The why of DSI

Hi folks

Great EMCrit Live show today. for those of you who missed out catch the podcast coming out soon. But next time try to make it along. It would be great to have a huge international online audience at the next one and we can have some cool debate and dialogue.

Now I will announce the winner of the first PHARM competition soon but today Scott was talking about DSI and touched on a few things. I wanted to emphasise some of these

Firstly I want to refer people back to EMCrit Podcast 40. This should be the reference we all use when we talk about DSI, the original concept.

I accept that its natural that clinicians will modify and alter the original concept to suit them. Just like RSI has been modified and everyone does it a bit differently.

Scott advises ketamine, one dose, preoxygenate, paralytic and tube. Thats pure vanilla DSI. If you dont want to use ketamine due to hypertension, then he talks about dexmedetomidine.

My modification of DSI is to use fentanyl in hypertensive patients, small doses like 50mcg.

The point is, its sedation/analgesia to allow some preoxygenation to occur prior to intubation. It is still a fairly short lived procedure in its original concept. Look at the timings on this slide from Scott

Dont confuse how to improve preoxygenation ( CPAP,BVM with PEEP, nasal cannula etc) with DSI per se. DSI is a procedural sedation. Preoxygenation is a separate but linked issue.