•  Anticipated need for airway management in pts at risk for deterioration

•  Assess difficulty of intubation early

•  In pts w/ acute respiratory failure, BVM ventilation or noninvasive positive pressure ventilation (NiPPV) can be a bridge but not a substitute to intubation

•  Choose appropriate intubation algorithm

•  Choose appropriate intubation tool

•  VL: 1st choice, if available; failure rate is lower than w/ standard DL

•  DL: Most commonly used (Mac or Miller blade)

•  Awake sedated airway eval: Injection, inhalation, or topical application of local anesthetic then intubation via, VL or fiber optic → requires cooperative pt, noncrash airway

Pearls

•  Have rescue devices at the ready: EGD, cricothyrotomy kit

•  Good BVM technique saves lives

RSI

•  Preparation

•  Monitor O₂ sat, BP, rhythm, ≥1 IV

•  BVM, suction, ET CO₂ detector, oral airway, Bougie

•  Intubation equipment (eg, laryngoscope): Blade, backup blade, check video monitor/light

•  ETT: 8 (male), 7 (female); check cuff, load stylet/10 cc syringe; pediatrics tube size: = 4 + (age in y/4) → or use Broselow tape

•  RSI medications/doses

•  Assess for difficult BVM, difficult intubation, & difficult cricothyrotomy → prepare appropriately

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