Hi Folks! Many of you have requested these DSI protocols from Dr Rob Bryant , Emergency Physician in Salt Lake City, Utah. He has responded to your requests!Here are the files for download. Please use them as reference and educational material only and attribute the authorship if presenting material to others. Upcoming podcast interview with Dr Bryant on his experiences of implementing DSI in his shop and how the nurses he works with now call DSI – “Damn Sexy Intubation!”
DSI one page protocol
DSI presentation
Delayed Sequence Intubation Formal Protocol
preoxygenation and prevention of hypoxia (Weingart and Levitan seminal paper on emergency oxygenation)
Minh,
Sorry for the delay. Here are my DSI materials that should be enough to convince any reasonable Respiratory Therapy department / ED director to proceed with a DSI protocol.
1. DSI presentation powerpoint slides from the talk I gave to my group to sell DSI to them
2. One page DSI protocol that describes the process in easy steps
3. Formal protocol, with printable cards that can be laminated as DSI pocket references. (I am working on a ‘PV’ card for Michelle Lin’s PV card collection)
4. Weingart / Levitan article from March annals of EM.
Let me know what questions you have, and when (and how) you want to discuss this.
It is one of my favorite procedures as it truly takes a situation that was a guaranteed clusterf#$% and turns it into a smooth, safe, controlled experience.
Thanks for the excellent podcast and blog,
Rob
Rob Bryant MD
Utah Emergency Physicians
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Prehospital and Retrieval Medicine - THE PHARM dedicated to the memory of Dr John Hinds 
Once we get ketamine on the North Carolina formulary I’m very interested in getting this added as a protocol for EMS. Literature shows we could avoid even more intubations. Granted, if we put it on the trucks we would be ahead of our ED!
As you investigate the Oxylator (Mihn), you’ll find it can perform the role of pre oxygenation detailed in the one-page DSI document. During the apneic period, the Oxylator will continue to ventilate the patient, though, unless you turn off the Automatic mode. I personally do not agree with this long standing fixation on allowing apnea during the airway management of full-stomach patients. Most of the patients whom I’ve seen regurgitate during RSI procedures were as a result of the fasiculations from succinycholine. Gentle positive pressure ventilation will not predispose opening of the UES (upper esophageal Sphincter). And by gentle, I mean controlling the inspiratory flow rate to 30 lpm. You can do that with a machine (like an Oxylator or a formal ventilator) or you can do it with a modified (and expensive) BVM that holds the inspiratory flow rate to 30 lpm maximum. Those are by O-Two medical technologies (Smart Bag, http://www.otwo.com/prod_bmv.htm). I tried one of these at a trade show, and the flow limiting aspect of these bags makes it so hard to squeeze the bag that it almost takes the efforts of manual chest compressions to ventilate the patient. Go the technological route, and consider CONTINUING ventilation throughout the traditional “apneic” period. It’s baloney.
Jim, Agree with the above. You will find that a nasal cannula at 15 lpm with a BVM held tightly with a PEEP valve will also give safe insp flow and PEEP.