Keith's Airway Card
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Airway Management Card: RSI Essentials
  --Keith Conover, M.D., FACEP, Department of Emergency Medicine
    Mercy Hospital of Pittsburgh  version 1.1 8/2/01
    ASCII text version

þ Preoxygenate but NO assisted ventilations
  (don't want air in the stomach)
þ Prepare equipment
þ Pretreat with drugs (^ ICP, v HR, ^ secretions)
 - atropine 0.5-1.0 mg (**REQUIRED for kids < 6)
 - lidocaine 100 mg [1.5 mg/kg] (good theater, ?benefit)
 - topical Neosynephrine/lidocaine for nasal
þ Sedate/Paralyze (crash intubation adult dose below; see below for
  details/less urgent RSI/peds doses):
 - Trauma (and option for ALL RSI situations):
  + etomidate 20 mg (or ketamine 200 mg) plus
  + Sux 150 mg
 - Head Injury/CVA/SAH:
  + etomidate 20 mg (OR thiopental 300 mg) plus
    (option: prefasciculate with Vec or Pavulon
     1 mg, ? benefit) plus
    (option: lidocaine 100 mg, ? benefit) plus
  + Sux 150 mg
 - Asthma/COPD:
  + ketamine 200 mg or Versed 10 mg plus
  + Sux 150 mg
 - Chest Pain/CHF:
  + fentanyl 100 mcg plus
  + Sux 150 mg
 - Generic Medical Illness/Drug OD:
  + Versed 10 mg plus
  + Sux 150 mg
þ Cricoid pressure (Sellick maneuver)
  with BURP: backward upward rightward pressure
þ Intubate
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þ SEDATE:
 - etomidate 20 mg (Amidate)
   [0.3 -0.4 mg/kg]; onset 1', lasts 3-12'
   slight ^BP, ñ if trauma; + for head inj;        or:
 - Versed 10 mg (midazolam)
   [0.1-0.4 mg/kg] onset 60-120 sec, lasts 30-60'
   amnestic, min. ICP/BP effect, anticonvulsant    or:
 - fentanyl 100-500 mcg (Sublimaze)
   [0.5-2 mcg/kg (sedation)
   5-10 mcg/kg (single-agent anaesthesia)]
   onset 4-10', lasts 45-60'
   mild v BP; no ^ ICP, ^ dose neuroprotect.       or:
 - thiopental 300 mg (Pentothal)
   [3-5 mg/kg]; onset 10-15 sec, lasts 5-30'
   v BP, X trauma, asthma, porphyria; + neuroprot. or:
 - propofol 100 mg (Diprivan)
   [1-2 mg/kg]; onset 10-20 sec, lasts 10-15'
   v BP; + antiemetic, anticonvuls, neuroprotect.  or:
 - ketamine 200 mg (Ketalar)
   [2-6 mg/kg - dose for IM]; onset 1-5', lasts 10-16'
   ^ BP, X head inj, chest pain; + for resp failure

þ Paralyze
 - If time,
  + defasciculate: pancuronium or vecuronium
    1 mg, wait 3' (Pavulon, Vec=Norcuron,)
    [0.01-0.03 mg/kg] followed by
  + succinyl choline 150 mg ("Sux," Anectine)
    [1-4 mg/kg]; onset 1«-2', lasts 5-12'
    defasciculate first if head inj, penetr eye inj;
    X if: infant (? musc dyst, ˜HR); >= 7 d post
    burn-crush (^ K+); asthma (histamine release)
    ^ dose if defasciculated or if < 10 years; and/or:
 - pancuronium/vecuronium 7 mg (Pavulon, Vec= Norcuron)
   [0.1-0.2 mg/kg]; onset 4', lasts 20-60'         or:
 - Zemuron 70 mg (rocuronium) [0.6-1.2 mg/kg]
   esp. for kids  (lasts 30-60 minutes)
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