Check, monitor, access
Machine checked, suction working, airway equipment of the size you want and a size either side. Monitoring on and reading before any drug is given: saturation, capnography, blood pressure and electrocardiogram are the minimum, and they go on first because they are how you will know what is happening.
Pre-oxygenate properly
Three minutes of tidal breathing on a tight-fitting mask with high flow, or eight vital capacity breaths if time is short, aiming for an end-tidal oxygen above 0.85. This replaces the nitrogen in the functional residual capacity with oxygen and buys the apnoeic time that everything else depends on.
Opioid before hypnotic
The opioid is given first so it is at peak effect when the laryngoscope goes in. Fentanyl takes three to five minutes; giving it as the tube passes is giving it too late to blunt the pressor response it was drawn up for.
Hypnotic, then check you can ventilate
In a routine induction, confirm you can ventilate by hand before giving a relaxant. That order is what keeps a difficult airway from becoming a crisis, and it is the step a rapid sequence deliberately gives up in exchange for speed.
Relaxant, then intubate at the right time
Wait for the relaxant to work. Intubating early against a partly paralysed larynx causes trauma and makes the second attempt harder. A nerve stimulator or simply the stated onset time is more reliable than impatience.
Watch it done
Intubation tips and tricks
Positioning, the laryngoscope, the view, and what to do when the view is poor.
Source: ABCs of Anaesthesia · Watch on YouTubeWatch for
- Ear to sternal notch positioning
- The blade in the vallecula
- External laryngeal manipulation
Tracheal intubation (direct laryngoscopy)
The procedure in ninety seconds: the view, the tube through the cords, the confirmation.
Source: Medscape · Watch on YouTube