Page 190 - 2023 SMOG Digital

Pre-Intubation Checklist

PRE-INTUBATION CHECKLIST
INSTRUCTIONS FOR USE
The Pre-Intubation Checklist serves as a final reference prior to administering a sedative and paralytic during a
Rapid Sequence Intubation. Run the checklist to ensure preparation is complete before embarking on induction
and paralysis. Refer to RAPID SEQUENCE INTUBATION for how to do an RSI.

Consider Dangerous Physiology Issue: SBP <100, SpO 2 <94%, Metabolic Acidosis
 Appropriately modify or avoid RSI in unstable patient
 SBP <100  Consider resuscitation with IVF and vasopressors, Lower the dose of sedative
 Sat <94%  Consider use of CPAP or BVM with PEEP valve to increase Mean Airway Pressure
during Pre-Oxygenation
 Severe Met. Acidosis Consider awake intubation or delayed sequence intubation with severe
Metabolic Acidosis
Difficult Airway Evaluation (LEMON, HEAVEN Criteria)
 Consider alternate airway, cricothyrotomy, or modify plan

PLAN Rapid Sequence Intubation, Delayed Sequence Intubation, Rapid Sequence Airway (SGA), or
Cricothyrotomy
 Choose the most appropriate technique for physiology and anatomy
Evaluate Cricothyrotomy Landmarks and Assess Procedural Difficulty
Induction Agent/Paralytic
 Choose and draw up appropriate Sedative and Paralytic
Push-Dose Pressors
 Consider drawing up or administering Push-dose Epinephrine
Post-tube Sedation / Analgesia
 Prepare Post-intubation Sedation and Analgesia
Consider Pretreatment 3-5 minutes prior
 Fentanyl (TBI, CVA, MI, Ao Dissection); Atropine (Pediatric)
Failed Airway Plan Verbalized to the team
 Discuss management plan for failed intubation
PreOx ≥ 3 minutes with 15 LPM NRB or BVM + PEEP, and NC 4-6 LPM
Apneic Oxygenation with NC 15 LPM once Induced/Sedated
PATIENT PREPARATION Oxygenated ≥ 94% prior to Induction
 Consider using CPAP or BVM + PEEP if unable to reach 94% with NRB
Positioning: 30° Head-up for Pre-Ox, Ear-to-Sternal Notch for Intubation
 If C-Spine Consideration, open front of C-Collar and perform Manual In-line Stabilization

Monitor is Visible (HR, BP, SpO 2 %, RR, EtCO 2 )
Reliable IV Access Tested
BVM (± PEEP Valve) on Oxygen
Waveform Capnography on BVM (minimum Colorimetric)
EQUIPMENT ± Back-up Laryngoscope ETT, ETT size down, 2x Stylet, 2x Syringe, Tube Securing
± Video Laryngoscope powered on
Bougie
OPA, NPA, SGA (iGel, LMA, King LT)
Nasogastric or Orogastric Tube
Cricothyrotomy Kit
Suction on and accessible

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