Wednesday, November 26, 2008

What's in your RSI box?

Nurse K posted a random bleg a while ago about RSI boxes. I must admit that when she mentioned that her ED didn't have a RSI (Rapid Sequence Induction) box, I was slightly surprised. I thought all EDs had something similar - I mean, having one makes a lot of sense.

But then again, my old hospital's ED didn't have one either.

So Nurse K, here's what we have in our ED:
- Meds in the box:
* Atropine Sulfate (1 mg/10 ml) prefilled syringe X 1
* Etomidate (2 mg/ml) 10 ml vial X 1
* Ketamine Hydrochloride (50 mg/ml) 10 ml vial X 1
* Lidocaine Hydrochloride 2% (100 mg/5 ml) prefilled syringe X 1
* Midazolam (2 mg/2 ml) vial X 2
* Succinylcholine (20 mg/ml) 10 ml vial X 1
* Vecuronium (10 mg) vial X 1

- Dilutants:
* Sterile Water for injection (10 ml) vial X 2

- Tools:
* 60 ml syringe X 1
* 20 ml syringe X 2
* 10 ml syringe X 2
* 3 ml syringe X 3
* BD 18G 1.5 inch IV needle X 2
* Easy Cap II Carbon Dioxide detector X 2 (no longer used. Now part of intubation bag)

- Misc:
* Alcohol swabs x 15
* Controlled substance documentation form

Some piccys:

RSI Box against a standard computer keyboard (to provide scale for sizing).

Closer view of RSI (notice the red pharmacy lock indicating a stocked, ready to use box).

Naturally, no nursing job can be complete without "documentation". A typical pharmacy use/waste form. Two RNs (or an RN and Pharmacist) to initial waste/use before restocking and locking the box.

We have 3 such boxes in our ED. Our airway/intubation kits are separate (they usually hang out in the trauma/code rooms near our crash carts). A while ago we decided to switch out CO2 detectors from the RSI boxes to the airway boxes. There are separate kits for peds intubation (in separate boxes as well). We also have our own anti-platelet/thrombolytic boxes (tPA, tnkASE, Integrilin).

Once a box has been used, a nurse (or tech) walks the box down to pharmacy and it gets re-stocked.

So, what's in your RSI box?