33.0 RAPID SEQUENCE INTUBATION and VENTILATOR
All Providers
- Indications
- Respiratory failure or apnea not amenable to other measures
- Cardiac monitor, ETCO2, pulse oximetry,
- Treatment Plan
- Assist advanced personnel with equipment and monitoring
- Evaluate airway – LEMON, etc.
- Prepare backup methods for BVM (King, iGel)
- IV/IO access patent
- Prepare equipment
- monitors and oximeter
- suction
- BVM, nasal and oral airways
- Endotrachael tube, syringe, scope (laryngoscope, video)
- Have a backup plan
Adult & Pediatric (not to exceed adult dose)
Paramedic
- Induction
- Etomidate 0.3 mg/kg IV/IO
- preferred in head injury patients
- Ketamine 1-2 mg/kg IV/IO
- preferred in patients with asthma
- sympathetic stimulation, no dose change in hemodynamic compromise
- PARALYTICS
- Succinylcholine 1.5 mg/kg IV/IO
- duration of action – 5 minutes
- consider 10% of loading dose as defasciculating dose
- contraindicated in hyperkalemia, can aggravate bronchospasm
- Rocuronium 1 mg/kg IV/IO
- duration of action approximately 40-60 minutes
- Secure tube
- Consider ongoing sedation/paralysis
- Consider NG/OG
- ETCO2 titrated to 35 mmHg unless otherwise indicated
- Initial Ventilator Settings
- Tidal Volume: 6 ml/kg
- Respiratory Rate: 10 per minute
- FiO2: (100%)
- PEEP of 5 cm H20 in COPD
- PEEP of 10 cm H2O in morbidly obese