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Department of Pediatrics : Academic Divisions : Emergency Medicine : Resident Manual : Trauma : Pediatric Trauma Intubation Algorithm

Rapid Sequence Intubation

1. Gather equipment:

  • O2
  • CardioPulmonary monitor
  • Bag-valve-mask
  • Tracheal tube size and +/-0.5 tube size
  • Stylet
  • Suction
  • Drugs as below
  • Consider NG tube

2. Pre-assessment

Difficult to bag? Difficult to intubate?
Always ask yourself these questions. If there are concerns, consider anesthesia involvement or back-up.

3. Pre-oxygenate - Use NRB, have BVM available

4. Lidocaine

1.5mg/kg Lidocaine if suspected head injury *most effective if given 4 min prior to intubation

5. Atropine
0.01-0.02mg/kg (0.1mg min -0.5mg max)
*decreases vagal response and oral secretions

6. Sedative/Hypnotic

  • Versed 0.1-0.2 mg/kg
  • Etomidate 0.3mg/kg
  • Thiopental 4-5 mg/kg
  • Ketamine 1-2mg/kg

7. Paralytic

  • Rocuronium 1mg/kg
  • Succinylcholine 2mg/kg (depolarizing paralytic)
    • Contraindicated in crush injury, hyperK, neuromuscular disorders, penetrating eye injuries, day 3 or later following trauma or large burns, history or family history of malignant hyperthermia or pseudocholinesterase deficiency.
    • Duration 3-10min
  • Vecuronium 0.1-0.2mg/kg
    • Duration 30-90min

8. Intubate with Sellick maneuver

9. Confirm tube placement (CO2 detector, auscultation)

10. Post-intubation care
Sedation and Paralysis

#tubes td { border-bottom : 1px solid #ddd; } Tube/Line sizes

 ETTCVLNGTChest tubeFoley Catheter
Newborn3.0-4.03F5-8F10-14F5-8F
2-12mo3.5-4.03F8-10F14-20F8F
12-24mo4.0-4.54F8-10F14-24F8F
2-3 yrs4.54F8-10F14-24F8-10F
4-5 yrs5.0-5.54-5.5F10-12F20-32F10F
6-7yrs5.5-6.05.5F12F20-32F10F
8-11yrs6.0 cuffed5.5F14F28-38F12F
12-15yo6.5-7.0 cuffed5.5-6F14F28-38F12-16F
>15yo7.0-8.0 cuffed7-8.5F16-18F28-38F14-16F



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