Drug Assisted Intubation
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Because neuromuscular blocking agents (NMBAs) can cause respiratory arrest, health care team members skilled in intubation must be present and ready at the bedside before the medication is administered. Ensure that an alternative airway is immediately available in case intubation fails.
A personal or family history of malignant hyperthermia is a contraindication to succinylcholine.undefined#ref9">9 Relative contraindications include conditions that increase the risk of succinylcholine-induced hyperkalemia (e.g., hyperkalemia; myopathies or neuromuscular disorders; or burns, crush injuries, or recent severe infections).9
Take steps to eliminate interruptions and distractions during medication preparation.
This skill is performed by health care professionals with additional knowledge, skills, and demonstrated competence, and in accordance with the professional’s regulatory scope of practice and the organization’s practice.
NMBAs (also called paralytics) are the foundation of emergency airway management. They allow placement of the oral endotracheal (ET) tube while minimizing potential complications, such as aspiration. There are two classes of NMBAs.
Drug assisted intubation (DAI) is performed for these purposes:
If the patient expresses concern regarding the accuracy of a medication, the medication should not be given. The concern should be explored, the intubator notified, and the order verified.
See Supplies tab at the top of the page.
Do not use medication that is cloudy or precipitated unless such is indicated by its manufacturer as being safe.
The induction agent should always be administered before the NMBA.
Rationale: This maneuver can allow a better view of the glottis.
The routine use of cricoid pressure (Sellick maneuver) for DAI or during cardiac arrest is not recommended.3,8 Cricoid pressure can worsen the laryngoscopic view.3
Rationale: The American Heart Association (AHA) recommends continuous waveform capnography in addition to clinical assessment to monitor tube placement.8,10
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