Conscious Sedation: Etomidate Rapid Induction for Intubation

Program Goals Background on Intubation Current Methods and Practices New Medications and Theories Patient Selection Difficult Airway

Background Endotracheal intubation is considered the “Gold Standard” for airway management. Currently only Oral and Nasal Intubation are available for use.

Oral Intubation Orotracheal intubation is the most commonly used means of securing the airway in the adult patient. It can prove difficult in awake patients or patients with an intact gag reflex. Success rates for oral intubation with an acutely dyspnic patient are low. It can be difficult to secure the airway of a breathing, conscious patient.

Nasal Intubations Blind Nasotracheal Intubation is an under utilized skill, that is difficult to be proficient in. It has a high occurrence of trauma and infection. It is a blind procedure. Patient must be breathing.

New Practices Etomidate Etomidate is a short acting hypnotic. When utilized, Etomidate will relax the patient enough to produce intubation conditions within seconds. Etomidate has a relatively short half life of 10 minutes. Proven efficacy of 80%.

Etomidate is NOT A paralytic An analgesic

Etomidate Contraindications: Known Hypersensitivity to Etomidate Under the Age of 10.

Precautions Possible hypoventilation or apnea in overdosage. Myoclonus: Diffuse muscle contraction. Pre-medicate with a Benzodiazepine before administration of Etomidate

Side Effects Pain at injection site, try to use the antecubital fossa. Hypotension Apnea Tachycardia Nausea and Vomiting

Etomidate Etomidate is not an analgesic, anticipate reflex hypertension and tachycardia. Not indicated to relax or reduce trismus or clenching of the jaw. You must assess the patient as a candidate for this procedure.

Clearing the Patient It is imperative that each possible patient receive a thorough examination for difficulty in intubation. Any patient found to be of high risk, or high degree of difficulty should not receive Etomidate.

MEDIC TUBES +T Mouth / Mandible Excessive Weight Deformity Incisors C-Spine Thyromental Distance Uvula Burns Emisis Stridor TRISMUS

Mouth / Mandible Measure the opening size of the mouth. Anything less than three fingers should be considered a potential problem Check to make sure the mandible is centered and free from deformity and fracture.

Excessive Weight Obese patients that have large necks and small chins can be very difficult to intubate. Be sure your patient has an adequate range of motion in their neck and lower jaw.

Deformity Inspect the face, neck, mouth, and oropharnyx for deformity, swelling, bleeding, or any potential problems.

Incisors Inspect the mouth and teeth for loose debris. Buckteeth may result in poor visualization. Check for dental appliances and remove any that can be.

C-Spine Inspect the neck, patients with short large necks can be difficult to intubate. If the patient is immobilized be sure to have in-line stabilization maintained. Remember it is more difficult to intubate someone in c-spine because the axis is not lined up correctly.

Thyromental Distance Measure the distance from the chin to the thyroid cartilage, anything under three finger widths can be a difficult intubation.

Protocol 1.Routine paramedic care 2.Routine preparation for intubation 3.Contact medical control for etomiate 4.Administer 0.3 mg/kg IVP over 30 to 60 seconds 5.Intubate 6.Verify tube placement with third party device

Post procedure Complete the etomidate survey and clip to the QI/QA hospital copy