Standards Procedure (Skill)
Clinical Indications: Level: EMT-P only
Ø Need for airway control in a patient who has a gag reflex or trismus.
Clinical Contraindications:
Ø Significant burns between 24 hours and 2 weeks old.
Ø Known neuromuscular disease such as myasthenia gravis, amyotrophic lateral sclerosis, muscular dystrophy, or Guillian-Barre syndrome.
Ø Patient or family history of malignant hyperthermia.
Ø At no time should RSI be attempted if the patient cannot be adequately ventilated with a BVM.
Procedure:
a. Preoxygenate patient with 100% oxygen via NRB or BVM.
b. If trauma or spinal injury is suspected, 2nd caregiver will hold manual stabilization.
c. Monitor patient with pulse oximetry and cardiac monitor.
d. Access and ensure a patent IV line.
e. Evaluate for difficulty of airway (LEMON)-see appendix
f. Prepare equipment (intubation kit, BVM, suction, RSI meds, combi-tube, cricothyrotomy kit, CO2 detection devices.)
g. If patient is <8 years old, administer atropine (minimum dose of 0.1 mg/kg not to exceed a total single dose of 0.5mg.)
h. If patient is > 8 years old, consider atropine at 1 mg to prevent a vagal stimulation.
i. Administer Norcuron 0.01mg/kg IVP as necessary for patient condition.
j. Apply cricoid pressure (Selleck’s maneuver) by a 3rd caregiver.
k. Preoxygenate patient for at least 2 minutes.
l. Administer Etomidate (0.2-0.6mg/kg){alternative midazoam (2-5mg)}
m. Administer Succinylcholine (1mg/kg) {alternative Norcuron (0.1 mg/kg)}
(pediatric dose of Succinylcholine is 1.5 mg/kg)
n. Intubate patient and verify tube placement.
o. Release cricoid pressure and secure tube placement.
p. Reassess tube placement often especially when moving patient.
q. Document procedure, time, and results on the ACR.
Certification Requirements:
Successfully complete an annual skill evaluation including the indications, contraindications, technique, and possible complications of the procedure.