- Pre-oxygenation of the RSI candidate.
- Position the patient in a semi-recumbent position (head-up greater than 20⁰).
- Place a nasal cannula in the patient’s nares and connect to an oxygen regulator.
- Place a non-rebreather or CPAP device at 5 cm H2O over the nasal cannula and connect to a second oxygen regulator.
- If the patient is not saturating above 90%, remove non-rebreather or CPAP and provide ventilations utilizing a bag valve mask.
- Administer sedative.
- Position the patient into the sniffing position and manually open the airway utilizing two hands.
- Attempt to maintain an oxygen saturation greater than 95%.
- Remove the nasal cannula if unable to get a high quality seal with the CPAP or bag valve mask.
- Administer paralytic.
- Remove CPAP, non-rebreather mask, or bag valve mask and leave the nasal cannula flowing at 15 liters per minute.
- Intubate the trachea and confirm tube placement.
- Remove the nasal cannula.
- Apneic oxygenation can still benefit the trauma patient; keep the patient supine with spinal precautions in place and do not use CPAP.