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    ICU One Pager Intubation Checklist

    Uploaded by

    Carlos Hernandez Campos
    This document provides guidance on intubation procedures including: 1) Gathering necessary equipment, assessing the airway, planning medications and approach. 2) Steps for performing intubation including positioning, visualization, tube placement and confirmation. 3) Post-intubation management including securing the tube, monitoring vitals, ventilation settings, and documentation. 4) Guidance for handling difficult airways and potential complications including alternative airway devices and emergency cricothyrotomy.

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    © All Rights Reserved
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    ICU One Pager Intubation Checklist

    Uploaded by

    Carlos Hernandez Campos
    76 views4 pages
    This document provides guidance on intubation procedures including: 1) Gathering necessary equipment, assessing the airway, planning medications and approach. 2) Steps for performing intubation including positioning, visualization, tube placement and confirmation. 3) Post-intubation management including securing the tube, monitoring vitals, ventilation settings, and documentation. 4) Guidance for handling difficult airways and potential complications including alternative airway devices and emergency cricothyrotomy.

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    Intubación Check List

    Original Title

    ICU_one_pager_intubation_checklist

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    This document provides guidance on intubation procedures including: 1) Gathering necessary equipment, assessing the airway, planning medications and approach. 2) Steps for performing intubation including positioning, visualization, tube placement and confirmation. 3) Post-intubation management including securing the tube, monitoring vitals, ventilation settings, and documentation. 4) Guidance for handling difficult airways and potential complications including alternative airway devices and emergency cricothyrotomy.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    76 views4 pages

    ICU One Pager Intubation Checklist

    Uploaded by

    Carlos Hernandez Campos
    This document provides guidance on intubation procedures including: 1) Gathering necessary equipment, assessing the airway, planning medications and approach. 2) Steps for performing intubation including positioning, visualization, tube placement and confirmation. 3) Post-intubation management including securing the tube, monitoring vitals, ventilation settings, and documentation. 4) Guidance for handling difficult airways and potential complications including alternative airway devices and emergency cricothyrotomy.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

    INTUBATION

    Version 1.1 Nick Mark 2014


    (1 of 4)

    GATHER/TEST EQUIPMENT
    NC ETT x2 sizes Video scope Cric kit
    BVM + PEEP Valve Blade x2 LMA
    Free flowing IV OPA Bougie Ventilator
    EKG, SpO2 monitor Suction Capnograph

    PLAN PRE-MEDICATION
    Assess for difficult airway (LEMON) LIDOCAINE 1.5 mg/kg
    Look externally (beard, teeth, etc) FENTANYL 3 mg/kg
    Evaluate with 3:3:2 finger rule
    Mallampati score
    Obstruction (burns, ) INDUCTION
    Neck Mobility ETOMIDATE 0.3 mg/kg
    Anticipate risks (HOpI killers) KETAMINE 1 - 2 mg/kg
    HYPOTENSION ! fluid? pressors? PROPOFOL 2 - 3 mg/kg
    OXYGENATION ! pre-ox plan? MIDAZOLAM 2 - 4 mg
    pH (ACIDOSIS) ! adequate vent? FENTANYL 100 mcg
    ICP ISSUES ! Premed? BP control?
    Approach: RSI / DSI / Awake
    Pre-Medication and Paralytics PARALYTIC
    Consider Succ contra-indications
    Primary and secondary airway plan ROC 1.2 -1.5 mg/kg
    SUCC 1.5 mg/kg
    Emergency plan/Cric preparations CISATRACURIUM 0.3 mg/kg

    TIME-OUT/VERBALIZE PLAN
    CONSENT/EXPLAIN (if possible), verify DNR/DNI STATUS
    Verbalize the above plan and assign roles Don PPE
    INTUBATION
    Version 1.1 Nick Mark 2014
    (2 of 4)
    MODIFIED CORMACK-
    PREPARATION/INDUCTION LEHANE GRADE
    Position patient, adjust height of bed
    De-nitrogenation <1%
    Push medications and wait

    VISUALIZATION/TUBE PLACEMENT
    4.3%
    Insert Laryngoscope
    Sweep tongue, advance blade, lift jaw
    Consider placing towel under occiput

    “Call the view” and suction if needed 67%


    Adjust view if needed
    If unable to visualize ! alternative blade/operator
    Still unable to visualize ! go to plan B
    Place tube, withdraw stylete
    If unable to pass ! use smaller size tube + lube 87%
    If persistent problem ! difficult airway procedure

    CONFIRMATION
    >95%
    Auscultate
    Capnography
    Probability of a
    Repeat DL/VL if uncertain difficult airway

    ETT SIZING/DEPTH
    Women 7.0 - 8.0 mm ETT 21 cm
    Men 7.5 - 8.5 mm 23 cm
    Peds (16 + age in yrs) / 4
    INTUBATION
    Version 1.1 Nick Mark 2014
    (3 of 4)

    POST INTUBATION MANAGEMENT


    Secure ETT
    Reassess hemodynamics and oxygenation
    Consider fluid bolus/pressors
    If unstable !hemodynamic collapse post intubation protocol

    Analgesia/Sedation plan
    Hypertensive: propofol gtt + fentanyl bolus
    Hypotensive: fentanyl bolus + low dose midazolam bolus
    address and treat cause of hypotension

    Ventilator settings
    Oxygenation: start FiO2 1.0, if hypoxemic add PEEP
    wean FiO2/PEEP for goal SpO2 > 90%
    Ventilation: ensure MV is at least matching pre-intubation
    MV
    use ETCO2 or ABG to adjust
    Document plateau pressure (before paralytics wear off) _____
    Monitor for breath stacking as paralytics wear off
    Connect in-line suction
    Place NG/OG Tube
    ABG (ideally at least 10 min post intubation)
    Chest radiograph (ideally post NG placement)
    HOB > 30 degrees
    INTUBATION
    Version 1.1 Nick Mark 2014
    (4 of 4)

    DIFFICULT AIRWAY PROCEDURE


    CICO (can’t intubate can’t oxygenate) ! eFONA
    FACE After each failure consider:
    MASK 1. MANIPULATION of
    Head/neck position
    External larynx
    Device
    SURGICAL 2. Use of ADJUCTs
    SUPRA- AIRWAY ENDO 3. Different SIZE/TYPE
    GLOTTIC TRACHEAL 4. Use of SUCTION
    AIRWAY TUBE 5. Optimizing MUSCLE TONE
    MAXIMUM of THREE attempts of each
    technique. At least one attempt should be
    performed by the most experienced clinician.

    EMERGENCY FRONT OF NECK AIRWAY (eFONA)


    1. Position (neutral neck) and Prep: sterilize skin, local analgesia (if time)
    2. Palpate cricothyroid and stabilize trachea (non-dominant hand)
    3. Vertical incision 2-3 cm midline
    4. Horizontal incision 1-2 cm through cricothyroid membrane
    5. Insert scalpel into trachea, rotate 90 degrees
    6. Place Tracheal hook into incision, apply superior traction
    7. Insert endotracheal tube and confirm placement

    HEMODYNAMIC COLLAPSE POST INTUBATION


    POSITION – esophageal, R mainstem? ! 1. verify placement
    PEEP – Auto-PEEP from breath-stacking? ! 2. break circuit, use BVM
    PRELOAD – loss of preload? hypovolemic? ! 3. fluid bolus
    TONE – loss of sympathetic tone ! 5. start/increase pressors
    TENSION – development of tension PTX? ! 4. chest US, consider needle

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