Intubation in fast sequence

The technique of intubation in fast sequence (ISR) was defined by Walls (Indigo plants off Emergency Medicine, July 1996), it consists of “a series of specific actions intended to obtain in optimal manner and rapid an intubation orotrachéale at a patient of the urgency at the risk for the aspiration”, and more precisely of “the quasi simultaneous administration of sedatives and an agent of blocking neuromusculaire in order to facilitate intubation orotrachéale”. The ISR is thus a technique of intubation orotrachéale adapted to the context of the Urgence.

Since 1996, the ISR was spread gradually in the services of urgencies of the whole world where it became a standard technique, replacing even advantageously other techniques of intubation.

The techniques allowing the final inspection of the air routes and ventilation should be controlled by any doctor working with the urgencies and the ISR in fact part. Moreover, this technique supports the success of an intubation because it makes it possible to obtain technical requirements and physiological ideal and thus decreases the risks of failures and complications. That is all the more important as the patients met with the urgencies are patients at the risk (unstable on the level hemodynamic, in hypoxia, at the risk of aspiration because with full stomach…).

Unfolding of the ISR

The course of an intubation in fast sequence can be divided into various successive phases:

  1. Preparation, of the patient and the material.

  2. Pre-oxygenation of the pure oxygen patient.
  3. Preprocessing, in certain specific indications.
  4. Sedation: administration of hypnotic (the Thiopental is the reference, the Propofol and the étomidate can be employed according to the situation) a
  5. muscular Relaxation: administration of a curare (the succinylcholine is the reference, the Rocuronium can be employed in the event of counter-indication)
  6. Protection of the air routes, by applying the Maneuver of Sellick.
  7. Passage of the tube itself.
  8. Checking of the position of the tube by the pulmonary bilétérale and symmetrical sounding, confirmed in the ideal by three layouts successive and identical to the capnogramme
  9. Relaxation of the operation of Sellick.

Quotations

  • “ I remember, with horror, the early days off emergency medicine, when almost No emergency physician could access the appropriate drugs to C RSI. We struggled, our patient suffered, and, No doubt, lives sums were lost. ” Kenneth V. Iserson, MD

References

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