Protocol 2-044 - Airway: RSI

Polk, Hickory, Cedar, & St Clair EMS Protocols

Patient weight (lbs): (kg):
Patient height (ft): (in): (OPTIONAL, only needed if calculating ideal weight.)
Calculated ideal weight (lbs):








NEMSIS Protocol: 9914007 - Airway-Rapid Sequence Induction (RSI-Paralytic)


Change Log:

DateLink to
Description of change
01/29/14pdfAdded request second unit if possible.
02/22/14pdfRemoved Ketamine contraindication to Head injury.
12/15/14Added O2 for 5 min if possible.
12/29/14Removed call for orders from title and moved it into the top of the ALS instructions for clarity.
04/03/15Added Consider Bougie and Consider Suction. Moved all instances of Gastric Tube when identified with Intubation to this protocol.
04/28/15pdfAdded 15 lpm O2 via NC. Added avoid BVM if SpO2 above 90%. Added maintain warmth. Added indication for RSI. Added 250 ml fluid bolus. Added Fentanyl as premedication. Added Ketamine onset and duration. Added Etomidate contraindicated in sepsis. Increase Rocuronium dose from 1 to 1.5 mg/kg. Added elevate head of cot. Moved continued paralysis under continued sedation. Added option for Ketamine continued sedation.
04/28/15Created Section 6-111 - RSI Dosing Sheet for quick reference sheet.
05/08/15Replaced specific seizure control meds and dosages with reference to seizure protocol.
06/08/15Updated shading and other factors for better readibility.
08/06/15Added comment to delay paralysis to allow preoxygenation if appropriate.
09/16/15Modified initial paralyzation doses per Dr. Merk request. Changes rapid dose from 1.5 mg/kg to 0.6 mg/kg. Changed continued paralyzation to only be indicated when patient is moving.
09/16/15Updated chart to reflect new Rocuronium doses and concentrations from pharmacy.
11/17/15Made prophylactic atropine administration to pediatric a consideration due to 2015 AHA reccomendations removed atropine from routine administration prior to intubation.
01/26/16pdfAdded comment that EMH is not authorized for RSI.
07/24/16pdfSplit into two pages due to text getting too small to read.
07/25/16Removed specific list of Succinylcholine contraindications and replaced with reference to the medication section.
02/02/17pdfChanged name to Rapid/Delayed. Moved delayed Rocuronium to preferred.
02/02/17pdfAdded comment to use ideal body weight.
08/24/17Added comment to consult EMT for contraindications. Increased sedation dose of Ketamine from 1 to 1-2 mg/kg. Increased parayzation dose of Rocuronium from 0.6 to 1.2 mg/kg. Removed Ativan, Succinylcholine, and Vecuronium.
09/22/17Modified pediatric Versed dosages.
11/11/17pdfRemoved Lidocaine for head injury prior to intubation. Added comment that continued paralysis is if patient movement even after sedation.
11/29/17pdfUpdated quick reference chart to new dosages.
12/13/17pdfPer Dr. Carter, removed upper airway obstruction as an RSI contraindication.
12/18/18pdfRemoved contraindication of sepsis for Etomidate.
07/23/19Added note to use ideal body weight for paralytic dosing.
07/23/19pdfAdded tidal volumes for ventilation based on weight. Made adjustments for paralytics to be dosed by ideal body weight.
04/11/20Added content from old Section 6-111 - RSI Dosing Sheet. Spent a lot of time getting all the code to work on this protocol for the weight-based doses (actualideal). Also built a tool that returns equipment sizes based on the weight entered. Hope people like it.
04/11/20pdfAdded content (without substantive modification) from old Protocol 6-110 - Rapid/Delayed Sequence Intubation (RSI).
04/14/20At the request of the EMS directorEMS operations chief, removed the requirement to contact MEDICAL CONTROL prior to starting RSI. Will run this past Dr. Nicholes.
06/06/21pdfMoved to
10/14/21pdfAdded comment to maintain etco2 between 35-45 or 35-40. Requested by Brice 2/25/21. Approved by protocol committee 5/26/21. Approved by Dr. Nicholes 6/8/21.
12/01/21Updated link to Versed.
02/25/22pdfAdded consider ventilator after intubation.
02/28/22Updated links for Rocuronium.
03/17/23Changed link to NS.
03/19/23Changed link for LR.
03/20/23Changed link for Ketamine.
03/20/23Changed link for Etomidate.
03/20/23Changed link for Atropine.

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