Title: Back 2 Basics Series: Your Simple RSI Checklist - SOAP ME<br/>Author: John Greenwood<br/><a href='http://umem.org/profiles/faculty/412/'>[Click to email author]</a><hr/><p>
<u><strong>Back 2 Basics Series: Your Simple RSI Checklist - SOAP ME</strong></u></p>
<p>
The use of a checklist during high stress medical procedures is often recommended. Rapid sequence intubation (RSI) is a classic situation where having a checklist can ensure adequate preparation however, if you <em>don’t </em>have a checklist – this simple mnemonic will make sure you are well prepared for a successful intubation.</p>
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<table border="1" cellpadding="1" cellspacing="1" style="width: 500px">
<thead>
<tr>
<th scope="col" style="text-align: left">
Mnemonic – “SOAP ME”</th>
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</th>
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<td>
<strong>S</strong>uction</td>
<td>
<ul>
<li>
Yankauer suction placed under the mattress on the right side, head of bed (x2 if GI bleed, vomiting, or lots of secretions)</li>
</ul>
</td>
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<td>
<strong>O</strong>xygen</td>
<td>
<ul>
<li>
Bag valve mask (with PEEP valve) ready</li>
<li>
Non-rebreather mask on patient (O<sub>2</sub> wide open)</li>
<li>
Nasal cannula on the patient (with 15L O<sub>2</sub>) during RSI</li>
</ul>
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<td>
<strong>A</strong>irways</td>
<td>
<ul>
<li>
Oral, nasal airways</li>
<li>
2 ETT (expected size & one size below) w/ balloons checked, & stylet straight to cuff</li>
<li>
1 ETT ready for video laryngoscopy (curved stylet needed)</li>
<li>
Rescue devices (Laryngeal mask airway, scalpel, etc.)</li>
</ul>
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<td>
<strong>P</strong>ositioning</td>
<td>
<ul>
<li>
Ear-to-sternal notch position</li>
<li>
Ramped if obese</li>
</ul>
</td>
</tr>
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<td>
<strong>M</strong>onitors & <strong>M</strong>eds</td>
<td>
<ul>
<li>
Continuous monitoring devices</li>
<li>
RSI Meds: Drawn up in carefully considered doses, labeled syringes
<ul>
<li>
Sedative (Ketamine, etomidate, etc.)</li>
<li>
Paralytic (rocuronium, succinylcholine)</li>
</ul>
</li>
<li>
Post intubation sedation meds (Propofol, fentanyl, etc)</li>
</ul>
</td>
</tr>
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<td>
<p>
<strong>E</strong>tCO<sub>2</sub> & other <strong>E</strong>quipment</p>
</td>
<td>
<ul>
<li>
Continuous EtCO<sub>2 </sub>or at least color-change device to confirm successful intubation</li>
<li>
Bougie placed under the mattress next to yankauer suction</li>
<li>
2 laryngoscopes (MAC 3 & 4) with lights checked.</li>
<li>
Video laryngoscope plugged in & turned on</li>
</ul>
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</tr>
</tbody>
</table>
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<p>
The SOAP ME mnemonic is a quick and useful technique to remember only the <em>basics</em> of airway management and preparation. Always remember to also assign roles to team members and communicate clearly to maximize your chances of success. </p>
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<span style="text-decoration: underline"><span style="text-decoration: underline"><u><strong>References</strong></u></span></span>
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<span style="text-decoration: underline"><span style="text-decoration: underline"><a href="http://www.airwaycam.com/emergency-airway-algorithms.html">Dr. Richard Levitan</a></span></span></li>
<li>
<a href="https://umem.org/profiles/faculty/81/" style="text-align: center">Dr. Ken Butler</a></li>
</ol>
<p style="text-align: center">
<strong style="text-align: center">Follow me on Twitter @JohnGreenwoodMD</strong></p>
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