Successful ETT, Nasal intubation, or Supraglottic Airway device

• Verify tube placement through ausculation, continuous capnography and pulse oximetry

• Secure tube

• 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

• Midazolam (Versed) 5 mg slow IV/IO, q 5-10 mins max 10 mg

• Consider analgesia: Pain Management for Fentanyl

• 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.