You're back?! Well... Welcome to episode two of the Rapid Sequence Interrogation (RSI) Podcast, and thanks for tuning in once again. If you are unaware, Mike Brown and I (Jared Patterson) are FOAMfrat educators looking to answer any of your EMS questions in a "rapid-fire" way. We take 3-5 of your questions and spend no more than 5 minutes answering them. We keep it short, just like the EMS attention span. Nothing is off-limits! Well, mostly. 


In this episode, Mike and I discuss five questions mixing some clinical topics and opinion pieces. We cover paralytic use in intubation/RSI, how to better engage medical director and drive protocol advancement, tagging bags, pre-oxygenation, and making your cot with "tight straps."


If you have a topic or question you would like addressed, contact us at This email address is being protected from spambots. You need JavaScript enabled to view it.. You can always message FOAMfrat on Facebook with your questions as well. 


Episode Questions:

1. I'm scared I may not get the airway/tube, so I only sedated my patient. Why would I paralyze them?

  • Everything regarding RSI is about setting yourself up for success. Utilizing a paralytic during the RSI or intubation procedure is no exception. You give a paralytic during the RSI/intubation procedure to increase your likelihood of success. 
  • If your patient has a pulse and you plan to RSI or intubate, PARALYZE THEM!
  • Paralytics reduce the likelihood of unwarranted events such as gagging, vomiting, patient movement, and biting down on equipment in the patient's mouth. Also, the pure relaxation and loss of muscle tone will create an environment for better intubation conditions, leading to a better glottic view. 


2. How can you best engage medical directors and drive protocol advancement?

  • Approach your medical director with evidence and enthusiasm -- come prepared. 
  • Don't take it personally if you are shot down. A persistent approach while showing strong evidence will assist with protocol advancement. 
  • Evidence. Evidence. Evidence. Just because someone else is doing it, or because it's on a podcast, doesn't mean you should make the change. 


3. Why should I pre-oxygenate my patient? How should I do it?

  • You should pre-oxygenate your patient to replace the predominantly nitrogenous mixture of room air within the lung to allow for several minutes of safe apnea time before desaturation occurs during the RSI or intubation procedure. Pre-oxygenation buys us time to place our tube without any negative or adverse effects -- sometimes several minutes, to upward of 8-10 minutes of safe apnea time before desaturation below 90% 
  • Simply put, how you pre-oxygenate is to utilize 100% oxygen, or as close to it as possible. Then have the spontaneously breathing patient take either eight vitals capacity breaths or continue tidal volume breathing for 3 - 5 minutes. If the patient isn't sufficiently breathing, PPV with a BVM and PEEP valve should replace the tidal volume breathing. 


4. Should bags and compartments be tagged or not?

  • Both of your hosts are in the "NO" camp. How do you know the crew before you replaced all of the equipment before tagging? If you're not regularly checking the equipment within your rig, how do you remain proficient in the location of vital equipment? How do you know that equipment isn't broken?


5. Does it really mean anything if you tighten the straps on your cot when you make it?

  • Mike doesn't think it means a darn thing! But, he also believes that we should all take pride and ownership in our overall professional appearance. 
  • Jared would "press" his sheets if he could... REALLY?! A well-made cot represents an EMS professional who cares about the fine details, making its way into patient care. 
  • Tuck your shirt in, John Beck!



Thanks for listening, fam. 


Podcast 103 - The EMS PA? w/ Chip Lange
Podcast 102: No Agenda w/ Chris Meeks & Jay Nance

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