Successful ETT, Nasal intubation, or Supraglottic Airway device
- Verify tube placement through ausculation, continuous capnography and pulse oximetry
- Manage Hypotension
- Provide sedation as needed
- Ketamine 2 mg/kg IV/IO bolus max single dose 200 mg; see Ketamine Dosing Chart, May repeat once after 10 minutes
OR
- If dysynchronous with mechanical ventilation in spite of adequate sedation, consider Vecuronium (Norcuron) 0.1 mg/kg to a max dose of 10 mg
PEARLS:
- Etiology of hypotension post intubation: Tension pneumothorax, Hyperventilation, Hypovolemia, or shock.
- Ketamine should be used for sedation in the presence of hypotension.
- Waveform capnography and pulse oximetry must be utilized for a minimum of 5 minutes after tube placement prior to the administration of Vecuronium (Norcuron) and is required for intubation verification and ongoing patient monitoring.
- Bradycardia after tube placement is a strong predictor or a misplaced endotracheal tube (ETT).
- It is required that the airway be monitored continuously through waveform capnography and pulse oximetry.
- An Airway evaluation form must be completed on every patient who receives advanced airway management.
- Confirm airway placement by ED staff prior to moving the patient from EMS stretcher.