View source for Drug Assisted Intubation

====Patients who require intubation have at least one of the following 5 indications:====
*1. Failure to ventilate
*2. Inability to maintain airway patency
*3. Inability to protect the airway against aspiration
*4. Failure to adequately oxygenate
*5. Anticipation of an injuries or illness that will eventually lead to the inability to maintain airway patency i.e. Angio Edema, Bad Strep Infection, Ludwig’s Angioedema etc.

====The (7) Seven P’s of DAI====
*1. Prepare
*2. Pre-oxygenate
*3. Pretreatment / Treatment
*4. Paralysis if needed
*5. Protection and positioning
*6. Placement and proof
*7. Post-intubation management

====Prepare:====
*Have all emergency airway supplies prepared and ready, (i.e. Bougie Tube, King Vision, King Airway, Cric-kit) Pre-oxygenate:
* If time permits, pre-oxygenate all patients via NRBM or BVM. 2 Person BVM is recommended once medications are administered. Pretreatment / Treatment:
*Consider [[Lidocaine|LIDOCAINE]] 1.5mg/kg for patients with increased Intracranial pressure. (i.e. head trauma, brain tumor, stroke.) *Administer as early as possible prior to intubation.
<!--*Administer [[Analgesics|FENTANYL]]: Adult 3mcg/kg. Pediatric 1-2mcg/kg.  -->
*Administer [[Morphine_Sulfate|MORPHINE]]: Adult 2-20mg

===Intubation attempt should be made after Fentanyl or Etomidate is administered.===

====Paralytics if needed:====
*If intubation is unsuccessful due to the patient being clinched, strong gag reflex, or seizure, consider Succinylcholine: Adult 1.5mg/kg. Pediatric 2mg/kg.
*Do not administer to patients with Hx of HYPERKALEMIA, RHABDOMYOLYSIS, Severe Burns and Malignant hyperthermia. (i.e. peaked T waves, kidney insufficiency, renal failure, acidosis, crush injuries.)
*If ventricular dysrhythmias are present after medication administration, consider Calcium Chloride. 

====Placement and proof:====
*Allow medications to work.
*Maintain Sellick’s maneuver until cuff inflated.
*Ventilate with bag-valve mask if unsuccessful.
*Confirm tube placement EtCO2 and lung sounds.
*Visualize the ET tube passing through the vocal cords.
*st-intubation management:
*Secure endotracheal tube with commercially available device
*Continued sedation (i.e. Versed) (watch for hypotension) consider Fentanyl for pain and sedation
*Continuous SaO2 and EtCO2 monitoring
*Reassess vital signs frequently
*Restrain patient to prevent accidental extubation

====Remember to titrate to effect all medications administered====


====ONCE THE DECISION IS MADE TO PERFORM (DAI), THE LEAD PARAMEDIC MUST CONSIDER THE FOLLOWING:====
*2 PERSON BVM.
*ESTABLISH THE AIRWAY - IF INTUBATION ATTEMPTS FAIL, RETURN TO BVM USE AND TRY TO KEEP SaO2 ABOVE 92% DURING ADDITONAL ATTEMPTS.
*AN ATTEMPT TO PLACE THE KING AIRWAY SHALL BE MADE.
*IF THE KING AIRWAY FAILS, RETURN TO BVM.
*IF UNABLE TO VENTLATE VIA BLS BVM PERFORM SURGICAL CRICOTHYROTOMY

[[Category:Primary Care|0205]]