UMEM Educational Pearls

Title: Back 2 Basics Series: Your Simple RSI Checklist - SOAP ME

Keywords: Airway, critical care, RSI, rapid sequence intubation (PubMed Search)

Posted: 11/3/2014 by John Greenwood, MD (Emailed: 11/4/2014) (Updated: 11/4/2014)
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Back 2 Basics Series: Your Simple RSI Checklist - SOAP ME

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 don’t have a checklist – this simple mnemonic will make sure you are well prepared for a successful intubation.

Mnemonic – “SOAP ME”
Suction	Yankauer suction placed under the mattress on the right side, head of bed (x2 if GI bleed, vomiting, or lots of secretions)
Oxygen	Bag valve mask (with PEEP valve) ready Non-rebreather mask on patient (O₂ wide open) Nasal cannula on the patient (with 15L O₂) during RSI
Airways	Oral, nasal airways 2 ETT (expected size & one size below) w/ balloons checked, & stylet straight to cuff 1 ETT ready for video laryngoscopy (curved stylet needed) Rescue devices (Laryngeal mask airway, scalpel, etc.)
Positioning	Ear-to-sternal notch position Ramped if obese
Monitors & Meds	Continuous monitoring devices RSI Meds: Drawn up in carefully considered doses, labeled syringes Sedative (Ketamine, etomidate, etc.) Paralytic (rocuronium, succinylcholine) Post intubation sedation meds (Propofol, fentanyl, etc)
EtCO₂ & other Equipment	Continuous EtCO₂or at least color-change device to confirm successful intubation Bougie placed under the mattress next to yankauer suction 2 laryngoscopes (MAC 3 & 4) with lights checked. Video laryngoscope plugged in & turned on

The SOAP ME mnemonic is a quick and useful technique to remember only the basics of airway management and preparation. Always remember to also assign roles to team members and communicate clearly to maximize your chances of success.

References

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