Rapid sequence intubation process8/8/2023 The EMP is a key member of the bedside care team and uniquely positioned to communicate this evolving data. While the agents used in RSI have changed little, knowledge regarding optimal dosing, appropriate patient selection, and possible adverse effects continues to be gained. It is necessary for the practicing EMP to update previous practice patterns in order to continue to provide optimal patient care. Since then, the role of the EMP as well as the published evidence regarding RSI agents, including dosing, adverse effects, and clinical outcomes, has grown. The mechanism of action and pharmacokinetic/pharmacodynamic profiles of these agents were described in a 2011 review. Various medications are chosen to sedate and even paralyze the patient to facilitate an efficient endotracheal intubation. RSI is the process of establishing a safe, functional respiratory system in patients unable to effectively breathe on their own. This is of paramount importance to us as providers and to our community as a whole.The dosing, potential adverse effects, and clinical outcomes of the most commonly utilized pharmacologic agents for rapid sequence intubation (RSI) are reviewed for the practicing emergency medicine pharmacist (EMP). Overall, implementation of quality and performance improvement strategies can mitigate the occurrence of adverse events and lead to improved health outcomes for our patients. Continuous evaluation of FPS and the incidence of RSI-related complications will allow for assessment of not only our quality improvement initiative, but of our educational methodology as well. Furthermore, our clinical skills training process involves an integrative approach, pioneered by our interdisciplinary team of educators. Integration of a checklist in the RSI procedure will help to increase FPS rates and act as a method to aid in continuous evaluation and improvement of overall airway performance.Īlthough many airway performance improvement studies exist, our institution is unique in that we are a new Emergency Medicine (EM) Residency program that will be comprised of only post-graduate year 1 (PGY1) and post-graduate year 2 (PGY2) EM residents at the commencement of data collection. The introduction of checklists as a process improvement tool has been identified as a successful strategy for improving the effectiveness and quality of procedures throughout healthcare. To maximize FPS and increase the safety of the procedure, it is essential to develop a tool to maximize efficacy. Thus, establishing effective methods of decreasing the occurrence of failed attempts will result in an immediate reduction of unintended issues. The number of failed intubation attempts (3+) has been directly correlated with the an increased development of complications. According to the 4th National Audit Project of the Royal College of Anesthetists, it was determined that 30% of patients in the ED and 60% of patients in the ICU experiencing an airway related incident, suffered brain damage or death. These complications commonly lead to poor or life-threatening outcomes and include desaturation, hypotension, dysrhythmia, cardiac arrest, pneumothorax, dental trauma, and esophageal intubation. Unfortunately, many complications can arise during RSI, the incidence of which has remained high. According to a variety of studies published over the last decade, including a large, multi-center systematic review and meta-analysis, the mean FPS rate (84%) has been used as an institutional benchmark for ED airway proficiency. First-pass success (FPS) in Rapid Sequence Intubation (RSI) is the most commonly utilized metric for evaluation and allows for comparison across clinical environments. Why Should I Register and Submit Results?Ĭontinuous evaluation and improvement of airway performance in the Emergency Department (ED) is essential for achieving positive clinical outcomes and reducing the incidence of related adverse events.
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