Rapid sequence intubation

Intubating Agents

Sux

1.5mg/kg

2mg/kg kids

4mg/kg IM if no line

Roc

1mg/kg to intubate

0.6mg/kg to paralyze

Premeds

Atropine .01-.02 mg/kg

Lido 1.5mg/kg

Etomidate 0.3mg/kg

Vecuronium

intubate 0.3mg/kg

paralyze 0.1mg/kg

1) Preparation

SOAPME (Suction, oxygen, airway, pharmacology, monitoring, equipment)

2) Preoxygenate (can replace 30ml/kg of nitrogen)

100% NRB for 3-5 minutes or 8 vical capacity breaths w/ high-flow O2

3) Pretreatment

Inc ICP: Lidocaine 1.5mg/kg + Fentanyl 3-5mcg/kg

Isc Heart Dz/Dissection: Fentanyl 3-5mcg/kg

Reactive Airway Dz: Lidocaine 1.5mg/kg

Children (up to 10) Atropine .01-.02mg/kg (min 0.1/max 0.5)

4)Paralysis with induction

(see intubating agents)

5) Protection and positioning:

cricoid pressure until placement confirmed

sniffing position

6) Pass Tube

End-tidal CO2 detection is primary means of ETT placement confirmation

Cola-complication: need CO2 detection for at least 6 ventilations

7) Postintubation management

CXR

Long-active sedative (Midazolam 0.5mg/kg, Fentanyl 3mcg/kg)

Resp Arrest pts: consider esophageal detector device to confirm placement

7/1/09 Pani (Adapted from Harwood Nuss/Chp 1)