ABSTRACT

Endotracheal intubation creates, maintains and/or protects the airway, plus f­acilitates ventilation. The objective of rapid sequence induction intubation is to secure the airway as rapidly as possible and assumes that the patient has a full stomach and is at risk of aspiration of gastric contents. Pre-determined doses of intravenous anaesthetic and a rapid-acting paralysing drug are given to enable the ­intubation. Indicators of raised intracranial pressure with or without mass effect such as focal neurological signs, papilloedema, altered conscious level, bradycardia, hypertension and abnormal respiratory pattern. Two doctors are required, one with anaesthetic experience and previous training in the procedure to perform the block, and the other to perform the manipulation. Use a specifically designed and properly maintained Bier's block cuff, and check first for leaks or malfunction. Apply the cuff to the upper arm over cotton-wool padding.