RSI · AIRWAY

CRASH CARDCC-RSI-01 · ACUTE CARE 04

PREPARE before the first attempt

Pre-oxygenate	100% O₂ ≥3 min or 8 VC breaths
Apneic O₂	NC 15 L/min — on through attempt
Position	ear-to-sternal-notch · ramp if obese
Backup	suction on · bougie · SGA at hand
Pressor	push-dose epi drawn up before drugs
Plan	verbalise A→B→C · assign roles

INDUCTION → PARALYSIS IV · mg/kg

AGENT	mg/kg	ONSET	DURATION	HEMODYN.
INDUCTION
Etomidate	0.3	30–60s	3–10m	neutral
Ketamine	1–2	30–60s	5–15m	↑BP ↑HR
Propofol	1.5–2.5	<60s	5–10m	↓↓BP
Midazolam	0.1–0.3	60–90s	15–30m	↓BP · slow
PARALYSIS
Succinylcholine	1.5	45–60s	6–10m	↑K⁺
Rocuronium	1.2 RSI	45–60s	30–60m	neutral

ROC 1.2 intubating conditions ≈ sux speed · plan for 30–60 min down
NO ANALGESIA etomidate / midazolam — pair with fentanyl

NO SUX — USE ROC

Hyperkalemia known / suspected
Burns / crush >72 h out
Denervation GBS · ALS · SCI
MH history personal / family

SHOCK / LOW BP

SI ≥1 → ketamine or etomidate
cut induction dose 25–50%
avoid propofol
push-dose epi 5–20 µg q2–5m

FIELD REFERENCE · NOT A PROTOCOLVERIFY LOCALLY

FRONT

FAILED AIRWAY change something every attempt

Each attempt	blade · bougie · position · operator
SpO₂ falling	stop → 2-hand BVM + OPA/NPA
BVM fails	supraglottic (i-gel / LMA)

⚠ CAN'T INTUBATE · CAN'T OXYGENATE

1 ≤3 attempts total → 2 declare CICO aloud → 3 last SGA try → 4 scalpel–bougie–tube cric → 5 confirm EtCO₂

Decide to cut while SpO₂ still >80 — fixation on the tube kills.

QUICK DOSES mg by weight · midpoint doses

WT kg	ETOM 0.3	KETA 1.5	SUX 1.5	ROC 1.2
50	15	75	75	60
60	18	90	90	72
70	21	105	105	84
80	24	120	120	96
90	27	135	135	108
100	30	150	150	120
110	33	165	165	132

POST-INTUBATION confirm → sedate

CONFIRM EtCO₂ waveform · equal sounds · secure depth
HYPOTENSIVE fluids · push-dose epi 5–20 µg q2–5m

PUSH — RE-SEDATE
Fentanyl	25–100 µg IV
Midazolam	1–2 mg IV
WATCH
Propofol	↓BP
Dexmedetomidine	↓HR

DRIPS
Fentanyl	25–200 µg/h
Propofol	5–50 µg/kg/min
Midazolam	1–5 mg/h
Ketamine	0.5–2 mg/kg/h
Dexmedetomid.	0.2–0.7 µg/kg/h

SEDATE BEFORE PARALYZE

roc 30–60 min outlasts every induction agent — re-dose sedation first

VERIFY AGAINST LOCAL PROTOCOLCC-RSI-01

BACK

REAL CARD ARTWORK · VECTOR TEXT — ZOOM ALL YOU WANT

CC-RSI-01 · ACUTE CARE 04

RSI & Airway Drugs Reference Badge

Pre-oxygenation through failed airway: induction and paralytic doses, onset, duration, hemodynamics.

$14First run — ships July 25

1

Free US shipping
Rigid PVC · water-resistant
2.25 × 3.5 in · badge-reel slot

SKU	CC-RSI-01
Series	ACUTE CARE 04
Size	2.25 × 3.5 in (CR80)
Material	Rigid PVC, water-resistant
Finish	Dark ink on field-kit tan
For	ER/ICU nurses, paramedics, flight and tactical medics.

Field reference — not a protocol. Verify against local protocol.

On this card

Rapid sequence intubation, condensed to the numbers you actually reach for — from pre-oxygenation through the failed airway and post-intubation sedation, on one dense field-kit card. Built for ER and ICU nurses, paramedics, flight crews, and tactical medics who assist or push airway drugs under pressure.

Front

a PREPARE checklist (pre-oxygenation, apneic O₂, positioning, backup gear, push-dose epi drawn up, plan and roles); the induction → paralysis table — etomidate, ketamine, propofol, midazolam, succinylcholine, and rocuronium with mg/kg dose, onset, duration, and hemodynamic profile; and paired amber panels: NO SUX — USE ROC (the hyperkalemia contraindications: burns/crush, denervation, MH history) and SHOCK / LOW BP (shock-index trigger, agent choice, dose reduction, avoid propofol, push-dose epi dosing).

Back

the FAILED AIRWAY ladder — change something every attempt, two-hand BVM, supraglottic — with an amber CAN'T INTUBATE · CAN'T OXYGENATE strip (attempt limit, declare CICO, scalpel–bougie–tube cric, confirm EtCO₂); a QUICK DOSES table with pre-multiplied mg by weight, 50–110 kg, for all four agents; and a POST-INTUBATION section — confirmation, hypotension response, re-sedation pushes, and sedation drip ranges (fentanyl, propofol, midazolam, ketamine, dexmedetomidine) — closed by the boxed rule: SEDATE BEFORE PARALYZE. Rigid PVC, water-resistant, standard CR80 badge size in the tan field-kit colorway with dark olive-and-amber print. Punched badge-reel slot at the top — clips behind your ID and survives the shift. Content is clinician-reviewed and drawn from textbook-standard values. Field reference only, not a protocol — always verify against your facility's protocols.

Pairs with

VENT TRANSFER

CRASH CARD

GAS EXCHANGE problem → correction

O2	SpO2 / PaO2 low	↑ FiO2 then ↑ PEEP
CO2	EtCO2 / pCO2 high	↑ RR then ↑ volume
CO2	EtCO2 / pCO2 low	↓ RR

DOPES

Displaced tube
Obstructed / plugged
Pneumothorax
Equipment failure
Stacked breaths

DOTTS

Disconnect vent
O2 100% · bag by hand
Tube: suction + EtCO2
Tweak settings
Sounds equal

HIGH PRESSURE kink · plug · biting · bronchospasm · PTX
LOW PRESSURE disconnect · cuff leak · extubated

TIDAL VOLUME 6 mL/kg PBW · by height & gender

HT	F mL	M mL
5'0"	275	300
5'2"	300	330
5'4"	330	355
5'6"	355	385
5'8"	385	410
5'10"	410	440
6'0"	440	465
6'2"	465	495
6'4"	495	520

ARDSNET (ARMA)

TV 6 mL/kg PBW · range 4–8
Plat ≤30 · if >30: ↓TV 1 mL/kg → min 4
RR ≤35 · titrate to pH
pH 7.30–7.45 · ≥7.15 tolerated
PaO2 55–80 · SpO2 88–95
ΔP ≤15 (Amato, post-hoc)

PBW derives from height + gender, not weight. 8 mL/kg = table × 1.33.

⚠ STILL HYPOXIC — ESCALATE IN ORDER

1 sedate deeper → 2 paralyze → 3 ↑PEEP (Plat ≤30, ΔP ≤15) → 4 prone if able → 5 accept SpO2 88 / pH ≥7.15 → 6 ECMO call (P/F <80)

High PEEP derecruits in seconds — clamp the tube before ANY circuit break.

FIELD REFERENCE · NOT A PROTOCOLVERIFY LOCALLY

Vent TransferCC-VT-01

LAB VALUES

CRASH CARDCC-LV-01 · ACUTE CARE 01

BASIC METABOLIC PANEL adult reference

	Na	135–145
▲	K	3.5–5.0
	Cl / CO₂	98–106 / 23–29
	BUN / Cr	7–20 / 0.6–1.2
▲	Glucose	70–100 (fasting)
	Calcium	8.5–10.5
	Mg / Phos	1.7–2.2 / 2.5–4.5

EXTENDED CHEMISTRY

	Anion gap	8–12
	Osmolality	275–295 mOsm/kg
	Ammonia lab-specific	15–45 µg/dL
	Lipase lab-specific	10–140 U/L

ABG arterial · PaCO₂ / PaO₂ mm Hg

	pH	7.35–7.45
	PaCO₂	35–45
	PaO₂	80–100
	HCO₃⁻	22–26 mEq/L
	SaO₂	95–100 %
▲	Lactate	0.5–2.0 · >4 critical mmol/L

▲ amber = high-alert analyte — recap on back

FIELD REFERENCE · NOT A PROTOCOLVERIFY LOCALLY

Lab ValuesCC-LV-01

ETT SIZING

CRASH CARDCC-ETT-01 · ACUTE CARE 02

PEDIATRIC ETT uncuffed-led · cuffed = −0.5 · depth at lip

AGE	lb	kg	UNCUFF	CUFF	DEPTH cm
Preterm	2–5	1–2.5	2.5–3.0	—	6–8
Newborn	7–11	3–5	3.0–3.5	—	9–10
6 mo	15	7	3.5–4.0	3.0–3.5	10.5–12
1 yr	22	10	4.0–4.5	3.5–4.0	12–13.5
2 yr	26	12	4.5	4.0	13.5
4 yr	35	16	5.0	4.5	15
6 yr	44	20	5.5	5.0	16.5
8 yr	55	25	6.0	5.5	18
10 yr	70	32	6.5	6.0	19.5
12 yr	88	40	7.0	6.5	21
14 yr	110	50	7.0–7.5	6.5–7.0	21

FORMULAS · 1–10 YR

Uncuffed (age÷4)+4
Cuffed (age÷4)+3.5
Depth 3 × tube ID cm
Neonate kg + 6 cm at lip

BLADE

Preterm Miller 0
NB–2 yr Miller 1
2–8 yr Miller / Mac 2
8 yr+ Mac 3 · Mac 4 lg

SUCTION CATH 2 × ETT ID in Fr · 4.0 tube → 8 Fr

GASTRIC / OG 2 × ETT ID in Fr · decompress after BVM

STYLET straight-to-cuff ~35° · tip never past Murphy eye

⚠ FAILED AIRWAY — MOVE, DON'T REPEAT

1 reposition + bougie → 2 size down 0.5 → 3 SGA / LMA → 4 2-person BVM + OPA/NPA → 5 surgical airway — mark cricothyroid early if predicted difficult

Max 2 attempts per operator — SpO2 recovery between every attempt.

FIELD REFERENCE · NOT A PROTOCOLVERIFY LOCALLY

ETT SizingCC-ETT-01

WT kg	ETOM 0.3	KETA 1.5	SUX 1.5	ROC 1.2
50	15	75	75	60
60	18	90	90	72
70	21	105	105	84
80	24	120	120	96
90	27	135	135	108
100	30	150	150	120
110	33	165	165	132

WT kg	ETOM 0.3	KETA 1.5	SUX 1.5	ROC 1.2
50	15	75	75	60
60	18	90	90	72
70	21	105	105	84
80	24	120	120	96
90	27	135	135	108
100	30	150	150	120
110	33	165	165	132

WT kg	ETOM 0.3	KETA 1.5	SUX 1.5	ROC 1.2
50	15	75	75	60
60	18	90	90	72
70	21	105	105	84
80	24	120	120	96
90	27	135	135	108
100	30	150	150	120
110	33	165	165	132