Medication Facilitated Intubation (MFI)
- Age greater than 12
- Trauma with GCS < with gag reflex
- Trauma with significant facial trauma and poor airway control
- Closed head injury or major stroke with unconsciousness
- Acute burn with airway involvement and inevitable airway loss
- Respiratory exhaustion such as severe asthma, CHF or COPD with hypoxia
- Overdose with AMS where loss of airway is inevitable
- Evaluate: 3-3-2
- Mallampati Score
- Neck mobility
- Restricted opening
- Distorted airway
- Stiff lungs or c-spine
- Age Less than 12
- Difficulty ventilating patients with BVM
- Anticipated difficult intubation based on physical exam of airway structures or airway history.
A minimum of two Paramedics on scene prior to sedation
- Pre-oxygenate with 100% Oxygen via BVM or CPAP if possible
- If non-traumatic., provide apneic oxygenation with 15 LPM oxygen via nasal cannula under BVM/CPAP
- Place at 30⁰ - 45⁰ angle
- Monitor O2 sat with pulse oximetry
- Ensure functioning IV access
- Monitor heart rhythm with EKG
- Etomidate 15 mg or 7.5 mL
- Intubate trachea
- May repeat two times for a total of 3 attempts
- See Post Airway Management
- Notify receiving facility or contact Medical Control
- Intubation equipment includes: intubation kit, bougie, BVM, suction, RSI medications, BIAD, waveform capnography.
- All appropriate measures must be taken to attempt to increase O2 saturation to greater than or equal to 94 % prior to intubation.
- Do not use CPAP on the trauma patient.
- Waveform capnography and pulse oximetry must be utilized for a minimum of 5 minutes after tube placement.
- Bradycardia after tube placement is a strong predictor of a misplaced endotracheal tube (ETT).
- An airway evaluation form must be completed on every patient who receives Medication Facilitated Intubation (MFI)