Assemble required equipment and staff
Be prepared for failed airway/deterioration
Patient on cardiac monitor with pulse oximetry (preferably waveform capnography)
Apply non-rebreather mask at flush rate and nasal cannula to 15 L/min each
Administer induction agent,
Ideally ketamine 1-2mg/kg given mp blunting of patient respirations or airway reflexes
In hypertensive and tachycardic patients, dexmedetomidine can be administered at 1 mcg/kg. It is a α-2 agonist, which provides sedation with no blunting of respiratory drive or airway reflexes
If SpO2 is <95% then use NIPPV or bag-valve mask with PEEP valve at 5-15 cmH20
If no improvement within 10 minutes, consider proceeding to intubation with suboptimal pulse oximetry reading
Administer neuromuscular blocker and wait 45-60 seconds
Perform apneic oxygenation using 15 L/min O2 via nasal prongs +/- continue CPAP
Intubate patient
Ideally ketamine 1-2mg/kg given mp blunting of patient respirations or airway reflexes
In hypertensive and tachycardic patients, dexmedetomidine can be administered at 1 mcg/kg. It is a α-2 agonist, which provides sedation with no blunting of respiratory drive or airway reflexes
If SpO2 is <95% then use NIPPV or bag-valve mask with PEEP valve at 5-15 cmH20
If no improvement within 10 minutes, consider proceeding to intubation with suboptimal pulse oximetry reading
Delayed sequence intubation
Rapid sequence intubation
Awake intubation
Extracorporeal membrane oxygenation
Extubation
Weaning mechanical ventilation
Blind digital intubation
Bag valve mask ventilation