• Anticipated need for airway management in pts at risk for deterioration
• Assess difficulty of intubation early
• In pts w/ acute respiratory failure, BVM ventilation or noninvasive positive pressure ventilation (NiPPV) can be a bridge but not a substitute to intubation
• Choose appropriate intubation algorithm
• Choose appropriate intubation tool
• VL: 1st choice, if available; failure rate is lower than w/ standard DL
• DL: Most commonly used (Mac or Miller blade)
• Awake sedated airway eval: Injection, inhalation, or topical application of local anesthetic then intubation via, VL or fiber optic → requires cooperative pt, noncrash airway
Pearls
• Have rescue devices at the ready: EGD, cricothyrotomy kit
• Good BVM technique saves lives
RSI
• Preparation
• Monitor O2 sat, BP, rhythm, ≥1 IV
• BVM, suction, ET CO2 detector, oral airway, Bougie
• Intubation equipment (eg, laryngoscope): Blade, backup blade, check video monitor/light
• ETT: 8 (male), 7 (female); check cuff, load stylet/10 cc syringe; pediatrics tube size: = 4 + (age in y/4) → or use Broselow tape
• RSI medications/doses
• Assess for difficult BVM, difficult intubation, & difficult cricothyrotomy → prepare appropriately