Protocol 2-044-33 - Airway: RSI - Checklist

CMH EMS & MIH Protocols

Patient Preparation	Considerations	Setup	Post-Intubation
Preoxygenate NRB CPAP BVM Hemodynamics IV fluids Vasopressors Positioning Ear to sternal notch Ramp / 30 degrees Open collar Apneic oxygenation NC 15 lpm Monitoring SpO2 on opposite side of BP ECG BP q 5 min EtCO2	Hemodynamics Risk for hypotension Shock severity Oxygenation Risk for desaturation Set SpO2 lower limit LEMON check Look externally (feel cricothyroid membrane) Evaluate 3-3-2 (3 fingers between upper and lower teeth, 3 fingers between mandible and neck, 2 fingers between mandible and thyroid) Mallampati Obstruction or Obese Neck mobility pH Metabolic considerations Verbalize airway plan Designate roles	Laryngoscope(s) ETT(s) & syringe Bougie Stylette Suction(s) BVM with PEEP EtCO2 Supraglottic Surgical airway Medications Premedication Induction Paralytic Post-intubation Fluids Pressors	Confirm placement Waveform EtCO2 Lung sounds Epigastric sounds Secure ETT Analgesic Sedation Consider ventilator Consider paralysis OG/NG tube Consider sit patient up Reassess DOPE Vitals Pain

Patient Preparation

Considerations

Setup

Post-Intubation

Preoxygenate

NRB
CPAP
BVM

Hemodynamics

IV fluids
Vasopressors

Positioning

Ear to sternal notch
Ramp / 30 degrees
Open collar

Apneic oxygenation

NC 15 lpm

Monitoring

SpO2 on opposite side of BP
ECG
BP q 5 min
EtCO2

Hemodynamics

Risk for hypotension
Shock severity

Oxygenation

Risk for desaturation
Set SpO2 lower limit

LEMON check

Look externally (feel cricothyroid membrane)
Evaluate 3-3-2 (3 fingers between upper and lower teeth,
3 fingers between mandible and neck,
2 fingers between mandible and thyroid)
Mallampati
Obstruction or Obese
Neck mobility

Metabolic considerations

Verbalize airway plan

Designate roles

Laryngoscope(s)

ETT(s) & syringe

Bougie

Stylette

Suction(s)

BVM with PEEP

EtCO2

Supraglottic

Surgical airway

Medications

Premedication
Induction
Paralytic
Post-intubation
Fluids
Pressors

Confirm placement

Waveform EtCO2
Lung sounds
Epigastric sounds

Secure ETT

Analgesic

Sedation

Consider ventilator

Consider paralysis

OG/NG tube

Consider sit patient up

Reassess

DOPE
Vitals
Pain

Citations:

Protocol 9-010 - References
Flynn, 2021

Change Log:

Date	Link to previous version	Description of change
10/14/21		New attachment as an optional tool. Created by Brice Flynn. Approved by protocol committee 5/26/21. Approved by Dr. Nicholes 6/8/21.
02/25/22	pdf	Added ventilator in post-intubation.

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