BoardsBridgeTrauma Induction: RSI in the Unstable Trauma Patient
Rapid sequence induction with cervical-spine immobilization and secondary-injury prevention for trauma anesthesia
Trauma rapid-sequence induction is a time-pressured procedure that simultaneously secures the airway under manual in-line stabilization, defends against hypoxia and hypotension, and prevents secondary brain injury — the airway plan must explicitly address immobilization, device, operator, and rescue oxygenation rather than treat motion minimization as the sole goal.
If you forget
HEADLINE: Plan first-pass success — immobilization + device + operator + rescue O2; never motion minimization alone.
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Key numbers
- Succinylcholine 1.5 mg/kg IV; contraindicated after burns >24h, denervation >72h, crush, hyperkalemia, MH
- Rocuronium 1.2 mg/kg IV RSI dose (1.0 mg/kg intubating); reversal sugammadex 16 mg/kg
- Ketamine 1-2 mg/kg IV induction; 0.5-1 mg/kg in severe shock; 2 mg/kg in asthma
- Etomidate 0.3 mg/kg IV (single dose acceptable in trauma; avoid continuous infusion)
- SBP goal ≥ 100-110 mmHg in TBI (or MAP ≥ 80-85); SpO2 ≥ 94%
- Apneic oxygenation: nasal cannula 15 L/min throughout laryngoscopy
- First-pass success target ≥ 85-90% in trauma; aim EtCO2 waveform ≥ 6 consistent breaths
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: DAS Cervical Spine Airway 2024 · ACS TQP TBI Best Practices 2024
Re-review cadence: 12 months from reviewed date.
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Card ID: trauma-induction · Path: aba.trauma.primary-survey-resuscitation.trauma-induction