Pre-intubation & Intubation Medications - Airway

Question 1

What are the 4 sedatives recommended for RSI, and which is the preferred one?

Answer 1

1. Ketamine (preferred)
2. Midazolam
3. Etomidate
4. Propofol

Question 2

What is the preferred analgesic for intubation?

Answer 2

Fentanyl

Question 3

What are the two paralytics recommended for RSI, and which is the preferred one?

Answer 3

1. Rocuronium (preferred)
2. Succinylcholine

Question 4

What is the medication used for hypotension secondary to RSI, and is there a patch point?

Answer 4

Phenylephrine (Neosynephrine)
No patch required

Question 5

What are the SpO2 targets for:
Pre-intubation oxygenation?
Stopping intubation to re-oxygenate?
Initiating cricothyrotomy?

Answer 5

Pre-intubation: min 93%, >95% preferred
Stop intubation attempts if SPO2 <90%
Cricothyrotomy if SpO2 <88% despite SGA/BVM/OPA

Question 6

What are the 5 drilled responses to optimize the attempt at laryngoscopy in the difficult airway?

Answer 6

1. Extra laryngeal manipulation (ELM, AKA BURP)
2. Extra head elevation
3. Extra laryngoscope lift (2 hands)
4. Use Mac blade with Miller technique (use Mac 4)
5. Use bougie if not already in use