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- Apneic adult/adolescent with estimated weight greater than 80 lbs., without a gag reflex

- Respiratory arrest (adult/adolescent)

- Respiratory depression with an absent gag reflex (adult/adolescent)

- Unresponsive with respiratory depression (adult/adolescent)



- Obvious signs of death

- Do-Not-Resuscitate

- Known narcotic OD that responds to naloxone



- Intubation may be attempted a maximum of three times

- The patient should be ventilated between each attempt

- Each attempt may take no longer than 30 seconds

- Use the ETCO2 device 

- Consider Sedation for Intubation (clenched jaw, coughing or choking), BP > 90.


  1. Presence of bilateral breath sounds, absence of abdominal sounds.

  2. Size of ET tube.

  3. Cert # of medic inserting tube.

  4. Number of attempts required (per medic).

  5. Depth the tube is inserted (cm mark at the teeth).

  6. Time of tube insertion.

  7. Reassessment of bilateral breath sounds, absence of abdominal sounds and tube insertion depth and end-tidal reading EACH TIME THE PATIENT IS MOVED!  (Document in Narrative of ePCR confirmation of tube placement).

  8. Name of PRC physician verifying position and method used.

  9. Any procedural problems or complications.

  10. If another medic attempted ET, chart his/her cert#, number of attempts and any significant problems.


Flexible Intubation Device (FIG)


- Option for difficult intubation if lower area of glottic opening can be identified

- Age: 13 and older or 40 kg



1.  Direct laryngoscopy.

2.  “Sniff” position, Laryngeal Manipulation (Cricoid Pressure).

3.  Advance FIG under epiglottis into trachea (Angled tip pointing anteriorly).

4.  Advance FIG into trachea, black mark at teeth.

5.  May feel “washboard” effect as tip moves along tracheal rings.

6.  Maintain tongue elevation w/ laryngoscope blade.

7.  “Load” ETT over FIG (Watch ETT depth markers).

8.  Withdraw FIG and laryngoscope blade.

9.  Inflate cuff on ETT.

10.  Confirm ETT placement (usual techniques).

11.  Secure ETT.

King Vision Intubation

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