneic and gagless to start

with, do we induce? No. Why would we?

Sux is not the only agent and is not always the ideal choice. Depolarizing NMBs

are attributable to hyperkalemia, so if you have a pt where K+ levels are a

concern, you'd be better with vecuronium, pancuronium or some other

non-depolarizing drug.

Later,

Guy

> From: Gmed1c@... <mailto:Gmed1c% 40aol.com> <Gmed1c@...

<mailto:Gmed1c% 40aol.com> >

> Subject: Re: [Remotemedics. co.uk] Fw: RE: International SOS

> @groups. com

> Date: Saturday, 10 January, 2009, 5:20 PM

>

> Ian,

>

> Forgive my ignorance but what is RSI?

>

> Cheers

>

> Geoff

>

> [Remotemedics. co.uk] Fw: RE: International SOS

>

> Gents & amp; Ladies,Please see below from Diane at ISOS.ISOS Have a

> requirement for RSI competent Flight Medics. CV's to the address in

the

> mail.Best WishesIan

>

> ----- Original Message -----From: " Diane HUTCHINSON "

>;diane.hutchinson@

> internationalsos .com

>

January 19, 2009

Why not drop the tube then indeed....

Probably no reason, and it will probably go just fine.

But the evidence repeatedly suggests that RSI is superior to drug

assisted (ie sedation only) intubation - on both grade of view, ease of

intubation and number of attempts required - if you want the references

email me direct - but 5 minutes on Medline will bring them up.

Not saying what your doing is bad, its clearly thoughtful practice, just

that the evidence suggests you are making life harder for yourself than

it needs to be

" If we find someone apneic and gagless to start with, do we induce? No.

Why would we? "

Because doing a proper or modified RSI (unless they are in arrest) is

better for a hypoxic or injured brain than just sticking a laryngoscope

down and poking the tube in perhaps? Not preaching pathophysiology here,

but absence of gag or apnea (at least in a respiratory only arrest) does

not correlate with lack of an ICP response to laryngoscopy which in part

is what we are trying to avoid with RSI.

cheers

Craig

________________________________

From:

[mailto: ] On Behalf Of Guy

Sent: Tuesday, 20 January 2009 9:03 a.m.

Subject: RE: Fw: RE: International SOS

Before I initiate the process of rapid sequence induction (yes,

induction) I draw up a weight appropriate dose of Etomidate (or other

fast acting, short half life sedative) and the APPROPRIATE paralytic

given the disease process. Paralysis IS NOT anesthesia. A paralyzed

patient can indeed feel and experience the entire, god awful process of

intubation. I realize you were not suggesting otherwise, but I just

wanted to clear that up.

If I have a decompensating CHF or COPD pt who is not responding to

pharmacological interventions and cannot tolerate (or fails to improve

with) simple pressure support (i.e. C-Pap) and we all agree that RSI is

indicated, I of course would draw up all of the necessary medications

for the sequence. However . . .

If after etomidate, the patient becomes completely unconscious and

apneic with no gag reflex, why not drop the tube right then? Long term

sedation will follow momentarily with versed or propofol, so what

benefit do we derive from paralysis in this instance? If one fails to

assess a malampati score and fails to make the necessary plan B

accomodations and fails to secure the airway, how is paralysis helping

us then? Don't get me wrong, i'm not saying a good paralytic isn't

necessary on the whole, I'm just saying why introduce a pharmacological

agent to produce a change in the patient if they already manifest the

condition needed to secure the airway? Textbook? If we find someone

apneic and gagless to start with, do we induce? No. Why would we?

Sux is not the only agent and is not always the ideal choice.

Depolarizing NMBs are attributable to hyperkalemia, so if you have a pt

where K+ levels are a concern, you'd be better with vecuronium,

pancuronium or some other non-depolarizing drug.

Later,

Guy

> From: Gmed1c@... <mailto:Gmed1c%40aol.com> <mailto:Gmed1c%

40aol.com> <Gmed1c@... <mailto:Gmed1c%40aol.com>

<mailto:Gmed1c% 40aol.com> >

> Subject: Re: [Remotemedics. co.uk] Fw: RE: International SOS

> @groups. com

> Date: Saturday, 10 January, 2009, 5:20 PM

>

> Ian,

>

> Forgive my ignorance but what is RSI?

>

> Cheers

>

> Geoff

>

> [Remotemedics. co.uk] Fw: RE: International SOS

>

> Gents & amp; Ladies,Please see below from Diane at ISOS.ISOS Have a

> requirement for RSI competent Flight Medics. CV's to the address in

the

> mail.Best WishesIan

>

> ----- Original Message -----From: " Diane HUTCHINSON "

>;diane.hutchinson@

> internationalsos .com

>

January 19, 2009

I hate to drop in on a coversation ,i teach with the difficult airway course

taught to paramedic ,rn,md,crna and others ,to combat the gag reflex we teach

lidocaine with all intubation either rsi or dai ,we teach tight heart for aaa

,tight lungs for copd, tight brain for head injury or cva. Does any one else do

this

[Remotemedics. co.uk] Fw: RE: International SOS

>

> Gents & amp; Ladies,Please see below from Diane at ISOS.ISOS Have a

> requirement for RSI competent Flight Medics. CV's to the address in

the

> mail.Best WishesIan

>

> ----- Original Message -----From: " Diane HUTCHINSON "

>;diane.hutchinson@

> internationalsos .com

>

January 19, 2009

A couple of bits of news, Rocuronium, which nearly parallels Sux in

its onset time, is now generic. I think Roc is the best paralytic for

the procedure for that reason, as well as the potassium issues, and

malignant hyperthermia that is associated with Sux. Unfortunately,

Roc also requires refrigeration.

[sugammadex] is a fairly new drug, and it's even a new class of drug.

It encapsulates non-depolarizing muscle relaxers in a sugar matrix,

deactivating the NDMR very quickly. Roc-On,...Roc-Off. So if there is

any debate about the duration of Roc, compared with Sux, [sugammadex]

provides additional strength to the argument for Roc.

Tyler Cascade

I misspelled Sugammadex. My apologies.

Also, just to clarify, I was referring to the onset time for

rocuronium, not the fact that it is now generic.

Tyler Cascade

January 19, 2009

Ric,

And the evidence for lidocaine blunting the ICP response is ...... ?

Aware its taught, but it is to the best of my knowledge very much a

north american " cultural " thing with limited evidence.

Pre-treating with potent opiate and deep sedation yes, but aside from

couple of studies which have limited clinical application whats the

evidence for lidocaine?

Craig

________________________________

From:

[mailto: ] On Behalf Of Ric wilkinson

Sent: Tuesday, 20 January 2009 6:31 p.m.

Subject: RE: Fw: RE: International SOS

I hate to drop in on a coversation ,i teach with the difficult airway

course taught to paramedic ,rn,md,crna and others ,to combat the gag

reflex we teach lidocaine with all intubation either rsi or dai ,we

teach tight heart for aaa ,tight lungs for copd, tight brain for head

injury or cva. Does any one else do this

[Remotemedics. co.uk] Fw: RE: International SOS

>

> Gents & amp; Ladies,Please see below from Diane at ISOS.ISOS Have a

> requirement for RSI competent Flight Medics. CV's to the address in

the

> mail.Best WishesIan

>

> ----- Original Message -----From: " Diane HUTCHINSON "

>;diane.hutchinson@

> internationalsos .com

>

January 20, 2009

Don't apologize for preaching pathophysiology. It's nothing to be shy about and

I certainly don't mind.

Paralysis does not negate the effect of reflex sympathetic response to

laryngoscopy. Furthermore, if you do in fact use succinylcholine, resulting

muscle fasciculations increase serum K+ levels, increase ICP and IOP, and have

been shown (in rare cases) to induce masseter spasm.

When elevated ICP is a concern (intracranial HTN, trauma, etc.) lidocaine is

used to blunt the hemodynamic effects, thus reducing ICP. Even this has not been

shown to improve patient outcomes. At least I haven't seen anything post 2003

suggesting it, maybe you have.

Ketamine is the only deep sedation agent I have ever seen used AFTER RSI that

has the potential to increase ICP. Etomidate (pre-paralysis) and midazolam

(post) have been shown to have little effect on, or decrease ICP without

decreasing central perfusion pressure. So if RSRL is a concern, even in the

absence of traumatic brain injury, the deep sedation agent you use after

securing the airway will often help reduce ICP.

When complete RSI is indicated, it is indicated. The appropriate pre and post

tube sedation should be employed as well as the proper paralytic and

defasciculation agent. However, my experience has shown that many patients

(particularly CHF and COPD decompensation) do not require the full sequence. I

am not convinced that following the recipe just to say I did is the right thing

to do in such cases. Not saying you are preaching otherwise, just wanted to

clarify.

Peace,

Guy

> From: Gmed1c@... <mailto:Gmed1c% 40aol.com> <mailto:Gmed1c%

40aol.com> <Gmed1c@... <mailto:Gmed1c% 40aol.com>

<mailto:Gmed1c% 40aol.com> >

> Subject: Re: [Remotemedics. co.uk] Fw: RE: International SOS

> @groups. com

> Date: Saturday, 10 January, 2009, 5:20 PM

>

> Ian,

>

> Forgive my ignorance but what is RSI?

>

> Cheers

>

> Geoff

>

> [Remotemedics. co.uk] Fw: RE: International SOS

>

> Gents & amp; Ladies,Please see below from Diane at ISOS.ISOS Have a

> requirement for RSI competent Flight Medics. CV's to the address in

the

> mail.Best WishesIan

>

> ----- Original Message -----From: " Diane HUTCHINSON "

>;diane.hutchinson@

> internationalsos .com

>

January 20, 2009

Since its only Guy and I arguing with each other I wont go on much more!

The reflex sympathetic response is only part of the ICP issue with

intubation, the other part is skeletal muscle tone and responsiveness -

this is the role of paralysis.

I cannot speak for the rest of the world, but within the Australasian

anaesthetic community not using paralysis in a patient where there were

ICP concerns I believe would be verging on negligent.

And i frequently do a modified RSI with diffierent regimens - all Im

saying is RSI without paralysis isnt RSI and that the evidence suggests

that DAI results in a more difficult intubation than full RSI - YMMV.

cheers

Craig

________________________________

From:

[mailto: ] On Behalf Of Guy

Sent: Tuesday, 20 January 2009 11:15 p.m.

Subject: RE: Fw: RE: International SOS

Don't apologize for preaching pathophysiology. It's nothing to be shy

about and I certainly don't mind.

Paralysis does not negate the effect of reflex sympathetic response to

laryngoscopy. Furthermore, if you do in fact use succinylcholine,

resulting muscle fasciculations increase serum K+ levels, increase ICP

and IOP, and have been shown (in rare cases) to induce masseter spasm.

When elevated ICP is a concern (intracranial HTN, trauma, etc.)

lidocaine is used to blunt the hemodynamic effects, thus reducing ICP.

Even this has not been shown to improve patient outcomes. At least I

haven't seen anything post 2003 suggesting it, maybe you have.

Ketamine is the only deep sedation agent I have ever seen used AFTER RSI

that has the potential to increase ICP. Etomidate (pre-paralysis) and

midazolam (post) have been shown to have little effect on, or decrease

ICP without decreasing central perfusion pressure. So if RSRL is a

concern, even in the absence of traumatic brain injury, the deep

sedation agent you use after securing the airway will often help reduce

ICP.

When complete RSI is indicated, it is indicated. The appropriate pre and

post tube sedation should be employed as well as the proper paralytic

and defasciculation agent. However, my experience has shown that many

patients (particularly CHF and COPD decompensation) do not require the

full sequence. I am not convinced that following the recipe just to say

I did is the right thing to do in such cases. Not saying you are

preaching otherwise, just wanted to clarify.

Peace,

Guy

> From: Gmed1c@... <mailto:Gmed1c%40aol.com> <mailto:Gmed1c%

40aol.com> <mailto:Gmed1c%

40aol.com> <Gmed1c@... <mailto:Gmed1c%40aol.com> <mailto:Gmed1c%

40aol.com>

<mailto:Gmed1c% 40aol.com> >

> Subject: Re: [Remotemedics. co.uk] Fw: RE: International SOS

> @groups. com

> Date: Saturday, 10 January, 2009, 5:20 PM

>

> Ian,

>

> Forgive my ignorance but what is RSI?

>

> Cheers

>

> Geoff

>

> [Remotemedics. co.uk] Fw: RE: International SOS

>

> Gents & amp; Ladies,Please see below from Diane at ISOS.ISOS Have a

> requirement for RSI competent Flight Medics. CV's to the address in

the

> mail.Best WishesIan

>

> ----- Original Message -----From: " Diane HUTCHINSON "

>;diane.hutchinson@

> internationalsos .com

>

January 20, 2009

Craig & Guy,

That many other people have not entered this discussion is not an indication of

disinterest.

I thought you both have presented a lot of good information and have presented

your cases well. It was a good review for me with some newer information as

well.

On topic, I think that the argument of a complete RSI v/s a partial procedure to

" fit the need " has been ongoing for some time now, as has the arguments for a

particular choice

of sedation, paralytic, the use on Lidocaine and Atropine in children undergoing

an RSI.

All of these arguments, and the collective experiences/studies that feed them,

are of course important because at some point someone formulates and adopts

protocols based on the most current studies and their own experience. These

someones are going to be

MDs or a group of MDs who are usually specialist in their field. Actual working

protocols are usually confined to a particular institution, agency or maybe a

political jurisdiction that has medical over site for several agencies. Some

protocols are very strict and specific while others are in truth no more than

guidelines......what ever the medical over site is comfortable with and works

for the medics .....and the patients.

Don't get me wrong here (and of course someone usually does), but I would like

to know what sorts of actual protocols are being used in brief and less of the

background information and pros and cons of medications, and sequence of

events. For realistically, as a non'MD I am usually bound by protocols and the

back ground information although

interesting and educational is not in my realm to debate when I have a crashing

patient.

Would anyone like to comment of existing protocols?

Mike S.

Wm. M. (Mike) Spurgeon, NREMT-P

DynCorp Medical

Herat, Afghanistan

> From: Gmed1c@... <mailto:Gmed1c%40aol.com> <mailto:Gmed1c%

40aol.com> <mailto:Gmed1c%

40aol.com> <Gmed1c@... <mailto:Gmed1c%40aol.com>

<mailto:Gmed1c%

40aol.com>

<mailto:Gmed1c% 40aol.com> >

> Subject: Re: [Remotemedics. co.uk] Fw: RE: International SOS

> @groups. com

> Date: Saturday, 10 January, 2009, 5:20 PM

>

> Ian,

>

> Forgive my ignorance but what is RSI?

>

> Cheers

>

> Geoff

>

> [Remotemedics. co.uk] Fw: RE: International SOS

>

> Gents & amp; Ladies,Please see below from Diane at ISOS.ISOS Have a

> requirement for RSI competent Flight Medics. CV's to the address in

the

> mail.Best WishesIan

>

> ----- Original Message -----From: " Diane HUTCHINSON "

>;diane.hutchinson@

> internationalsos .com

>

January 20, 2009

Bro, we're not arguing. I respect your position. Just because we are the only

ones talking doesn't mean we are the ony ones reading, thinking and potentially

learning. We're all on the same team. The original respondent didn't know what

RSI was, I bet he does now!

The core issue is this: What is RSI for? What does it do for you and your

patient? The beauty of RSI is that it lets you take a tense, uncontrolled

situation and control it on your terms. When you are trying fruitlessly to

control an airway that you know isn't secure, or support the respiratory status

of someone you know is about to eat shit, you are powerless and your patient is

suffering. RSI makes all that go away by allowing you to get the patient ready

for the tube in a calm, relaxed, controlled manner. I am confident that we can

agree on that.

You are completely correct that RSI without paralysis is not RSI.

You contend that there is a statistical correlation between DAI and difficult

intubations. I can certainly see how this would be the case if sampling ALL

patients (particularly TBI), but for a great number of the patients whose airway

I have electively controlled, paralysis has not been necessary and it's omission

did not create any hindrance to successful intubation. What's more it avoided

the potential complications associated with sux (a well beaten dead horse by

now). This does not mean that I believe DAI and RSI are clinically equal or

universally interchangeable, but everything has it's place.

I would of course, never attempt to force a tube on a pt exhibiting any degree

of skeletal muscle tone or responsiveness, that goes without saying.

I apologize if this has annoyed you.

Go All Blacks!

Guy

> From: Gmed1c@... <mailto:Gmed1c% 40aol.com> <mailto:Gmed1c%

40aol.com> <mailto:Gmed1c%

40aol.com> <Gmed1c@... <mailto:Gmed1c% 40aol.com> <mailto:Gmed1c%

40aol.com>

<mailto:Gmed1c% 40aol.com> >

> Subject: Re: [Remotemedics. co.uk] Fw: RE: International SOS

> @groups. com

> Date: Saturday, 10 January, 2009, 5:20 PM

>

> Ian,

>

> Forgive my ignorance but what is RSI?

>

> Cheers

>

> Geoff

>

> [Remotemedics. co.uk] Fw: RE: International SOS

>

> Gents & amp; Ladies,Please see below from Diane at ISOS.ISOS Have a

> requirement for RSI competent Flight Medics. CV's to the address in

the

> mail.Best WishesIan

>

> ----- Original Message -----From: " Diane HUTCHINSON "

>;diane.hutchinson@

> internationalsos .com

>

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