The crashing patient: preparation for intubation

Airway and breathing

The use of an airway checklist is particularly important in high risk patients with the potential to deteriorate quickly. Our recommended checklist is available here.

The following can also be used as a memory aid.

‘SOAP-ME’

Suction

Oxygen – BVM attached to oxygen Fi02 1.0, ongoing BIPAP

Airways - (ETT, LMA, adjuncts – guedels, nasopharyngeal airway)

Positioning – sit upright until drugs given

Monitoring and Medications - Continuous pulse oximetry and cardiac monitoring

Medications:

Ketamine 2mg/kg IV for induction (bronchodilator properties, more cardiovascular stability)

Suxamethonium 1.5mg/kg IV

If ketamine unavailable use the induction agent with which you are most familiar

Rocuronium 50mg IV for post induction paralysis

Sedative infusion for maintenance post intubation

End tidal CO2 - Calibrate monitor and use to confirm ETT placement

Circulation

2x large bore IV cannulae

IVF on pump set attached to one of the cannulae and use this to flush your RSI drugs, keep the other cannula free for resuscitation drugs if needed

Give a fluid bolus 500mL to optimise preload and reduce risk of hypotension on PPV. This can be repeated.