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OSCE Checklist: Rapid Sequence Intubation (RSI)

  • Writer: Mayta
    Mayta
  • Nov 28, 2024
  • 2 min read

Updated: Nov 30, 2024



Identification and Patient Introduction

  1. Introduce Yourself: State your name and role clearly.

  2. Verify Patient Identity: Confirm the patient's full name and date of birth.

  3. Consent: Explain the procedure and gain informed consent if possible, considering the urgency.

Indications for Intubation

  • Failure to maintain/protect airway.

  • Failure to oxygenate or ventilate.

  • Anticipated clinical course deterioration.

Complications and Risk Disclosure

  1. Trauma Risks:

    • Oral, nasal, or pharyngeal injuries.

    • Fractured teeth.

    • Tracheal or esophageal damage from excessive stylet or force.

  2. Physiological Risks:

    • Hypoxia during prolonged attempts.

    • Aspiration of gastric contents.

    • Cardiovascular instability.

Contraindications

  1. Near-death scenarios where intubation is non-beneficial.

  2. Difficult airway assessment:

    • L: Look externally for predictors (facial trauma, small mouth).

    • E: Evaluate 3-3-2 rule (mouth opening, thyromental distance).

    • M: Mallampati score.

    • O: Obstruction or obesity.

    • N: Neck mobility limitations.


 

Steps of RSI ("7 Ps")

  1. Preparation:

    • Ensure suction, oxygen, airway equipment, pharmacology, and monitoring devices are ready.

    • Check laryngoscope (Macintosh/Miller), endotracheal tubes (ETT 7.0-8.0 mm), syringes, and backups (e.g., video laryngoscope).

  2. Preoxygenation:

    • 100% oxygen for 3 minutes or 8 deep breaths with high-flow O2.

    • Consider bag-mask ventilation if SpO2 < 90%.

  3. Pretreatment:

    • Lidocaine: 1.5-2 mg/kg (blunts cough reflex).

    • Fentanyl: 2-3 mcg/kg (reduces sympathetic response).

    • Atropine: 0.01 mg/kg in pediatric cases.

    • Defasciculating agent for succinylcholine use.

  4. Paralysis and Induction:

    • Sedative: Etomidate (0.3 mg/kg), Ketamine (1-2 mg/kg), or Propofol (2 mg/kg).

    • Neuromuscular blocker: Succinylcholine (1.5 mg/kg) or Rocuronium (1.2 mg/kg).

  5. Positioning:

    • Sniffing position for standard cases.

    • RAMP position for obese patients.

  6. Placement:

    • Crossed-finger technique for mouth opening.

    • Insert laryngoscope, visualize glottis, and advance ETT 3-4 cm past vocal cords.

    • Confirm placement with capnography (EtCO2), bilateral chest auscultation, and chest rise.

  7. Postintubation Management:

    • Inflate cuff, secure ETT, confirm placement with imaging (CXR).

    • Initiate ventilation settings and monitor continuously.


 

Post-Procedure Management

  1. Secure Tube:

    • Confirm tube depth (e.g., 21-24 cm at the lips).

    • Secure with tape or commercial holder.

  2. Monitor:

    • Continuous pulse oximetry and EtCO2.

    • Regular chest auscultation.

  3. Documentation:

    • Record medications, doses, time of intubation, and complications.


 

Checklist Summary

This checklist ensures adherence to protocols and structured documentation of the RSI process. Modify per institutional guidelines and patient-specific conditions for the best outcomes.

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Message for International Readers
Understanding My Medical Context in Thailand

By Uniqcret, M.D.
 

Dear readers,
 

My name is Uniqcret, which is my pen name used in all my medical writings. I am a Doctor of Medicine trained and currently practicing in Thailand, a developing country in Southeast Asia.
 

The medical training environment in Thailand is vastly different from that of Western countries. Our education system heavily emphasizes rote memorization—those who excel are often seen as "walking encyclopedias." Unfortunately, those who question, critically analyze, or solve problems efficiently may sometimes be overlooked, despite having exceptional clinical thinking skills.
 

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Please be aware that while my articles may contain clinically accurate insights, they are not always suitable as direct references for academic papers, as some content is generated through AI support based on my knowledge and clinical exposure. If you wish to use the content for academic or clinical reference, I strongly recommend cross-verifying it with high-quality sources or databases. You may even copy sections of my articles into AI tools or search engines to find original sources for further reading.
 

I believe that my knowledge—built from real clinical experience in a high-intensity, under-resourced healthcare system—can offer valuable perspectives that are hard to find in textbooks. Whether you're a student, clinician, or educator, I hope my content adds insight and value to your journey.
 

With respect and solidarity,

Uniqcret, M.D.

Physician | Educator | Writer
Thailand

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