Airway

Preparation (monitors, laryngoscope/BVM, ETT/stylet/syringe, all medications, suction,
-IV, LEMON for difficult airway, rescue devices)
            -Look; Evaluate 3-3-2 rule; Mallampati; Obstruction evidence; Neck mobility
Preoxygenation with 100% oxygen (NO positive pressure ventilation unless desat < 90%)
            -100% O2 for 5 minutes OR 2 to 6 Full Vital Capacity breaths of 100% O2
                        -Denitrogenizes alveoli and allows much longer time before desaturation occurs.
Pretreatment (LOAD)
            -Lidocaine- for RAD or increased ICP
            -Opioid (fentanyl)- blunts sympathetic responses (ICP/CAD/ruptured aneurysm)
            -Atropine- 10 years old and under
            -Defasciculation- increased ICP, penetrating eye injuries
Paralysis (and induction, which should be done first)
Protection with Sellick’s
Position for laryngoscopy
Placement with Proof (capnography the gold standard)
Post intubation management (hemodynamics, sedation and paralysis, vent settings)

Pretreatment

-Lidocaine 1.5mg/kg
-Opioid (fentanyl) 3mcg/kg
-Atropine 0.02mg/kg
-Defasciculating (pan/vec) 0.01mg/kg (10% of paralytic dose)

Induction

-Etomidate 0.3mg/kg
-Midazolam 0.3mg/kg
-Ketamine 1-2mg/kg
-Thiopental 3mg/kg

Paralytics

-Succinylcholine 1.5-2.0mg/kg
-Rocuronium 1mg/kg
-Pan/Vecuronium 0.15mg/kg

Sample sequences for 70kg adult:

Generic

Zero – 5 min:  100% oxygen
Zero:                Etomidate 20-30mg
                        Succinylcholine 100mg

Increased ICP

Zero – 5min      100% oxygen
Zero – 3min      Lidocaine 100mg
                        Vecuronium 1mg
                        Fentanyl 200mcg
Zero                 Etomidate 20-30mg
                        Succinylcholine 100mg

RAD/COPD

Zero – 5min      100% oxygen
Zero – 3min      lidocaine 100mg
Zero                 ketamine 100mg
                        Succinylcholine 100mg