It is imperative for pharmacists and other health care professionals to understand the dosing, onset of action, duration of action, and potential adverse effects of these medications to ensure continued safe practices in these critically ill patients. Health care professionals may be less familiar with these alternative therapies in terms of their pharmacology and adverse effect profiles. Health care institutions have faced challenges in recent years due to expected, and unexpected, drug shortages resulting in alternative drug utilization and changes to their RSI medication boxes to accommodate these changes. If done appropriately, RSI results in a success rate of more than 98.5% ( Reynolds & Heffner, 2005).
The role of medication therapy in RSI procedures is to provide adequate sedation and paralysis in order to assist with endotracheal tube placement. These steps also allow for any patient requiring advanced airway protection to be intubated with a decreased risk of vomiting and aspiration regardless of their preparation prior to the procedure. Rapid sequence intubation (RSI) is a streamlined, six-step process developed and used in most EDs to ensure each patient receives rapid airway placement in a universally concise and consistent manner ( Reynolds & Heffner, 2005). Indications for endotracheal intubation may include airway protection for patients with an inability to maintain airway patency, respiratory distress, undergoing sedation for medical and surgical procedures, trauma, and neuromuscular paralysis ( Neumar et al., 2010). One way to ensure appropriate airway management in these patients is to place an endotracheal tube or other artificial airway to assist with ventilation. AIRWAY MANAGEMENT is one of the primary roles of emergency personnel when critically ill patients present to the emergency department (ED).
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