What Is Acute Initiation?

Acute initiation – in English rapid sequence induction – refers to a tracheal intubation. This procedure is usually performed in the emergency room. In order to succeed, however, it is necessary to follow a series of steps that can endanger the patient’s life if they are skipped.

As one study says: ‘For the medical specialist in emergency medicine, airway management in care units and hospitals is a fundamental part of their basic competencies’.

Therefore, it is important that physicians know how to perform an emergency initiation. This will reduce the risk of lung aspiration in some patients.

When do doctors perform emergency initiation?

People need urgent initiation when they arrive at the emergency room with an imminent risk of ventilation failure. A quick evaluation prevents doctors from performing the procedure without precision.

The consequences of performing an acute initiation can range from hypoxia to causing damage to the airways when the tube is inserted into the airways. Therefore, it is important to be calm and follow the steps accurately.

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In some cases, it is not clear when intubation should be performed. However, when there is a possibility that the patient may need it, the doctor performs it.

However, the following symptoms must be considered. They can clearly indicate the need for an urgent initiation:

• Swollen hematoma (blood clot) in the neck
• Chest trauma with low blood pressure

• Extensive burns
• Obstruction of the airways
• Heart attack

If the patient, in addition to all this, is agitated because they cannot breathe normally, they need immediate anesthesia. Thereafter, the physician should perform the acute initiation as soon as possible.

Correct procedure

To perform a successful intubation, a series of steps must be followed. Doctors perform these steps in a smooth, fast and accurate manner. That way, they can avoid some of the consequences we mentioned earlier.

Actions before intubation

• Lift the patient’s head by placing a pillow under it.
• Lift the jaw by pushing it up and forward.
• Remove foreign bodies from trachea and oral cavity.

• Remove all secretions (blood, vomit).

Acute introduction

• Hold the laryngoscope with one hand, and insert through the corner of the mouth as you move your tongue and move the laryngoscope forward and upward.
• Place the tip of the instrument in the larynx.
• To reduce the risk of vomiting, another professional must perform the Sellick maneuver. They must do this within the duration of the intubation.
• In case the glottis or vocal cords are not very visible, another person must perform the BURP maneuver to reveal them. This allows doctors to position the laryngoscope correctly without damaging the airways.
• When the doctor inserts the tube correctly, they remove the laryngoscope without moving the tube. They will then connect it to the oxygen source.

Although we recommended using Sellick and BURP maneuvers, these should never be used if the patient suffers from trauma or has a foreign body in the trachea. This is very important to keep in mind.

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Medicine

In general, the use of medication is not necessary when performing acute initiation. However, there are cases where without medication it would be impossible to intubate the patient.

When a patient is restless, it is necessary to give them a sedative. In other cases, when the patient is in severe pain, you should also give them a painkiller in addition to a sedative.

There are a few circumstances where doctors in emergency rooms need to give patients a muscle relaxant. This is important when the tube cannot pass through the trachea due to pressure.

As you can see, induction is a procedure that all professionals working in the emergency room need to know how to perform properly. In this way, they can ensure that their patients experience the least possible damage to their airways.

In addition, it is important to know the medications they need to use in certain situations. Acute initiation is definitely an important first aid measure.