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RSI Checklist 3

The document provides a comprehensive checklist for Rapid Sequence Intubation (RSI) in pediatric patients, including preparation, procedure, and post-procedure steps. It outlines necessary medications, equipment, and endotracheal tube size selection based on patient weight. Additionally, it emphasizes the importance of team coordination and monitoring throughout the intubation process.

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Erwin Dela Gana
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22 views1 page

RSI Checklist 3

The document provides a comprehensive checklist for Rapid Sequence Intubation (RSI) in pediatric patients, including preparation, procedure, and post-procedure steps. It outlines necessary medications, equipment, and endotracheal tube size selection based on patient weight. Additionally, it emphasizes the importance of team coordination and monitoring throughout the intubation process.

Uploaded by

Erwin Dela Gana
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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UNC Pediatric ED Weight __________ kg

Rapid Sequence Intubation Checklist Allergies


Preparation
Ask team leader if difficult airway suspected
If yes, activate Pediatric Airway Emergency Pathway 974-4111
Evaluate any previous airway history (Epic: Anesthesia event OR difficult airway banner)
Identify intubator and back-up

Confirm pre-oxygenation is started Positioning


Nasal cannula _______ lpm Ear to sternal notch
Vapotherm _______ lpm If in c-collar, need
someone to hold in-line c-spine
Non-rebreather _______ lpm
Bag-valve mask

Equipment
Suction
ETCO2/stylet/ETT secure device
BVM + mask hooked up to 10 LPM oxygen
C-MAC (and laryngoscope backup)
See page 3 ETT size (age in years/4 + 3.5 cuffed) + additional tube 1/2 size smaller ________
Check ETT cuff
ETT Depth anticipated at lip (3 x ETT size) ________
NG tube size ________
Adjuncts: Oral airway _____, nasopharyngeal airway ______, LMA _______, Bougie
Monitor with QRS volume turned on

Procedure (Epiglottoscopy + Vocal Cord Visualization + Tube Delivery)


TIME OUT

Medications given (document meds on next page)

Apneic oxygenation at 15 L NC

Unsuccessful intubation?

Confirm adequate re-oxygenation


Discuss change of approach (position, equipment, intubator)

Post-Procedure
Confirm ETT depth _________ Secure ETT

Administer post-intubation medications (Post RSI Sedation Pathway attached)

NG tube placement

CXR

Rapid Sequence Intubation Weight __________ kg


Medication Worksheet Allergies

Premedication

Atropine 0.02 mg/kg (min 0.1 mg/dose, max 1 mg)-- 3 mins prior to sedative
Lidocaine 1.5 mg/kg (max 100 mg)-- 5 mins prior to sedative

Sedative

Etomidate 0.3 mg/kg (max 40 mg)-- consider avoiding in suspected sepsis


Midazolam 0.3 mg/kg (max 10 mg )
Ketamine ______ mg/kg --consider in asthmatics
___________ ______ mg/kg

Paralytic

Succinylcholine 1.5 mg/kg (max 150 mg)


Rocuronium 1 mg/kg (max 100 mg )

Post-intubation medications

Fentanyl 1 mcg/kg (max 100 mcg)


Fentanyl ggt 1 mcg/kg/hr (max 5 mcg/kg/hr)
Midazolam 0.1 mg/kg (max 4 mg)
Midazolam ggt _________ mg/kg/hr (0.1-0.3 mg/kg/hr)
Precedex 0.3 mcg/kg/hr (max 1.5 mcg/kg/hr)

Endotracheal Tube Size Selection Chart Weight __________ kg


Allergies

Weight Cuffed ETT size ETT at gum Blade size LMA size

<3 kg 2.5 9 cm 0 1

3-5 kg 3.0 9-10.5 cm 1 1

6-7 kg 3.0 10.5-11 cm 1 1.5

8-9 kg 3.0 10.5-11 cm 1 1.5

10-11 kg 3.5 11-12 cm 1-1.5 2

12-14 kg 4.0 13.5 cm 2 2

15-18 kg 4.5 14-15 cm 2 2

19-23 kg 5.0 16.5 cm 2 2-2.5

24-29 kg 6.0 17-18 cm 2 2.5

30-36 kg 6.5 18.5-19.5 cm 3 3

>36 kg 7.0-8.0 20-22 cm 3 3-5

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