Rapid Sequence Intubation

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Benefits vs. the risks of rapid sequence intubation in the pre-hospital environment:
Rapid sequence intubation is a very risky procedure even in a stable environment, but when the unknown variables in the pre-hospital environment are considered, this procedure becomes more criticized every time it is used. When initiating the rapid sequence intubation protocol, the paramedic takes total control over the patient’s airway. When evaluating the risks versus the benefits of an endotracheal tube insertion in the pre-hospital environment, paramedics must make split second decisions since the patient’s life depends on the paramedic’s knowledge and skills. If the paramedic’s attempt to intubate was unsuccessful, then he or she must be able to devise …show more content…

There have been several agencies in North Carolina, including Stanly County EMS, whom have abandoned this risky procedure due to the liability and effectiveness in the pre-hospital environment. Primarily, the main reason for the heightened criticism of Rapid sequence intubations stems from inadequately pre-oxygenating the patient before intubation. “Studies have shown that if the patient’s oxygen saturation in their blood is not above 90%, then the patient’s oxygen levels will start to tank when the paramedic starts the intubation procedure” (Davis et al). On the other hand, even if the patient has been pre-oxygenated before the paramedic starts the intubation, the paramedic could have a hard time sticking the endotracheal tube into the patient’s trachea. Since the patient cannot breathe on his or her own since they were paralyzed with potent drugs, the paramedic has just caused the patient’s brain to become depleted of oxygen. This turn of events could prove fatal for the patient. Another grave risk associated with rapid sequence intubations is that the patient’s blood pressure and heart rate could crash on the paramedic if the endoscope blade would happen to hit the vagus nerve in the back of the throat. In theory, if the patient is hypotensive, then the paramedic should avoid rapid sequence intubations, but if the paramedic had already started the procedure, he or she …show more content…

Usually, etomidate is the sedative of choice, followed by succinylcholine as the paralytic. These narcotics will be used to make it easier for the paramedic to gain access of the patient’s respiratory drive. Other drugs can be used to substitute or in addition to etomidate and succinylcholine. Midazolam can be used in place of etomidate if it is not available. Likewise, rocuronium can be substituted for succinylcholine if it is not available. While performing a rapid sequence intubation, the paramedic must assure he or she has the right dosage for the drugs of choice in the intubation. “In a six-year testing period, midazolam was shown to cause hypotension in patients because the drug was under dosed on many occasions” (Swanson et al). Throughout many different studies, doctors chose etomidate over midazolam because etomidate was the most hemodynamically stable drug between the two sedatives. “The study also concluded that etomidate could also decrease intracranial pressure within the skull” (Swanson et al). Etomidate has been studied for many years resulting in an abundance of knowledge about that specific drug, but Midazolam has not been through the testing that etomidate has. Even though there is not much scientific evidence supporting the usage of midazolam as a substitute for etomidate, midazolam is still considered the go-to drug when etomidate is not

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