Intubation
Made Short &
sweet
by Melissa Yuan-Innes, MD, CCFP-EM
www.melissayuaninnes.com

Prepare
• SOAPME: (Suction, oxygen, airway,
pharmacology, monitoring, equipment), or try
• Suction
• Oxygen
• Airway set-up
• Pharmacology: “What do you want?”
• Mask yourself
• Elevate patient (positioning)

Preoxygenate
• 3 minutes at 100 percent
• 8 deep (vital capacity) breaths
• http://journals.lww.com/em-news/Fulltext/2006/08000/
Preoxygenation,_Critical_in_RSI,_Often_Negates.24.aspx

Premedicate
LOA
• Lidocaine (?“tight head/lungs”)
• Opiates (“tight head/heart”)
• Atropine (tiny infants)
Or think ABC
A: Asthma
B: brains & babies
C: cardiovascular

Pacify the patient
• Etomidate: good for trauma (? not in
sepsis)
• Ketamine: asthma
• Midazolam: seizures

Paralyze
• Succinylcholine (or rocuronium)
• go big or go home

Pass the Tube
• get the epiglottis out of the way to see
the vocal cords

Post-Intubation Check
• CO2 detector
• (visualization, condensation,
auscultation)
• Secure the tube
• Chest X ray
• Sedate patient

Read Up
UpToDate Adults: http://www.uptodate.com/contents/
rapid-sequence-intubation-in-adults?
UpToDate Children: http://www.uptodate.com/contents/rapid-
sequence-intubation-rsi-in-children#H11 [gives error message if not logged in]