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INDICATIONS: Indicated for adult and pediatric patients (8 years of age or older) where intubation and ventilatory support are required to include both medical and trauma conditions. For pediatric patients under the age of 8, Physician's Orders are required to administer Etomidate! This procedure guideline should be used as a replacement for those situations where Midazolam (Versed) was indicated for airway management. '&''' ' ' '' ''''P[   U 0 These situations include, but are not limited to: 1.ASTHMA WITH DYSPNEA (2-8) 2.COPD WITH DYSPNEA (2-9) 3.PULMONARY EDEMA (2-12) 4.BURNS (2-54) 5.HEAD INJURIES (2-58) %%%%%$%$%$%$%$%$%$%$ %$%$%   Basic Life SupportOXYGEN! NRB or BVM Sellick s Maneuver Manual Jaw Thrust Nasal/Oral Airways Suctioning n" N  M  $ :  Pre-OxygenatePMinimum of 1 full minute with 100% 02 San Diego Study-Incidental Hypoxia If using a BVM, Sellick s Maneuver Breathing effectively, NRB to reduce Gastric Distention &  &aY F FSellick s Maneuver (Cric pressure)($($   Digital pressure on the cricoid membrane Occludes esophagus Precludes introduction of air into stomach May occlude stomach contents May lower epiglottis/chords into viewb)H&)H&   General Procedures. If sedation is necessary to facilitate intubation (unable to open the mouth due to trauma, or if the jaw is clenched, etc.) return to BLS procedures. &}((( eGeneral ProceduresEnsure best oxygenation and ventilation. Ensure a patent IV line exists. Give 0.3mg/kg Etomidate IV Push over 30-60 seconds for anesthesia. Attempt a maximum of 2 times to pass the tube through the vocal cords. Monitor for signs of hypoxia during attempts.Z2    _W   Monitoring Cardiac and Sp02 monitors in place. Second crewmember call-outs Monitor for signs of hypoxia: Significant decrease in heart rate Sp02 levels below 90% Ventricular ectopy RE-OXYGENATE!r$:M$:M$3 General ProceduresIf intubation successful, progress to Section C: SUCCESSFUL AIRWAY PROCEDURE If unable to intubate after Etomidate, progress to Section D: FAILED AIRWAY PROCEDURE. > L  3!'Section C: SUCCESSFUL AIRWAY PROCEDUREH(     Continuously monitor airway status to maintain intubation, adequate ventilation and adequate perfusion. Maintain sedation: Versed 2mg q3-5 minutes up to 10mg. Valium 5mg q3-5 minutes up to 20mg..{H{H/ "#Section D: FAILED AIRWAY PROCEDURE8$   Revert to BASIC LIFE SUPPORT airway procedures as described in Section B: OXYGEN! NRB or BVM Manual Jaw Thrust Nasal and Oral Airways Suctioning to keep the airway clear of secretions, blood and vomitus.^Jz .z##Section D: FAILED AIRWAY PROCEDURE8$   If able to effectively ventilate the patient with a BVM, consider insertion of a CombiTube and continue ventilations. If attempts at ventilation fail, or ventilation fails to perfuse the patient with oxygen, perform a Surgical Cricothyrotomy.v e( ,Q  Sedatives & Anesthetics<  The difference between Sedatives, Anesthetics and Paralytics: Sedatives sedate. Anesthetics put to sleep. Paralytics paralyze& ?ZNZ=$$ (( ((f3(( (( (  VERSED Sedative4Amnestic, anticonvulsant, reversible. Dose: 2mg increments every 3-5 minutes. Max dose: 10mg. Onset: 1-2 minutes Duration: 30-60 minutes ICP: Minimal effect BP: Decreases&' VALIUM Sedative& Anticonvulsant. Dose: 5mg increments Slow IVP every 3-5 minutes. Max dose: 20mg. 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