Rapid Sequence Intubation

1. Be prepared to perform a surgical airway.

2. Preoxygenate with 100% O2.

3.  Apply pressure over cricoid cartilage

4. Sedate:
- etomidate 0.3mg/kg
- or midazolam 2-5mg IV.

5. 1-2mg/kg succinylcholine IV (usual 100mg).

6. Intubate upon relaxation orotracheally.

7. Inflate cuff and confirm placement.

8. Release cricoid pressure.

9. Ventilate.

Notes
The provider should be skilled, knowledgeable and capable.
Etomidate
does not effect BP or ICP
- use with great care, ie avoid over-sedation.
Succinylcholine acts in <1min and lasts ~5mins.
- if ET tubing fails, you must bag-mask until paralysis resolves.
- avoid in those with chronic renal failure (hyperkalaemia risk), paralysis or neuromuscular disease.
Induction agents are dangerous in the hypovolaemic.
- small doses of diazepam or midazolam are appropriate, but have flumazenil available.