Medication Facilitated Intubation (MFI)

5.2

 

Indications:

  • 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

 

Difficult Laryngoscopy:

  • Look
  • Evaluate: 3-3-2
  • Mallampati Score
  • Obstruction
  • Neck mobility

 

Difficult BIAD:

  • Restricted opening
  • Obstruction
  • Distorted airway
  • Stiff lungs or c-spine

 

Contraindications:

  • 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 Dosing Chart

 

  • ≤ 100 lbs or  ≤ 45 kg
    • Etomidate 15 mg or  7.5 mL
  • 100-200 lbs. or 45-91 kg
    • Etomidate 20 mg or 10 mL
  • ≥ 200 lbs. or  ≥ 91 kg
    • Etomidate 30 mg or 15 cc

 

Ketamine Dosing Chart

 

  • ≤ 100 lbs or  ≤ 45 kg
    • Ketamine 100 mg or  2 mL

 

  • 100-200 lbs. or 45-91 kg
    • Ketamine 150 mg or 3 mL

 

  • ≥ 200 lbs. or  ≥ 91 kg
    • Ketamine 200 mg or 4 mL

 

  • Apply cricoid pressure
  • Intubate trachea
  • May repeat two times for a total of 3 attempts

 

Successful?

 

    • Yes

 

  • Notify receiving facility or contact Medical Control

 

    • No

 

PEARLS:

 

  • MFI should be utilized for patients with an immediate airway management need but by rendering apneic (paralytics) could be catastrophic for the patient.
  • Intubation equipment includes: intubation kit, bougie, BVM, suction, 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. If unable to preoxygenate to 94% or greeater, use BIAD
  • 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)