RSI Checklist

Emergency Consultant present or informed?
Keep
Discard
Unsure
Other
Please Specify:
If difficulty anticipated, anaesthetics mobilised?
Keep
Discard
Unsure
Other
Please Specify:
Allocate roles as required:
Keep
Discard
Unsure
Other
Please Specify:
Preoxygenation optimal? Mask O2? Nasal prongs 15L? Consider CPAP?
Keep
Discard
Unsure
Other
Please Specify:
IV access optimal? Fluid running opposite to BP cuff? Spare IV patent?
Keep
Discard
Unsure
Other
Please Specify:
Patient condition optimised? BP seen? Fluid bolus required? Vasopressor required?
Keep
Discard
Unsure
Other
Please Specify:
Patient position optimal? Occiput support? Ramping required?
Keep
Discard
Unsure
Other
Please Specify:
Monitoring- BP? ECG? O2 Sats? ET CO2?
Keep
Discard
Unsure
Other
Please Specify:
Drugs & Doses Checked? Induction agent? Paralytic agent? Vasopressor? Post RSI analgesia & sedation?
Keep
Discard
Unsure
Other
Please Specify:
BVM attached to O2?
Keep
Discard
Unsure
Other
Please Specify:
Suction working?
Keep
Discard
Unsure
Other
Please Specify:
OPA/NPA?
Keep
Discard
Unsure
Other
Please Specify:
Laryngoscope blade + light checked?
Keep
Discard
Unsure
Other
Please Specify:
ETT selected + cuff checked?
Keep
Discard
Unsure
Other
Please Specify:
Alternate ETT selected cuff checked?
Keep
Discard
Unsure
Other
Please Specify:
Stylet + bougie?
Keep
Discard
Unsure
Other
Please Specify:
Syringe for cuff inflation?
Keep
Discard
Unsure
Other
Please Specify:
Tube tie?
Keep
Discard
Unsure
Other
Please Specify:
Is this predicted to be a difficult airway?
Keep
Discard
Unsure
Other
Please Specify:
If airway difficult could we wake the patient up?
Keep
Discard
Unsure
Other
Please Specify:
What is Plan A
Keep
Discard
Unsure
Other
Please Specify:
Plan B?
Keep
Discard
Unsure
Other
Please Specify:
Plan C?
Keep
Discard
Unsure
Other
Please Specify:
Plan D
Keep
Discard
Unsure
Other
Please Specify:
Is equipment for plans B-D present?
Keep
Discard
Unsure
Other
Please Specify:
Are any specific complications expected?
Keep
Discard
Unsure
Other
Please Specify:
Immediate post-RSI care briefed?
Keep
Discard
Unsure
Other
Please Specify:
Any questions from the team?
Keep
Discard
Unsure
Other
Please Specify:
I am a...
Nurse
RMO/Intern
Registrar
Consultant
Other
Please Specify:
Other comments...
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