RSI Drugs Box
To maintain safety and communication during procedural sedation, resuscitation and induction of anaesthesia, and to reduce delay to safe drug administration, ‘RSI’ drug boxes are available to improve patient safety and resuscitation team performance.
They ensure a unified departmental approach to these common and high-risk situations.
Medications are provided in pre-stocked boxes that are available in all resus areas and will be taken to the patient’s bedside.
Boxes are designed to also be able to travel with the patients on transfers within the hospital (eg to ICU/ Radiology department).
Box Contents
ADULT Drug Box Contents
- Metoraminol minijet (2.5 mg/ 5 mL) x 2
- Phenylephrine minijet (0.5 mg/ 10 mL) x 1
- Atropine minijet (0.5 mg/ 5 mL) x 1
- Midazolam vial (10 mg/ 5 mL) x 1
- Rocuronium vial (50 mg/ 5 mL) x 3
- 20 mL syringe x 1
- 10 mL syringe x 1
- 5 mL syringe x 1
- Drawing-up needle x 3
- Labels x 2 for each above drug vial (except minijets)
PAEDIATRIC Drug Box Contents
- Metoraminol minijet (2.5 mg/ 5 mL) x 2
- Atropine vial (0.5 mg/ 5 mL) x 1
- Midazolam vial (10 mg/ 5 mL) x 1
- Rocuronium vial (50 mg/ 5 mL) x 3
- 10 mL syringe x 1
- 5 mL syringe x 1
- 3 mL syringe x 1
- Drawing-up needle x 3
- Labels x 2 for each above drug vial (except minijets)
Note: Atropine vial rather than minijet is used in Paed box as is drawn up neat for dosing, as per CUH Children's Resuscitation Book.
Induction/ sedation-analgesia drugs are kept separately: controlled drugs (fentanyl, ketamine) are available in the medication safes (Trauma Bay 1 and main Resus), other agents in main medication press. Propofol is not recommended as a sole induction agent in emergency department intubations.
Stocking/Checking Procedure
To be followed by resuscitation staff, as part of normal checks and restocking procedures:
- 6 drug boxes to be pre-filled (contents listed below)
- One box in each Trauma bay, three boxes in the resus area , 1 box in Children’s ED resus
- Remove outer packaging of Pre-Filled Syringes before placing in box
- Drugs disposed of after use
- Boxes restocked, used items replaced, immediately after use. Refilling is the responsibility of the user/ prescriber.
- Boxes sealed with tags after restock completed
- Boxes checked as part of normal drug checks by airway registrar (Adults) at start of each shift (transparent compartments, so no need to open)
Boxes produced, stock list agreed upon by EM consultant and nursing management groups, stakeholders consulted and feedback received (ICU/ anaesthesia consultant group, EM registrars).
Ongoing nurse and doctor education via integration into departmental induction, teaching sessions and simulation program.
