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Clinical Indications:

    Need for airway control in a patient who has a gag reflex or trismus.

Clinical Contraindications:

    Significant burns between 24 hours old and 2 weeks old.
    Known neuromuscular disease such as myasthenia gravis, amyotrophic lateral sclerosis, muscular dystrophy, Guillain-Barre syndrome.
    Chronic renal failure and on hemodialysis
    Age less than 12 years
    Patient or family history of malignant hyperthermia


    1. Preoxygenate patient with 100% oxygen via NRB mask or BVM
    2. Monitor oxygen saturation with pulse oximetry and heart rhythm with ECG
    3. Ensure functioning IV access
    4. Evaluate for difficult airway (LEMON)-see appendix
    5. Perform focused RSI neurological exam.- see appendix
    6. Prepare equipment (intubation kit, BVM, suction, RSI medications,BAID (King), Cricothyrotomy kit, CO2 detection devices.
    7. Administer Etomidate 0.3 mg/kg
    8. Stroke/head trauma suspected? If yes, Lidocaine 1mg/kg
    9. In-line c-spine stabilization by second caregiver using inline immobilization by second caregiver.
    10. Apply cricoid pressure using BURP technique.
    11. Administer Succinylcholine 1.5mg/kg
    12. Intubate trachea
    13. Verify ET placement
      a. Auscultation

      b. ET capnograph

      c. Pulse oximetry

    14. May repeat Succinylcholine if inadequate relaxation after 2 minutes
    15. Release cricoid pressure and secure tube
    16. Reassess and document after each patient movement, electrical therapy, change in bag compliance, change in Pt status, and transfer of Pt care at the hospital.
    17. Document the procedure, time, and result (success) on/with the patient care report (PCR)

Certification Requirements:

    Successfully complete an annual skill evaluation inclusive of the indications, contraindications, technique, and possible complications of the procedure.

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