Delayed Sequence Intubation or DCI…Deadly Critical Intubation? Nope that doesnt sound better..

Another PK SMACC 2013 entry by yours truly! Enjoy



6 thoughts on “Delayed Sequence Intubation or DCI…Deadly Critical Intubation? Nope that doesnt sound better..

  1. Minh,

    Very nice podcast.

    At least for me, the title gave me the impression that this podcast was going to be an argument against DSI. I do think you did a fine job presenting evidence in support of DSI. I too believe that the name delayed sequence intubation may set it up with a bad wrap, because to paraphrase you, who wants to delay intubation. In talking with colleagues locally (a few hundred miles north of Weingart), I think many preconceived misconceptions stem from a basic misunderstanding of the fact that there is absolutely nothing rapid about RSI.

    I think RSI was a poor name choice for the procedure in the first place, but we are stuck with it. As an educator of airway management providers from the basic EMT through physicians of various disciplines, I believe that it is our obligation to instill a proper sense of what RSI truly is and what it is not. Far to often RSI or some perverted version of it is all many providers come out of training with, and often bad training at that.

    Here in the states, we are seeing a rapidly growing number or non-emergency medicine trained physicians working in the emergency department as their primary employment. A few years ago I did a review of numerous family practice and internal medicine training program curricula and found that the vast majority of these programs have no formal airway management training; and many consider ACLS as adequate airway management and intubation education. We are also seeing a growing number of hospitalist and intensivist programs being staffed by family practice and internal medicine trained providers and often these providers are responsible for all intubations outside the operating suite.

    I have taught a basic to advanced airway management class for the residents at my facility for several years, and unfortunately this year the program was completely cut due to budget cutbacks. It is unfortunate to see many facilities consider airway management training so low on their priority list that it is the first to go during hard budget times.

    Kyle Williams, RN, CFRN, EMT-P
    Flight Nurse – Paramedic
    New York, USA

    1. thanks Kyle for your feedback! We all have an airway. It is essential to life. It gives us our voice. The trachea is a remarkable piece of design and organic engineering, flexible enough to bend but robust enough to maintain gas exchange to the outside.

      to respect it, we must constantly train to the highest level achievable.

  2. I’ve never seen DSI done but preoxygenating under ketamine seems like an optimally safe approach to preparing for intubation. Hopefully some studies will propel it into the mainstream.

    Just an aside, I’m a PGY-I in Canada and I’m seeing propofol used almost exclusively for procedural sedations whereas ketamine was preferred at the med school I went to in the US. I preferred ketamine.

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