EquipmentTable
BVM (± PEEP Valve) on OxygenWaveform Capnograph on BVM & Tested
Video LaryngoscopeIntubation Equipment
(Tube, 2xBend Stylet, 2 Syringes, Back-Up Laryngoscope, OPA, Tube-Securing Device)
Failed Airway Equipment at Bedside(At minimum: Bougie, SGA, Scalpel)
Suction x 2
Patient PrepDenitrogenation
Oxygenated (Consider CPAP)Look in Mouth · Dentures
Positioning(Face Parallel, Ears/Notch, 30° Head-Up, Collar Plan)
Monitors (Pulse Ox Visible)Reliable Access
Nasal Prongs for ApOx± Gastric Tube
PlanHOp Killers-Hemodynamics, Ox, pH
RSI · Awake · DSI · RSA · ICP/VascularInduction Agent/Muscle Relaxant
Push-Dose PressorsFailed Airway Plan Verbalized
Cric-Con Evaluation (± Mark/Inject)Post-Intubation Sedation
EMCrit Call/Response Intubation Checklist
TeamRoles Assigned for Each Stage of Failed Airway Plan
Pulse Ox Watcher/Reoxygenation Role AssignedELM/Head Elev. Assistant Briefed
Team is all in PPEby Weingart S, Nickson C, Rabinovich J, Strayer R.version 2013-02-06
Awake Intubationo Glycopyrrolate 0.2 mg IV & Ondansetron 4mg IV (give as early as possible)
o Suction mouth and then pad dry with gauzeo Nebulized Lidocaine 4% 5ml @ 6 lpmo Atomized Lidocaine 4% 3ml sprayed into posterior oropharynxo Viscous Lidocaine lollipop 2%, place on tongue depressoro Preoxygenateo Positiono Restrain armso Switch to nasal cannula at 15 lpmo Sedate with aliquots of Ketamine (10-20 mg) or 1-2 ml Ketamine-
Heavy Ketofol (75 mg Ketamine, 25 mg propofol in the same syringe)o Atomized Lidocaine 4% 3ml sprayed through cordso Intubate awake or place bougie, then sedate/paralyze
Initial Post-Intubation Analgo-Sedation
o Fentanyl 2 mcg/kg bolus then 1 mcg/kg/hror
o Hydromorphone 0.5-1 mg bolus then repeat q 10 minutes until analgesia
and
o Midazolam 0.05 mg/kg bolus then 0.025 mg/kg/hror
o Propofol 0.5 mg/kg bolus then 20 mcg/kg/minor
o Ketamine 1 mg/kg bolus then 0.5 mg/kg/hrTitrate to calm, spontaneously-breathing patient
Push-Dose Epio In a 10 ml syringe, add 9 ml NSo Into this syringe draw up 1 ml of
Cardiac-Arrest (1:10000) Epinephrineo Shake Syringe Hardo Label “Epinephrine 10 mcg/ml”o Dose 0.5-2 ml (5-20 mcg) q 1-5 mino Throw away at end of shift if unusedIntubation Meds
Drug Normotensive DoseNormotensive Dose
(70 kg Pt)Hypotensive Dose
Ketamine 2 mg/kg 140 mg 0.5 mg/kgKetofol (100 mg ketamine,100 mg propofol to make 20 ml) 0.2 ml/kg 14 ml
Etomidate 0.3 mg/kg 20 mg 10 mg
Propofol 1.5-3 mg/kg 150 mg 15 mg
Succinylcholine 1.5-2 mg/kg 140 mg 2 mg/kg
Rocuronium 1.2 mg/kg 80 mg 1.6 mg/kg
Vecuronium 0.3 mg/kg 20 mg
Pretreatment3-5 minutes prior to intubationo Lidocaine 1.5 mg/kg for High-ICP/Vascular with elevated BPo Fentanyl 3 mcg/kg for High-ICP/Vascular with elevated BP
(alternatively Remifentanil 3 mcg/kg)o Scopolamine 0.4 mg for amnesia in hypotensive pt intubation
Sux Contrao Malignant Hyperthermia Historyo Strokes with hemiparesis > 72 hours oldo ICU Stay > 2 weekso Burns/trauma > 72 hours oldo NMJ Diseaseo Myopathies/Muscular Dystrophieso Preexisting Hyperkalemia or Strong
suspicono Guillain-Barre
o Females: 3.5, 7.5 ET Max, inflate 4 ml, 18 cm to tipo Males: 4.5, 8.5 ET Max, inflate 5 ml, 20 cm to tip
Initial Vento Assist Control/Volume Modeo Vt 8 ml/kg IBWo RR 16 (10 in asthma/copd)o IFR 60 l/mino PEEP 5 (0 in asthma/copd)o FiO2 40%
Low pH Tubeo Place on Vent (SIMV-Volume, Vt 550, FiO2
100%, IFR 30 lpm, PS 10, PEEP 5, RR 0)o Place on ETCO2o RSA or Vent as Bag (Change RR to 16)o Change Vent to (IFR 60 lpm, RR 30, VT
8 ml/kg, FiO2 40%)o Confirm same ETCO2 and send ABG
AirQs
Fold and use only this side during Checklist Procedure
Cric-Cono All Airways: Discuss/Feel/See Kit (5)o Diff. but Stable: Mark/Kit to Bedside/US (4)o Diff. & Hypoxemic: Inject / Prep / Open Kit /
Scalpel in Hand (3)
InfoGo to
emcrit.org/airway
This checklist is for informational purposes only. ALL information must be vetted with your clinical judgment, pharmacy, and hospital committees/regulations.
Do
you
have
a ta
ble?
All e
quip
men
t mus
t be
on a
pro
cedu
re ta
ble,
not
on
the
bed
or o
n th
e pa
tient
.
Is th
ere
a BV
M h
ooke
d up
to o
xyge
n se
t to
max
imal
flow
?Is
ther
e a
PEEP
val
ve if
satu
ratio
n on
hig
h-fiO
2is
<95%
?
Is w
avef
orm
cap
nogr
aph
prep
ared
?Te
sted
by
blow
ing
and
hook
itup
to T
he B
VM. Q
ualit
ativ
e Sh
ould
be
with
in e
yesig
ht (L
eave
itin
Its p
acka
ge)
Is th
e vi
deo
lary
ngos
cope
set u
p?Al
l int
ubat
ions
shou
ld b
e pe
rfor
med
with
a v
ideo
dev
ice
if CM
AC(d
ecid
e if
resid
ent w
ants
to lo
ok a
t scr
een)
, oth
erw
ise sh
ould
be
pres
ent a
t bed
side
Is in
tuba
tion
equi
pmen
t pre
pare
d an
d re
ady?
Two
func
tiona
l lar
yngo
scop
es—
sized
and
che
cked
, pro
perly
size
d or
al a
irway
, ETT
tube
with
styl
et b
ent a
t bot
h en
ds in
hoc
key
stic
k co
nfig
urat
ion,
with
syrin
ge
atta
ched
—ba
lloon
che
cked
, 2nd
tube
in p
acka
ge w
ithin
eye
sight
, Ext
ra 1
0 m
l syr
inge
, Tub
e-Se
curin
g De
vice
Is fa
iled
airw
ay e
quip
men
t pre
pare
d an
d re
ady?
All e
quip
men
t nec
essa
ry to
effe
ct th
e fa
iled
airw
aypl
an m
ust b
e at
the
beds
ide.
Usu
ally
this
cons
ists o
f 2 N
PAs,
a b
ougi
e, a
n ap
prop
riate
size
d Ai
rQ IL
A, su
rgilu
be
and
a sc
alpe
l all
still
in th
eir p
acka
ges.
Is th
e su
ctio
n eq
uipm
ent p
repa
red?
2 su
ctio
ns tu
rned
on,
one
at i
ntub
ator
’s ri
ght h
and-
-List
en to
eac
h. P
ull o
n tu
bing
to m
ake
sure
it is
att
ache
d to
the
off-c
ente
red
atta
chm
ent.
Ask
intu
bato
r to
verb
aliz
e th
at if
suct
ion
is ne
eded
, the
y w
ill n
eed
to p
ut th
eir f
inge
r ove
r the
hol
e
Hav
e w
e de
nitr
ogen
ated
?8
brea
ths o
n m
axim
al fl
ow N
RB o
r 3 m
inut
es o
f tid
al v
olum
e br
eath
ing.
Do n
ot re
mov
e th
e N
RB/M
ask
until
pt i
s apn
eic
Hav
e w
e pr
eoxy
gena
ted?
Sat ≥
95%
on
NRB
or s
witc
h to
CPA
P Pr
eox.
Sho
uld
achi
eve
a sa
tura
tion
of ≥
95%
or y
ou m
ax o
ut o
n PE
EP 1
5 cm
/H20
Mon
itors
? Is th
e pa
tient
hoo
ked
upto
BP
set t
o cy
cle
q1 m
inut
e, E
KG, a
nd a
pul
se o
x vi
sible
to re
sus l
eade
r & in
tuba
tor o
r a p
ulse
ox
wat
cher
ass
igne
d?
Is th
e pa
tient
pos
ition
ed a
dequ
atel
y?Ea
r to
ster
nal n
otch
and
face
pla
ne p
aral
lel t
o ce
iling
unl
ess s
pina
l pre
caut
ions
If sp
inal
pre
caut
ions
, hav
e pl
an fo
r col
lar r
emov
al a
nd in
line
stab
iliza
tion
Is th
e he
ad o
f bed
at 3
0° o
r in
Reve
rse-
Tren
dele
nber
g?
Is th
ere
relia
ble
acce
ss?
At le
ast o
ne, p
refe
rabl
y tw
o. If
ther
e is
any
doub
t, pl
ace
IO
Is th
e pa
tient
pre
pare
d fo
r ApO
x (N
oDES
AT)?
Is a
nas
al c
annu
la o
n th
e pa
tient
for a
pnei
c ox
ygen
atio
n?
Is a
pla
n ve
rbal
ized
for w
ho w
ill re
mov
eth
e pa
tient
’s N
RB fr
om O
2po
rt a
nd sw
itch
to N
C@
15 lp
maf
ter m
eds a
re p
ushe
dor
is N
C on
a se
para
te o
xyge
n cy
linde
r?
Wou
ld th
e pa
tient
ben
efit
from
pre
-intu
batio
n N
GT?
RSI o
r Aw
ake?
· DSI
?· R
SA?
· ICP
/Vas
cula
r?Co
nsid
er p
erfo
rmin
g aw
ake
intu
batio
n in
pat
ient
s pre
dict
ed to
be
diffi
cult
airw
ay/r
eoxy
gena
tion
and
will
allo
w 5
-10
min
utes
pre
para
tory
tim
e
Cons
ider
Del
ayed
Seq
uenc
e In
tuba
tion
in p
atie
nts n
ot to
lera
ting
preo
xyge
natio
n/de
nitr
ogen
atio
n/pr
epar
ator
y po
sitio
ning
or p
roce
dure
s
Cons
ider
Rap
id S
eque
nce
Airw
ay (I
nduc
e pa
tient
and
imm
ed. p
lace
SG
A) in
pat
ient
s who
will
nee
d to
be
bagg
ed d
urin
g ap
neic
per
iod
Cons
ider
an
ICP/
Vasc
ular
intu
batio
n in
nor
mot
ensiv
e/hy
pert
ensiv
e pa
tient
s at r
isk fr
om a
n in
crea
se in
sym
path
etic
tone
/MAP
Are
the
peri-
intu
batio
n m
edic
atio
ns re
ady?
Full
poss
ible
dos
eof
indu
ctio
nag
ent w
ith d
ose/
ml l
abel
ing
Full
poss
ible
dos
eof
mus
cle
rela
xant
with
dos
e/m
l lab
elin
g
If pt
has
pot
entia
l for
BP
decr
ease
, pus
h-do
se p
ress
ors s
houl
d be
dra
wn
up a
nd a
t bed
side
in a
syrin
ge m
arke
d w
ith d
ose/
ml l
abel
ing
Wha
t is t
he p
lan
for u
nexp
ecte
d di
ffic
ult o
r fai
led
airw
ay?
The
team
mus
t ver
baliz
e th
e en
tire
prog
ress
ion
of th
e fa
iled
airw
ay p
lan
incl
udin
g w
ho w
ill p
erfo
rm e
ach
step
Wou
ld th
is pa
tient
ben
efit
from
the
pres
ence
of a
2nd
ED A
tten
ding
or a
con
sulta
nt?
Can
the
cric
othy
roid
mem
bran
e be
pal
pate
d?Co
nsid
er m
arki
ng, c
onsid
er u
ltras
ound
-gui
ded
mar
king
, con
sider
pre
-intu
batio
n pr
ep w
ith li
doca
ine
2% w
ith e
pine
phrin
e
Wha
t is
the
plan
for p
ost-
intu
batio
n se
datio
n?A
plan
for a
n an
alge
sic
and
a se
dativ
e sh
ould
be
verb
aliz
ed a
nd p
repa
ratio
n sh
ould
star
t dur
ing
the
intu
batio
n pr
epar
atio
ns if
ther
e ar
e av
aila
ble
pers
onne
l
Eq
uip
men
t
Pati
en
t
Pla
n
Print the next 2 pages on both sides of 1 sheet of paperFold at the dotted line
Use only the above the fold portion in the peri-intubationThe 2nd page includes explanations of the checklist for students, residents, and when training with the checklist
Below the fold are some reference itemsSend me comments and ideas for improvement
Thanks,Scott