The key points for Senior Staff to remember:
- You can still call anesthesia, particularly for airways anticipated to be difficult.
- The pre-sedation/analgesia and post-sedation documentation must be done in EPIC, where you need to identify ASA classification, Mallampati score, etc.
- Intubations should be a two-provider (Sr. staff, fellow, APP) procedure. The existing policy outlines that the Sr. Staff draws up, labels and administers the paralytic in all but the most emergent intubations when only one provider is available, in which case the bedside nurse can do this.
- Sugammadex is the reversal agent for rocuronium and will also be stocked in the PYXIS. It costs over $3000 / dose, but should rarely be needed even if it were cheap.
- Nursing is becoming familiar with RSI and paralytics, and if you their help in an emergent (one-provider) intubation, please be patient that this is not (and should not) be a regular activity for them.
- Because intubation is probably the most high-risk procedure we do, I will ask everyone (non-EM, as you’ve been doing RSI) who rounds in the MICU to watch this YouTube video:
- The division also strongly encourages anyone who feels they need some training to participate as a learner in the Sim Center for some hands on training.
- You can still intubate without RSI, but the literature is quite clear that RSI is the safest and most successful method in the vast majority of patients.
- Attached are the Tier 1 policies on such procedures (moderate sedation and deep sedation) for your review along with a NEJM paper on management of the difficult airway.