Hospitals & Services
Skilled assistance is mandatory; where possible a team of 4 is required.
"Intubator" who controls and co-ordinates the procedure.
A person to apply in-line traction where the stability of the cervical spine is unclear.
Cricoid pressure is recommended in all emergency situations and should be applied at the commencement of induction.
Cricoid pressure may distort the larynx so that intubation is made more difficult. It should be modified at the discretion of the Intubator, and requires an understanding of the procedure.
Suxamethonium 1-2mg/kg (100mg)
Consider rocuronium 1-2mg/kg (50-100mg) if suxamethonium contra-indicated, eg;
Burns patients >48 post injury
Spinal injury patients where spasticity is present
Chronic neuromuscular disease (Myasthenia Gravis, GBS)
Atropine 0.6 – 1.2mg
Adrenaline 10ml of 1:10 000 solution
Ephedrine 30mgs in 10mls normal saline
Pre-oxygenate for 3-4 minutes with 100% oxygen. Patients receiving non-invasive ventilation should continue on this form of ventilation until the point of induction, and a PEEP valve applied to the AMBU-bag mask assembly.
Administer induction agent and suxamethonium
Apply cricoid pressure
Intubation under direct visualization
Inflate ETT cuff until there is no air leak during ventilation
Confirm ETT placement with capnographs and chest auscultation with normal ventilation
Release cricoid pressure (once tube position confirmed)
Secure ETT at correct length
Do not cut ETT
Connect patient to ventilator
Ensure adequate sedation and analgesia to cover period of muscle relaxant and continue as indicted by clinical scenario
Insert naso-/-orogastric tube if not already present
If ongoing relaxant required use pancuronium or rocuronium