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PROCESS OF RSI Plan. Preparation (drugs, equipment, people, place) Protect the cervical spine. Positioning (some do this after paralysis and induction) Preoxygenation. Pretreatment (optional; e.g. , and lignocaine) Paralysis and Induction. Placement with proof.
The steps in performing RSI are often described by the six Ps: preparation, preoxygenation, pretreatment, paralysis and induction, placement of the tube, and postintubation management (Fig. 5.1).
The average size of the tube for an adult male is 8.0, and an adult female is 7.0, though this is somewhat an institution dependent practice. Pediatric tubes are sized using the equation: size = ((age/4) +4) for uncuffed ETTs, with cuffed tubes being one-half size smaller.
One important difference between RSI and routine tracheal intubation is that the anesthesiologist does not typically manually assist the ventilation of the lungs after the onset of general anesthesia and cessation of breathing, until the trachea has been intubated and the cuff has been inflated.
Uncuffed endotracheal tube size (mm ID) = (age in years/4) + 4. Cuffed endotracheal tube size (mm ID) = (age in years/4) + 3.
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5 The approximate uncuffed endotracheal tube size may be chosen for children over one year by the formula: size (mm) = age (years)/4 + 4. (Cuffed endotracheal tube: size (mm) = age (years)/4 + 3.5).
RSI is indicated for a patient in acute respiratory failure due to inadequate oxygenation or ventilation, and for airway protection in a patient with an altered mental status.
Steps of RSI (7 Ps) Preparation Plan. Preoxygenation. Pre-treatment. Paralysis and induction. Protection and positioning. Placement with proof. Post-intubation management.
Patients who require intubation have at least one of the following five indications: Inability to maintain airway patency. Inability to protect the airway against aspiration. Failure to ventilate. Failure to oxygenate. Anticipation of a deteriorating course that will eventually lead to respiratory failure.
Touch and read method : depth of intubation is calculated as follow : length from mouth angle to epiglottis tip plus 12.5cm for male. Risk group is defined as the patients whose airway length from medial incisor to carina is below 23cm. Conventional method : depth of intubation is 21cm at the medial incisor for female.

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