How is rapid sequence intubation (RSI) performed?

Updated: Apr 07, 2020
  • Author: Keith A Lafferty, MD; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

Visualize the ET tube passing through the vocal cords.

Confirm tube placement. Observe color change on a qualitative end-tidal carbon dioxide device or utilize a continuous end-tidal carbon dioxide (ET-CO2) monitor. Use the 5-point auscultation method: Listen over each lateral lung field, the left axilla, and the left supraclavicular region for good breath sounds. No air movement should occur over the stomach. Two pilot studies have shown that ultrasonography can reliably detect passage of a tracheal tube into either the trachea or esophagus without inadvertent ventilation of the stomach. [49, 50]

See the image panel below.

Left panel: Bedside ultrasound of anterior neck fo Left panel: Bedside ultrasound of anterior neck for proper detection of the endotracheal tube before positive-pressure ventilation is applied. Middle panel: Proper placement of the endotracheal tube in the trachea as the esophagus is normally not visualized. Right panel: Misplacement of the endotracheal tube in the left-sided esophagus. Used with permission from Springer Publishing Company.

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