Paediatric DSI – dont Dis the DSI


In the August 2013 edition of Annals of emergency medicine, Scott Weingart and Eric Schneider ( both emergency physician -resuscitationists in USA) describe a case report in a letter to the journal.

It involves a 16 month old infant with bronchiolitis from respiratory syncitial virus, who deterioriates to the point of respiratory failure over course of a few days. On repeat presentation the child is in respiratory distress and clearly needing intubation and mechanical ventilatory support. However preoxygenation is impossible as the child cannot tolerate a face mask. With nasal cannula the SpO2 is 93%.

A delayed sequence intubation approach is adopted as described by Scott HERE
2mg/kg IV ketamine is given and full dissociation occurs, allowing preservation of spontaneous breathing but acceptance of oxygen mask application. The SpO2 raises to 99%.

Rocuronium 1mg/kg is given and successful intubation occurs on first pass with no drop in the SpO2 as nasal cannula oxygenation was continued throughout, and full denitrogenation had been accomplished.

This is the first report I am aware of in the medical literature of a paediatric DSI use.
Whilst I have performed several adult DSI cases, I have yet to do this in a child and this case report adds some experience to our knowledge base. Thanks to Scott and Eric!

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