ICU Knowledge Map · Procedure checklist

Endotracheal Intubation & Rapid Sequence Intubation

Educational checklist. Use local policy, institutional credentialing and patient-specific clinical judgment. This sheet does not replace the full audited procedure guide.

Patient: __________________

Date: __________

Operator: ______________

Supervisor: ______________

BEFORE

☐Indication confirmed and alternative strategy considered.
☐Contraindications / reasons to change strategy reviewed.
☐Consent or emergency justification documented as appropriate.
☐Team roles, time-out, rescue plan and required monitoring confirmed.
☐Equipment complete and immediately available.
☐Assign roles and verbalize Plan A/B/C/D
☐Optimize position; ramp obese patients and align external auditory meatus with sternal notch when appropriate
☐Preoxygenate aggressively; consider HFNO/NIV/PEEP strategy according to physiology
☐Treat hypotension before induction when possible and have vasopressor support running/ready
☐Choose induction/paralytic doses based on shock, RV failure, asthma, intracranial pathology and other physiology
☐Set the ventilator before the tube is placed

DURING — ORDERED TECHNIQUE

1.☐ Perform final team time-out: indication, predicted difficulty, drugs, rescue plan and hemodynamic plan
2.☐ Preoxygenate to maximize safe apnea time; use apneic oxygenation when appropriate
3.☐ Administer induction agent then rapid-onset neuromuscular blocker
4.☐ Perform laryngoscopy and identify the glottis; optimize with positioning/external laryngeal manipulation or adjuncts rather than repeated identical attempts
5.☐ Pass the tube through the cords to an appropriate depth; inflate cuff
6.☐ Immediately attach continuous waveform capnography and ventilate
7.☐ Secure the tube and reassess depth, bilateral ventilation and hemodynamics
8.☐ Start analgesia/sedation promptly and transition to the pre-planned ventilator strategy

CONFIRM SUCCESS

☐Sustained continuous waveform end-tidal CO2 is the primary confirmation method
☐Bilateral chest rise and breath sounds support but do not replace capnography
☐Check tube depth at teeth/lips and confirm position with imaging when clinically indicated
☐Reconfirm after transfer, proning, major position change or unexplained deterioration

AFTER

☐Document tube size/depth, device/grade/view, number of attempts and complications
☐Order/perform appropriate post-intubation imaging
☐Reassess sedation, analgesia, ventilator targets and VAP-prevention bundle

HARD STOPS / ESCALATE

☐Stop and reoxygenate when saturation is falling or attempts are becoming prolonged
☐Escalate immediately if ventilation/oxygenation cannot be restored
☐Do not continue serial laryngoscopy attempts without changing the strategy