Rapid Sequence Intubation Planner — Drug Doses and Checklist
⚠️For registered physicians only. Always involve senior anaesthetics or intensivist for RSI. DAS/AAGBI guidelines. Responsibility lies with the treating physician. Software may contain errors — verify all doses independently.
👤 Patient Parameters
years
kg
cm
🧒
Paediatric Weight Estimation (APLS)
Age 1–5: weight = (age + 4) × 2. Age 6–12: weight = (3 × age) + 7. Or use Broselow tape. Always use actual weight if available — measured weight preferred over any formula, especially in adolescents.
—
IBW (Devine)
kg · for vent tidal volume
—
Lean Body Weight
kg · for dose calc
—
BMI
kg/m²
🏥 Clinical Context
Haemodynamic instability
Full stomach / aspiration risk
Hyperkalaemia
Raised ICP
Reactive airways / bronchospasm
Pregnancy
Hepatic failure
Renal failure
ℹ️
DAS Guidelines — Assess for predicted difficult airway using LEMON, MOANS, RODS mnemonics. A difficult airway changes your plan, backup choices, and who you need in the room.
🍋 LEMON — Difficult Laryngoscopy
Structured checklist of LEMON risk factors, locally weighted for this tool — LEMON has no single validated numeric cut-off. Treat the score as a prompt to anticipate difficulty, not a validated probability.
😤 MOANS — Difficult BVM Ventilation
MOANS is a risk-factor mnemonic, not a validated score — any single factor present should prompt a plan for difficult BVM (oropharyngeal airway, two-person technique) regardless of the tally shown.
🔴 RODS — Difficult SGA/LMA
Supraglottic airway device rescue — assess if this is likely to work as a rescue plan.
🔪 SMART — Difficult Surgical Airway
Cricothyroidotomy access — pre-assess before you need it in a can't intubate can't oxygenate scenario.
📊 Airway Difficulty Summary
💨 Pre-oxygenation Strategy
Target SpO₂ ≥98% before RSI. Aim 3–5 min pre-oxygenation minimum. Optimise position and equipment choice based on patient.
Position
🛏️ Ramped / 20–30° Head-up
Standard position. Increases FRC, extends apnoea time, improves laryngoscopy view (especially obese). Ear-to-sternal notch alignment.
👃 Sniffing Position (Flat)
Head extension + neck flexion. Traditional position. Use if haemodynamically unstable and unable to tolerate head-up.
🔄 Left Lateral + Head-up
Active vomiting / full stomach risk. Reduces aspiration if vomiting occurs during RSI.
Standard nasal cannula at 15L/min (this is NOT true high-flow nasal cannula). Left in place during airway efforts, extends apnoea time — can continue through laryngoscopy. If a true HFNC device (e.g. Optiflow/Airvo) is available, run humidified high-flow at 30–70L/min instead — preferred where available.
Non-Rebreather Mask (NRM)
15L/min. Standard pre-oxygenation. Remove at point of laryngoscopy. Less effective than HFNC but universally available.
NIV / BiPAP / CPAP
Use for desaturating patients pre-RSI (SpO₂ <93% despite NRM). Bridge to improve saturations before attempt. Remove before laryngoscopy.
BVM with PEEP valve
If apnoeic / arrest setting. Gentle ventilation at 5–10 cmH₂O PEEP. Risk of gastric distension — cricoid pressure debated.
Pre-oxygenation Checklist
SpO₂ monitoring applied and working
Target ≥98% before proceeding
Continuous cardiac monitoring
3 or 5-lead ECG, NIBP cycling
End-tidal CO₂ (capnography) prepared
Confirm tube position post-intubation
IV access (≥2 large-bore) confirmed working
Patient in optimal position (ear to sternal notch)
Head-up 20–30° unless contraindicated
Pre-oxygenation device applied (NRM 15L/min, or true HFNC 30–70L/min if available)
SpO₂ target met (≥98%) or decision made to proceed
Suction on and working (Yankauer in hand)
BVM tested and connected to O₂
⚡ Pre-treatment Drugs (give 3 min before RSI — not always required)
💉 Induction Agents (select one)
💪 Neuromuscular Blocking Agents (select one)
Rocuronium + Sugammadex — common UK RSI combination
DAS 2025 emphasises early, full-dose neuromuscular block to optimise the first attempt. High-dose rocuronium (1.2–1.6mg/kg) provides equivalent conditions to suxamethonium within 60s. Sugammadex reverses rapidly (16mg/kg for immediate reversal). This combination avoids all suxamethonium contraindications. Ensure sugammadex is drawn up and available before starting RSI.
🆘 Reversal Agent
🔄 Post-Intubation Sedation & Analgesia
📋 Equipment Checklist (STOP — check before proceeding)
Laryngoscope (direct) — tested and working
Video laryngoscope (VL) prepared and on
Preferred for predicted difficult airway, obesity, C-spine precautions
ETT sizes: — (primary) and one size smaller
Bougie / Aintree catheter available
10mL syringe for cuff inflation
Tape / tube holder prepared
LMA/iGel sizes available (rescue device)
Surgical airway kit (scalpel-bougie-tube) available and located
Capnography waveform confirmed working
Drugs drawn up and labelled
Sugammadex drawn up and at bedside
Vasopressor prepared (noradrenaline/phenylephrine ready to push)
Ventilator set up and settings confirmed
Senior clinician present or immediately available
Roles assigned: intubator, drug nurse, assistant, scribe
🗺️ Difficult Airway Management Plans A–D (DAS-informed; local lettering — differs from DAS 2025's own Plan A/B/C/D)
✅ Tube Confirmation Checklist
🔴
Waveform capnography is the ONLY reliable method of ETT confirmation. Chest movement, bilateral breath sounds, and fogging are unreliable alone. If no capnography waveform: assume oesophageal intubation until proven otherwise.
The bag below is a commonly used dilution, not a national standard — overwrite the amount and volume to match the bag actually hanging. The pump rate is calculated from what is in these two boxes, nothing else.
kg
mgmL
—
mL/h
🌬️ Initial Ventilator Settings
ARDSNet / Lung-Protective Ventilation
Tidal volume 6 mL/kg IBW (not actual weight). PEEP titrated to oxygenation. Plateau pressure target <30 cmH₂O. Driving pressure (Pplat − PEEP) <15 cmH₂O. These settings apply broadly — adjust for specific pathology (e.g. COPD: lower rate, longer expiratory time; raised ICP: target PaCO₂ 4.5–5.0 kPa).
🎯 Post-RSI Targets
📋 Post-RSI Care Checklist
Ongoing sedation and analgesia running
Propofol + remifentanil or morphine infusion
Vasopressor started if haemodynamically unstable
Noradrenaline first-line. Phenylephrine if tachycardia concern.
ABG within 30 min of intubation
CXR confirmed tube position and pneumothorax excluded
Clinical decision support only. All doses and settings must be verified by the responsible clinician. DAS/AAGBI guidelines referenced. Responsibility lies with the treating physician. resusdoc.uk