by Weingart S, Nickson C, Rabinovich J, Strayer R. version
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1 EMCrit Call/Response Intubation Ch Plan HOp Killers-Hemodynamics, Ox, ph RSI Awake DSI RSA ICP/Vascular Induction Agent/Muscle Relaxant Push-Dose Presss Failed Airway Plan Verbalized Cric-Con Evaluation (± Mark/Inject) Post-Intubation Sedation P by Weingart S, Nickson C, Rabinovich J, Strayer R. version Roles Assig Pulse Ox E
2 ntubation Checklist Patient Prep Denitrogenation Oxygenated (Consider CPAP) Look in Mouth Dentures Positioning (Face Parallel, Ears/Notch, 30 Head-Up, Collar Plan) Monits (Pulse Ox Visible) Reliable Access Nasal Prongs f ApOx ± Gastric Tube Wa (Tube, 2 F
3 Equipment Table BVM (± PEEP Valve) on Oxygen Wavefm Capnograph on BVM & Tested Video Laryngoscope Intubation Equipment (Tube, 2xBend Stylet, 2 Syringes, Back-Up Laryngoscope, OPA, Tube-Securing Device) Failed Airway Equipment at Bedside (At minimum: NPA. Bougie, SGA, Scalpel) Suction x 2 lan
4 on Reliable Access Nasal Prongs f ApOx ± Gastric Tube (At is all in PPE Fold an tion IV (give as early as possible) eri opharynx e depress 1-2 ml Ketamineame syringe) cds paralyze on Meds ve D o se N o rm o te n sive D o se (7 0 kg P t) Pretreatment 3-5 minutes pri to intubation o Lidocaine 1.5 mg/kg f High-ICP/Vascular with elevated BP o Fentanyl 3 mcg/kg f High-ICP/Vascular with elevated BP (alternatively Remifentanil 3 mcg/kg) o Scopolamine 0.4 mg f amnesia in hypotensive pt intubation Cric-Con o All Airways: Discuss/Feel/See Kit (5) o Diff. but Stable: Mark/Kit to Bedside/US (4) o Diff. & Hypoxemic: Inject / Prep / Open Kit / Scalpel in Hand (3) H yp o te n sive D o se Push-Dose Epi o In a 10 ml syringe, add 9 ml NS o Into this syringe draw up 1 ml of Cardiac-Arrest (1:10000) Epinephrine o Shake Syringe Hard o Label Epinephrine 10 mcg/ml o Dose ml (5-20 mcg) q 1-5 min o Throw away at end of shift if unused Sux Contra Info Go to emcrit.g/ airway Initial Ana o Fentanyl 2 mcg/kg o Hydromphone 0. analgesia o Midazolam 0.05 mg o Propofol 0.5 mg/kg o Ketamine 1 mg/kg b Titrate to c Initial Ven
5 by Weingart S, Nickson C, Rabinovich J, Strayer R. version is all in PPE Fold and use only this side during Checklist Procedure Awake Intubation o Glycopyrrolate 0.2 mg IV & Ondansetron 4mg IV (give as early as possible) o Suction mouth and then pad dry with gauze o Nebulized Lidocaine 4% 6 lpm o Atomized Lidocaine 4% 3ml sprayed into posteri opharynx o Viscous Lidocaine lollipop 2%, place on tongue depress o Preoxygenate o Position o Restrain arms o Switch to nasal cannula at 15 lpm o Sedate with aliquots of Ketamine (10-20 mg) 1-2 ml Ketamine- Heavy Ketofol (75 mg Ketamine, 25 mg propofol in the same syringe) o Atomized Lidocaine 4% 3ml sprayed through cds o Intubate awake place bougie, then sedate/paralyze D rug Intubation Meds N o rm o te n sive D o se Nm otensive Dose (7 0 kg P t) Hypotensive Dose K e tam in e 2 m g/kg m g 0.5 m g/kg K e to fo l (1 0 0 m g ke ta m in e, m g p ro p o fo l to m a ke 2 0 m l) 0.2 m l/kg 1 4 m l Eto m id ate 0.3 m g/kg 2 0 m g 1 0 m g P ro p o fo l m g/kg m g 1 5 m g Su c c in ylc h o lin e m g/kg 140 m g 2 m g/kg Ro c u ro n iu m 1.2 m g/kg 8 0 m g 1.6 m g/kg V e c u ro n iu m 0.3 m g/kg 2 0 m g Pretreatment 3-5 minutes pri to intubation o Lidocaine 1.5 mg/kg f High-ICP/Vascular with elevated BP o Fentanyl 3 mcg/kg f High-ICP/Vascular with elevated BP (alternatively Remifentanil 3 mcg/kg) o Scopolamine 0.4 mg f amnesia in hypotensive pt intubation Cric-Con o All Airways: Discuss/Feel/See Kit (5) o Diff. but Stable: Mark/Kit to Bedside/US (4) o Diff. & Hypoxemic: Inject / Prep / Open Kit / Scalpel in Hand (3) Push-Dose Epi o In a 10 ml syringe, add 9 ml NS o Into this syringe draw up 1 ml of Cardiac-Arrest (1:10000) Epinephrine o Shake Syringe Hard o Label Epinephrine 10 mcg/ml o Dose ml (5-20 mcg) q 1-5 min o Throw away at end of shift if unused Sux Contra o Malignant Hyperthermia Histy o Strokes with hemiparesis > 72 hours old o ICU Stay > 2 weeks o Burns/trauma > 72 hours old o NMJ Disease o Myopathies/Muscular Dystrophies o Preexisting Hyperkalemia Strong suspicon o Guillain-Barre Info Go to emcrit.g/ airway Initial Post-Intubation Analgo-Sedation o Fentanyl 2 mcg/kg bolus then 1 mcg/kg/hr o Hydromphone mg bolus then repeat q 10 minutes until analgesia and o Midazolam 0.05 mg/kg bolus then mg/kg/hr o Propofol 0.5 mg/kg bolus then 20 mcg/kg/min o Ketamine 1 mg/kg bolus then 0.5 mg/kg/hr Titrate to calm, spontaneously-breathing patient Initial Vent o Assist Control/Volume Mode o Vt 8 ml/kg IBW o RR 16 (10 in asthma/copd) o IFR 60 l/min o PEEP 5 (0 in asthma/copd) o FiO2 40% AirQs This checklist is f infmational purposes only. ALL infmation must be vetted with your clinical judgment, pharmacy, and hospital committees/regulations. Low ph Tube o Place on Vent (SIMV-Volume, Vt 550, FiO2 100%, IFR 30 lpm, PS 10, PEEP 5, RR 0) o Place on ETCO2 o RSA Vent as Bag (Change RR to 16) o Change Vent to (IFR 60 lpm, RR 30, VT 8 ml/kg, FiO2 40%) o Confirm same ETCO2 and send ABG o Females: 3.5, 7.5 ET Max, inflate 4 ml, 18 cm to tip o Males: 4.5, 8.5 ET Max, inflate 5 ml, 20 cm to tip
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