Intubation
Guide
v2.3 · ⓘ Verify Concentrations
DSI
Patient Weight
lbs
Target Vital Signs
Hit BOTH × 3 min before paralytic
SpO₂ ≥94%
CPAP / BVM + PEEP
SBP >90
MAP >65
Fluids / Low-Dose Epi
3-Minute Timer
3:00
​
✓ 3 MIN MET — PROCEED
Enter weight to display doses
🎒 Equipment
⌄
Monitor: SpO2, EtCO2, EKG, BP, HR
Suction set up + tested
Laryngoscope - VL preferred
ET tubes + size smaller
Bougie / S-Guide
iGel backup
Inline EtCO2 + securing device
BVM + PEEP 5 · CPAP
2 O2 tanks · NC at 15 LPM
Cric kit at bedside
IV/IO secured + flushes
Low-dose Epi drawn up
Position: ear-to-sternal · HOB 15°
🍋 LEMON Assessment
⌄
L
Look Externally
  • Facial trauma
  • Large incisors
  • Beard / moustache
  • Large tongue
E
3-3-2 Rule
  • Mouth opening: 3 FB between incisors
  • Chin to hyoid: 3 FB
  • Hyoid to thyroid: 2 FB
M
Mallampati ≥ 3
Soft / hard palate only visible → difficult.
O
Obstruction
Epiglottitis · peritonsillar abscess · trauma
N
Neck Mobility
C-spine · arthritis · immobilization
Mallampati Classification
CLASS I
Soft palate, uvula, pillars
CLASS II
Soft palate, base of uvula
CLASS III
Soft palate only
CLASS IV
Hard palate only
⚠️ Key Considerations
⌄
  • Can't reach SpO2 94% → BVM + PEEP 10 · NPA/OPA or iGel
  • Can't intubate → iGel + ventilate
  • Cric if oxygenation impossible · needle jet if peds <12
  • 2 failed attempts → change operator OR iGel
  • Can't establish airway → nearest hospital
Other
  • Sux preferred for neuro exam (seizure / head injury / stroke)
  • Sux CI: hyperK+ · renal failure · MG · paralysis hx · burns/crush >48h · rhabdo
  • Etomidate not for post-intubation sedation in DSI
  • Paralytics don't sedate - always pair with analgesia + sedation
  • Bradycardia: stop, BVM 100% O2 PEEP 15 · Atropine PRN
  • C-spine: manual stabilization · collar open during laryngoscopy
  • Head injury: SBP ≥110 (MAP >80) · EtCO2 35
⚠ Failure Path
Att. 1 fails → change operator · Att. 2 fails → iGel
Can't ox/vent → Cricothyrotomy (needle jet if peds <12)
⚠ DOPE — Tube Trouble
D
Displaced: Check ETCO2 waveform · breath sounds · tube depth at lip
O
Obstructed: Suction · check for kink · mucus plug · bite block
P
Pneumothorax: Auscultate · decompress if tension
E
Equipment: Vent / O2 source / BVM / cuff inflation
Adult Crash
Patient Weight
lbs
Enter weight to display doses
⚠ Failure Path
SpO2 <88% + can't ox/vent → Cricothyrotomy
Peds <12 → Needle jet
⚠ DOPE — Tube Trouble
D
Displaced: Check ETCO2 waveform · breath sounds · tube depth at lip
O
Obstructed: Suction · check for kink · mucus plug · bite block
P
Pneumothorax: Auscultate · decompress if tension
E
Equipment: Vent / O2 source / BVM / cuff inflation
Peds RSI / DSI
Select Age
OR ENTER LENGTH
in
Tap an age or enter length
⚠ Peds Failure
Can't ox/vent → Needle jet (<12 yr)
Post-Intubation
Patient Weight
lbs
Enter weight to display doses
Midazolam
Alt Sedation
5mg
Weight-based bolus alt: 0 mg
Concentration: 1 mg/mL
5 mg IV/IO q15 min x 4, then PRN
Alt: 0.05 mg/kg bolus → 0.1 mg/kg/hr pump
RASS target -2 to -3 · pain → -4
Vent 10-12 BPM · SpO2 94-98 · EtCO2 35-45
Head injury: SBP ≥110 · EtCO2 35
⚠ DOPE — Tube Trouble
D
Displaced: Check ETCO2 waveform · breath sounds · tube depth at lip
O
Obstructed: Suction · check for kink · mucus plug · bite block
P
Pneumothorax: Auscultate · decompress if tension
E
Equipment: Vent / O2 source / BVM / cuff inflation
📊 RASS Scale
⌄
ScoreLabelDescription
+4CombativeViolent, danger to staff
+3Very agitatedPulls tubes; aggressive
+2AgitatedNon-purposeful; fights vent
+1RestlessAnxious, not aggressive
0AlertAttentive
-1DrowsySustained wake to voice >10s
-2Light sed.Brief wake to voice <10s
-3Mod. sed.Eye open to voice
-4Deep sed.Response to physical only
-5UnarousableNo response
Concentrations
Verify these against your agency's stock before use. Based on 2026 Clark County EMS Patient Care Protocols.
Drug
Conc.
Dose
Max
Ketamine
50 mg/mL
1 mg/kg
200 mg
Rocuronium
10 mg/mL
1.5 mg/kg
300 mg
Etomidate
2 mg/mL
0.3 mg/kg
60 mg
SUX
20 mg/mL
1.5 mg/kg
300 mg
Fentanyl
50 mcg/mL
1 mcg/kg
100 mcg
Midazolam
1 mg/mL
(5 mg / 5 mL)
5 mg post
0.1 mg/kg peds
—
If your agency stocks a different concentration (e.g. Midazolam 5 mg/mL), the mL volumes in this app will be wrong. Confirm before administration.
Questions, comments, concerns — contact
d.boyce@northcountryems.org
⚠ MAX DOSE You may have met the maximum dosage.
⚠ WARNING This protocol is based off of 5 mg per 5 mL (1 mg/mL). Verify your agency's concentration before drawing up — other agencies may stock different.
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