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Adult RSI case report form - Colorado.gov - colorado

Adult RSI case report form - Colorado.gov - colorado 2025

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The document is a case report form for the Colorado Department of Public Health and Environment, specifically for Emergency Medical Services (EMS) regarding Adult Airway Management and Rapid Sequence Intubation (RSI). It outlines the necessary information to be recorded after performing an RSI procedure, including patient details, signs of respiratory insufficiency, intubation indications, methods used, complications encountered, and medications administered. The form must be submitted within 7 days of the procedure.

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Click ‘Get Form’ to open the Adult RSI case report form in the editor.
Begin by entering the Record Number and Date of Procedure in the specified format (MM/DD/YYYY). Fill in the Patient's Gender and Age, along with the EMS Agency and Medical Director's details.
In the 'Signs of Respiratory Insufficiency' section, check all applicable signs such as Elevated EtCO2 or Diminished SaO2. Ensure you provide accurate information for effective reporting.
Complete the Patient Information section, detailing any airway management techniques used, including types of masks or ventilation methods applied.
Indicate whether satisfactory respiratory management was achieved and document any complications encountered during intubation. Use dropdowns or checkboxes for clarity.
Finally, review all entries for accuracy before saving your completed form. Once finalized, send a copy to cdphe.emtcert@state.co.us as instructed.

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