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o Preparation
Check monitors, IVs (2>1), equipment to see if they’re working
Patient’s external canal meatus should be level with sternal notch
Do this by placing bed linens to create a ramp under patient’s head
o Preoxygenation
3 minutes on 100% O2 nonrebreather mask or 6 vital capacity breaths
o Premedication – blunts adverse effect of laryngoscopy
Only if PREMED:
Pediatric – use ATROPINE 0.02 mg/kg
Reactive Airway Disease (asthma) – use LIDOCAINE 1.5 mg/kg
Elevated ICP (strokes) – use LIDOCAINE
MI – use FENTANYL 3 ug/kg
Elevated blood pressure
Dissection - FENTANYL
Give pretreatment 3 minutes before induction medications
o Paralysis with Induction
Induction meds first, then immediately give paralytic meds
Etomidate MC used
Use KETAMINE if CAD (causes tachycardia and thus demand
ischemia)
For paralytics, choose between succinylcholine and nondepolarizing agents
If crush injury (forearm fracture or diffuse bruising), use
VECURONIUM, ROCURONIUM (nondepolarizing agents)
o To reverse nondepolarizing agents, once you see partial
motor activity regained, give ATROPINE 1st (0.01 mg/kg IV),
then EDROPHONIUM (0.5-1 mg/kg IV)
Avoid succinylcholine for anything that may cause HYPERkalemia
o ALS, MS, muscular dystrophy, myasthenia gravis
o Stroke, spinal cord injury
o Major burns
o Sepsis > 5 days (esp. abdominal)
o Malignant hyperthermia history
o Caution with ESRD
o Placement of Tube (intubate)
o Postintubation
Confirm tube with ETCO2 and auscultation
ETCO2 confirms placement, NOT position and cannot r/o main stem
intubation
ETCO2 is most sensitive after SIX manual breaths
False negative ETCO2 can occur with massive PE, MI, or severe
pulmonary edema
Sedate with BENZOS or PROPOFOL to minimize agitation
OPIATES to control pain and blunt sympathetic response to intubation