Rapid Sequence Intubation Algorithm in Pediatric:

1. Obtain AMPLE History & Examine patient

2. Preparation

Equipment, Personal, Medications

3. Preoxygenation

EKG & pulse oximetry

Don’t bag till patient become apneic

4. Pre-medications

• Atropine .02mg/kg (0.1mg – Min)

• Lidocaine 1mg/kg (Head Injury & Pulmonary Hypertension)

• IV Fluid bolus 10 ml/kg – indicate in Hypovolumic, status

• asthma, increased intra-thoracic and abdominal pressure

• SEDATION (Based on type of patient)

• Normotensive
• Midazol
• am 0.05
• – 0.1mg/kg
• Etomidate

• 0.3 mg/kg
• Thiopental
• 2 -5 mg/kg
• Hypotensive / Cardiac
• Etomidate 0.3 mg/kg
• Ketamine 1-2 mg/kg

• Fentanyl 1-2mcg/kg
• (Cardiogenic Shock)
• Head injury / StatusEpi
• Thiopental 2-5 mg/kg
• Propofol 1-3 mg/kg

• Etomidate 0.3 mg/kg
• Status Asthma
• Ketamine 1-2 mg/kg
• Propofol 1-3 mg/kg
• Midazolam 0.1 mg/kg

5. Placement

Apply Cricoid Pressure

(Don’t relieve till ET tube placement was confirmed)

Paralyze

(Choose One)

Recoronium 1mg/kg

Succinylcholine 2mg/kg

Intubate within 45 sec

6. Confirm tube placement

Secure tube

Observe & monitor