Rapid Sequence/ Failed Intubation - Additional Information

Equipment Checklist
ETT Size
LMA Sizes
Induction Agents
Neuromuscular Blocker/Paralytic
Initial Ventilator Settings

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Equipment Checklist

S – Suction & Staff	B – BVM / ETT Blades
T – Tube (Endotracheal 3 x sizes)	A – Airway (oro / naso-pharyngeal)
O – Oxygen (Set Ventilator)	R – Rescue devices (LMA/ Bougie)
P – Pharmacology (Induction & Paralytic &  Resus drugs)	S – Surgical airway (Blade / Cricothyroidotomy kit)
I – IV Access
C – Connect Monitors

ETT Size

Patient Size	ETT Size	ETT Depth (oral)
Female / Small Male	7.0	19 – 21 cm
Large Female / Male	7.5 – 8.0	21 – 23 cm
Large Male	8.5 – 9.0	23 – 25 cm
Child	Age / 4 + 4 (uncuffed) Age / 4 + 3.5 (cuffed)	3 x ETT size in cm (approx)

LMA Sizes

Patient Weight	LMA Size	Cuff Volume
< 5 kg	1	4 ml
5 – 10 kg	1.5	7 ml
10 – 20 kg	2	10 ml
20 – 30 kg	2.5	14 ml
30 – 50 kg	3	20 ml
50 – 70 kg	4	30 ml
70 - 100 kg	5	40 ml
>100 kg	5 / 6	50 ml

Induction Agents

	Etomidate	Ketamine	Propofol	Midazolam	Thiopentone
DOSE	0.3 mg/kg (0.2-0.4 mg/kg)	2-4 mg/kg	2-2.5 mg/kg	0.2-0.3 mg/kg	3-5 mg/kg
70 kg	20 mg	140-210 mg	140 mg	15-20 mg	210 mg
Caution	SEPSIS	Seizures	Hypotension Elderly CVS Unstable	Use only if nil other agents available	Hypotension Limited availability
Indicated	CVS Unstable	CVS Unstable Asthma Head Injury			Seizures

Neuromuscular Blocker/Paralytic

Drug	Succinylcholine	Rocuronium
Dose	1.5- 2 mg/kg	1 – 1.2 mg/kg
70 kg patient	100-150 mg	70 – 85 mg
Onset of Action	30 – 60 seconds	60 – 120 seconds
Duration of Action	5 – 10 minutes	30 – 45 minutes
Caution & Contra-indications	>24 hrs post burns Hyperkalaemia Malignant Hyperthermia	Caution - difficult airway expected

Initial Ventilator Settings

	Normal Lungs	Bronchospasm COPD/Asthma	ARDS/Pneumonia
Mode	Assist Control / SIMV	Assist Control / SIMV	Assist Control / SIMV
Resp Rate (bpm)	12-14 (10-20)	10 (8 – 12)	18 (16-24)
Vt (ml/kg)	6 ml/kg (6-10)	6 ml/kg (6-8)	6 ml/kg (6-8)
Plateau airway pressure (P Plat) ; Pressure limit	< 30 cmH2O	< 30 cmH2O	< 30 cmH2O
PEEP	3 - 5	0 - 5	8 - 15
I:E Ratio	1:2	1:3 to 1:5	1:2
FiO2	1 (100%) wean to < 0.6 (60%) asap	0.4 (40%) titrate to requirement	1 (100%) wean to < 0.6 (60%) asap

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Rapid Sequence Intubation, Emergency Medicine: Western Cape; Drafted Nov 2014. Review Nov 2016