Position for RSI

[deleted126335]

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Curious as to what folks are doing re pt positioning. Head up, head down, or neutral. Arguments for each are obvious. Just want to see what people are actually doing.

 

[OB1🤙]

Head up for me.

I intubate everybody head up, unless the table physically cannot (i.e. cath lab).

 

[deleted59964]

head up - I position to optimise for intubation, not to prevent aspiration.
i figure most likely way to make patient aspirate is to fail at intubation, and then have difficult bag mask ventilation because the abdominal contents are sitting on the diaphragm.

 

[sevoflurane]

Reverse TB. Especially the large BMIs (w or w/o RSI).

 

[narcusprince]

Straightforward RSI Full stomach without any particulat matter in the oral pharynx head up. If actively vomiting and or succous in the mouth head down.

 

[Triple AAA]

I usually just leave the table flat and then place a ramp/blankets to optimize sniffing position. If they are actively desaturating and/or have significant abdominal girth, I'll put the head of the bed up. Of course, I may also keep them awake and intubate flat with the fiberoptic scope.

 

[Spinach Dip]

prone, with left knee bent at 90 degrees.

 

[Mman]

I think if they are enough head up and you give them a full induction dose and give the succinylcholine time to work, they theoretically shouldn't be able to aspirate. You need to either be head flat (or down) or have retching to get the gastric contents to be able to spill up into the oropharynx because it's either passively spilling with gravity or actively being forced up. So if I'm doing an IV induction and RSI, I'm going head up. Easier to intubate and I think less likely to aspirate.

 

[pgg]

Good sniff, head up a bit. I'm a believer that the most important part of an RSI is the R so I position to make my 1st attempt my best, if the airway isn't a chip shot.

Also, you get better preoxygenation/denitrogenation head-up, especially in the obese. Bonus points if they can tolerate a bit of CPAP prior to induction.