Box 1-1: Rapid Sequence Intubation

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).

  • 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 patient’s 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.