rapid sequence intubation guidelines 2019

The Macintosh blade has a curved spatula used to approximate the curvature of the tongue and move the epiglottis, mandible, hyoid bone, and other soft tissues out of the view of the glottis. The most commonly used laryngoscope blades are the Macintosh and Miller blades. Smaller tube sizes are not adequately large enough to perform a bronchoscopy if it becomes necessary. Generally, a 7.0 to 7.5 mm internal diameter size tube should be placed in a female patient, and a 7.5 to 8.0 mm tube should be placed in a male. An easily viewed pulse oximeter should be available. The clinician should test the lighting source on the laryngoscope and test the inflation of the endotracheal tube. Successive grades reveal less of the cords and have a decreased rate of successful intubation.īefore initiating the procedure, the clinician should make sure that the lighting in the room is adequate. In this grade, the provider can see nearly the entirety of the vocal cord anatomy. A Grade 1 view of the cords using this system indicates a high likelihood of successful intubation. The Cormack and Lehane Grading system allow the provider to evaluate their view of the vocal cord and estimates the chance of successful intubation. When intubating with a Macintosh blade (discussed later), the tip of the blade should ideally be placed at the base of the tongue in the vallecula, and a ventral and inferior movement of the blade reveals the vocal cords. The valley between the tongue and the epiglottis is called the vallecula. The origin of the epiglottis can be found at the base of the tongue. The epiglottis serves as the primary landmark that will direct successful endotracheal intubation. This position is called the 'sniffing position.' This allows for the best visualization of the anatomy, including the epiglottis and vocal cords. Ideally, the neck should be flexed at the lower cervical spine (C6-C7) and extended at the upper cervical spine (C1-C2). Proper positioning of the patient is vital to the success of the procedure.

Obstruction of the airway, including head and neck cancer, epiglottitis, can indicate a difficult airway.Ī neck that cannot be maneuvered into an ideal position due to trauma, c-collar, or rigidity can lead to a more difficult airway. Obesity (body mass index > 30) can be a predictor of a difficult airway. The timing of the pregnancy test at which the investigative team will consider a subject to be non-pregnant is a documented negative test during current hospitalization or upon direct transfer from outside institution during current illness.Mallampati 4 score indicates that the uvula cannot be visualized.Ī higher Mallampati score is an indication of a more difficult airway. Females of child-bearing age, defined as 18-50 years, who do not have a documented pregnancy test in this institution confirming that they are not pregnant or who do not have a confirmed surgical procedure preventing pregnancy, i.e., tubal ligation, hysterectomy.Patient is known or suspected of having increased intracranial pressure, based on the history and physical examination performed by the treating physician.Patient has a condition in which an increase in heart rate or blood pressure would be hazardous, as judged by the treating physician.Known contraindication to ketamine or etomidate.Undergoing rapid sequence intubation (RSI) in the Emergency Department.Why Should I Register and Submit Results?.

Rapid sequence intubation guidelines 2019