Box 1-1: Rapid Sequence Intubation
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Patient will not be able to maintain an airway or breathe after
paralysis. Use this technique only if you are comfortable with intubation.
Before Paralysis:
- Preoxygenate, IV lines, monitor, oximetry, equipment including
that for emergency surgical airway control.
- Lidocaine 1 mg/kg (100 mg*).†
- Atropine 0.01 mg/kg (0.5 mg, minimum of 0.1 mg*).‡
- Vecuronium 0.01mg/kg (1 mg*)§ prevents fasciculation IF
using succinylcholine (no need with rocuronium or vecuronium).
- Begin Sellick maneuver (cricothyroid pressure to prevent vomitting
and aspiration).
Paralysis:
- Midazolam 0.1 mg/kg (7mg*)|| OR Etomidate 0.3 mg/kg IV
(duration 3-5 minutes) THEN Succinylcholine 1.5 mg/kg (100
mg*)¶ OR Rocuronium 0.6-1.2 mg/kg IV OR
Vecuronium
0.10 mg/kg (10 mg*)
Intubation When Relaxed:
- Assess tube placemetn.
- Check patients temperature 8 minutes after intubation
if succinylcholine used.
*Usual adult dosage
†May be omitted in non-head injury cases
‡May be omitted in adults if no preexistent
bradycardia
§May use pancuronium (same does).
This step is optional.
||May use thiopental 3 to 5 mg/kg (300 mg*).
¶ Dose in children is 1.5 to 2 mg/kg. |
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