Codes — resuscitation cards

SpO₂ 90–98% — reduce the oxygen from 100%.

ETCO₂ 35–45 mmHg — about 10 breaths/min.

Airway secure, capnography confirms it. OG/NG tube.

MAP ≥65 mmHg — fluids, then norepinephrine.

12-lead now. STEMI → the STEMI card and the transfer call in parallel.

Re-run the H's and T's — the cause of the arrest itself (Cardiac Arrest).

Art line, second access, labs, POCUS, CXR, Foley — urine 0.5–1 mL/kg/hr.

Hold one temperature 32–37.5 °C for ≥36 h, then prevent fever. Core probe only.

Sedate — propofol or midazolam infusion. Paralytic only for shivering.

Treat seizures only if seen or on EEG.

Wait ≥72 h to prognosticate.

Glucose 70–180 mg/dL.

Correct K⁺, Ca²⁺, Mg²⁺ using the blood gas results.

ICU bed. No cath lab here — start the transfer call.

HR TYPICALLY <50 · CAUSING SIGNS/SYMPTOMS

CARDIOPULMONARY COMPROMISE? Hypotension · acutely altered mental status · signs of shock · ischemic chest discomfort · acute heart failure.

NO COMPROMISE — identify and treat underlying causes: support ABCs, consider oxygen, obtain 12-lead ECG. Observe.

ASSESSMENT AND SUPPORT — Maintain patent airway and provide oxygen · Assist breathing with positive-pressure ventilation as necessary · Attach cardiorespiratory monitor · Monitor pulse.

Bradycardia persists with cardiopulmonary compromise?

ATROPINE 1 mg IV — REPEAT q3–5 MIN, MAX TOTAL 3 mg

MAX 3 mg REACHED — further atropine unlikely to help. Move to pacing / epinephrine now.

Atropine is usually ineffective for Mobitz II 2nd-degree block or 3rd-degree (complete) block with a wide QRS/new bundle-branch block. Pace.

Transcutaneous pacing: pads on, 60–80/min, titrate to capture.

Epinephrine infusion 2–10 mcg/min IV, titrate to response (not per kg)

Call for help. Set up for transvenous pacing — Transvenous Pacing.

CONSIDER — Expert consultation · Transvenous pacing.

POSSIBLE CAUSES — Myocardial ischemia/infarction · Drugs/toxicologic (eg, calcium-channel blockers, β-blockers, digoxin) · Hypoxia · Electrolyte abnormality (eg, hyperkalemia).

BRASH — bradycardia + renal failure + AV-nodal blocker + shock. Check K⁺ (Hyperkalemia).

Beta-blocker/CCB — calcium, glucagon 5 mg IV (repeat at 10 min), HIET. Digoxin — DigiFab.

Raised ICP — Cushing's triad: bradycardia + hypertension + irregular breathing.

Finger-stick glucose first — treat and reassess.

Use local stroke scale then proceed to STAT CT head.

≤4.5h tPA/TNK window

≤24h (LVO) thrombectomy window

NIHSS ≥6 or FAST-ED ≥4 and TLKW <24 h → add CTA head/neck.

Before lytic: BP under 185/110. After: under 180/105 for 24 h.

Labetalol 10–20 mg IV over 1–2 min, may repeat once, then 2–8 mg/min.

Alternative: nicardipine 5 mg/hr, titrate by 2.5 mg/hr q5–15 min, max 15 mg/hr.

TNK 0.25 mg/kg IV single bolus, max 25 mg. Checklist and consent first.

Thrombectomy candidate — NIHSS ≥6 or FAST-ED ≥4, LVO on CTA/MRA, TLKW <24 h — or given TNK → transfer.

BP not controllable below 185/110 despite treatment

Any evidence of intracranial hemorrhage on CT

Recent major surgery/trauma, active internal bleeding, or recent ICH

On a DOAC with a recent dose, or INR >1.7 on warfarin

Platelets <100,000 or glucose <50 mg/dL uncorrected

Large, well-established infarct already visible on CT

Any neurologic decline post-TNK → STAT repeat head CT and send ICH labs immediately.

Symptomatic ICH → cryo 10 units, TXA 10–15 mg/kg, call neurosurgery.

TNK angioedema: methylprednisolone 125 mg IV · diphenhydramine 50 mg IV · famotidine 20 mg IV.

Larynx, palate, floor of mouth or oropharynx → consider early intubation or posterior pharynx evaluation with NP scope. Do not wait for stridor.

Stroke Box (Omnicell): the lytic/TNK response bundle is a premade box pulled from the Omnicell

Open the airway; bag-valve-mask with 100% O₂.

1 breath every 6 seconds (10/min) — pulse present, not breathing.

Recheck the pulse every 2 min. Pulse lost → compressions now — Cardiac Arrest.

Opioid overdose: naloxone 0.4–2 mg IV/IM/IN, repeat q2–3 min — keep bagging.

Airway obstruction / foreign body — look, suction, consider Heimlich/direct laryngoscopy removal.

Severe asthma — bronchodilators. Bagging feels tight: consider breath-stacking.

Cannot intubate and cannot oxygenate (best BVM + iGel), SpO₂ <70% and falling → stop attempting. DECLARE CICO — FONA

Physiology optimized first: fix hypotension, oxygenation, and pH before you push ("HOp killers").

Equipment out: BVM+PEEP on flush O₂ · VL + DL · OPA, bougie, SGA, cric kit · 2 suctions · eye protection.

Denitrogenate ≥3 min. ApOx by NC through the attempt. Target SpO₂ 100%.

Dentures out · cric marked · ear-to-sternal-notch · pulse ox visible and off the BP arm · cuff q3 min · IV tested · plan said aloud.

Say the CICO number out loud before you start: "below ___% and falling." Default <70%.

Drawn up: induction, paralytic, post-tube sedation, push-dose epi. Norepinephrine: see the Pressors & Inotropes card.

Say the 3 backups aloud: repeat with bougie or 2nd intubator · iGel sized · cric kit open.

Etomidate 0.3 mg/kg · ketamine 1–2 mg/kg · propofol 1–2 mg/kg, reduce in shock.

Succinylcholine 1–1.5 mg/kg · rocuronium 1–1.2 mg/kg.

Push-dose pressor drawn up before you push induction.

Confirm: breath sounds · tube depth secured · OG placed · CXR ordered and checked.

Analgesia and sedation started · vent settings documented · debrief called.

Rocuronium at an RSI dose lasts about 45–60 minutes and succinylcholine wears off in minutes — analgesia and sedation now.

Apneic-oxygenation flow: >15 L/min. Preoxygenation SpO₂ target: 100% / CPAP.

Post-intubation first doses: fentanyl 1 mcg/kg (0.5–2 mcg/kg range); propofol infusion started at 20 mcg/kg/min (5–50 mcg/kg/min range); midazolam 0.05 mg/kg; ketamine 0.5 mg/kg.

Epinephrine for a child, peri-intubation: START THE EPI INFUSION at 0.1 mcg/kg/min (range 0.1–1) on a pump, ready before induction — no push-dose for a child.

Etomidate button: 0.3 mg/kg, max 40 mg, rounded to 10 mg.

Ketamine button: 1.5 mg/kg (range 1–2), max 200 mg, rounded to 10 mg — bronchodilator

Propofol button: 1.5 mg/kg (range 1–2), max 200 mg — reduce/avoid in shock

Rocuronium button: 1.2 mg/kg, max 100 mg — lasts 45–60 min — sedate them

Succinylcholine button: 1.5 mg/kg, max 200 mg — check K⁺, burns, crush, myopathy

Fentanyl: 1 mcg/kg (range 0.5–2), max 100 mcg, rounded to 12.5 — first bolus

Hydromorphone: 0.015 mg/kg, max 1 mg, rounded to 0.25 — first bolus

Morphine: 0.05 mg/kg, max 5 mg — histamine release, avoid in shock

Propofol infusion: 5–50 mcg/kg/min — titrate, do not bolus — drops BP

Ketamine: 0.5 mg/kg, then 0.5–2 mg/kg/hr

Midazolam: 0.05 mg/kg first bolus, max 5 mg — drops BP, accumulates

Fentanyl infusion: 1–2 mcg/kg/hr after the bolus, rounded to 12.5.

IV access ×2 large-bore; continuous BP monitoring q5min; repeat neuro checks/GCS q5min.

Target SBP 140. Labetalol 10–20 mg IV q10min, or nicardipine 5 mg/hr titrated.

Labetalol 10–20 mg IV q10min, or nicardipine 5 mg/hr titrated.

On anticoagulation: reverse it in parallel, now — Reversal of Anticoagulants.

STAT non-contrast CT head; coags/platelets/glucose; call neurosurgery

No seizure prophylaxis. Treat a seizure that happens.

Herniating: head up 30°, hyperosmolar therapy, brief if any hyperventilation.

Cerebellar bleed ≥15 mL, brainstem compression or hydrocephalus → call neurosurgery.

EPINEPHRINE 0.3–0.5 mg = 0.3–0.5 mL IM of the 1 mg/mL ampoule (labelled "1:1000") · anterolateral thigh · repeat q5–15min. NOT the 0.1 mg/mL cardiac syringe — that one is 10× more dilute

Anaphylaxis Box (Omnicell): premade — epinephrine, antihistamine, and steroid preloaded — pulled from the Omnicell

EPI PUSH-DOSE — 10–20 mcg IV, every 2–5 min. From a 10 mcg/mL syringe only: 10–20 mcg (1–2 mL) — made by adding 1 mL of the 1 mg/10 mL cardiac syringe into 9 mL saline. If more than 2–3 pushes, start the infusion.

Crystalloid 20 mL/kg for hypotension (max 2 L). Repeat as needed.

Refractory shock: epinephrine infusion ~2–10 mcg/min — weight-based start on Pressors & Inotropes.

On a beta-blocker and not responding to epi: glucagon 1–5 mg IV slow push (watch for vomiting/aspiration).

Supine, legs up. Sitting if they cannot breathe. Left lateral if pregnant.

Angioedema or stridor progressing: intubate early and electively — the RSI checklist or Awake intubation.

Diphenhydramine 25–50 mg IV — relieves itch/hives only.

Famotidine 20 mg IV — weak evidence, adjunct only.

Methylprednisolone 125 mg IV, or prednisone 1 mg/kg PO.

If more than 2–3 pushes of push-dose epi have been needed, start the infusion.

Child: START THE EPI INFUSION at 0.1 mcg/kg/min (range 0.1–1 mcg/kg/min) on a pump — no push-doses for a child.

Stop the bleeding: pressure, then tourniquet. Junctional → pack the wound.

Penetrating, no TBI: permissive hypotension, SBP ~80–90 until the source is controlled.

With TBI: avoid hypotension — MAP ≥80.

Balanced blood products, not crystalloid. MTP early. Not a pressor — see Pressors & Inotropes.

Prevent the lethal triad: warm the patient, avoid crystalloid, give calcium and TXA.

TXA — Dose: 1 g IV over 10 min, then 1 g IV over 8 h. Must be given within 3 hours of injury.

Idarucizumab (Praxbind) 5 g IV = two 2.5 g/50 mL vials given consecutively.

If unavailable: PCC/aPCC 50 units/kg (max 4,000 units) — pharmacy-guided.

4F-PCC 50 units/kg (max 5,000 units).

Heparin: protamine 1 mg per 100 units given in the last 2–3 h. Max 50 mg, ≤5 mg/min.

Enoxaparin: protamine 1 mg per 1 mg if within 8 h; 0.5 mg per 1 mg at 8–12 h; none beyond.

4F-PCC by INR: 2–<4 → 25 units/kg · 4–6 → 35 · >6 → 50

Vitamin K 5–10 mg IV over 15–30 min, with the 4F-PCC.

Call pharmacy/hematology immediately — or use hospital protocol.

Avoid platelet transfusion unless thrombocytopenic or bleeding is from an antiplatelet agent.

4F-PCC 50 u/kg → 5,000 units (card's "dosing weight capped at 100 kg"); Kcentra 25 / 35 u/kg → 2,500 / 3,500 units (same 100 kg rule); TXA (ICH) 10-15 mg/kg → 1 g

Calcium gluconate 10%, 1 g IV over 2–3 min. Repeat EKG in 5 min; repeat calcium if still abnormal.

Or calcium chloride — more potent per gram but caustic/vesicant; central line strongly preferred.

Regular insulin 10 units IV (5 if insulin-naive or CKD) + one amp D50 (25 g) if glucose <250.

Check glucose at baseline, 30 min, then hourly for 4–6h.

Nebulized albuterol 10–20 mg over 10–15 min — adjunct, never alone.

Bicarbonate only if there is real metabolic acidosis alongside.

Furosemide 20–80 mg IV if they are making urine.

Kayexalate — most current EM guidance recommends against it.

Call nephrology. Dialysis is the definitive treatment.

Balanced blood products (plasma:RBC 1:1–1:2, cryo early), calcium with every pack.

ABC score ≥2 — penetrating · pulse >120 · SBP <90 · positive FAST, 1 point each.

≥4 units PRBC in 1 h with ongoing bleeding, or >50% blood volume in 3 h.

Start without platelets. A low-titer O whole-blood unit, if available, can substitute for a PRBC+plasma+platelet combination in one bag.

Notify Blood Bank: name, MRN/DOB, gender, location, activating physician.

O-negative for females <50; O-positive for everyone else, until the type is back.

Send: T&S, PT/INR, PTT, fibrinogen, D-dimer, CBC, lactate, BMP, iCa — plus a separate ABG.

Two large-bore IVs (18 G+) or a central line · core temp monitoring · Level 1 primed.

Crystalloid only until products arrive — then limit it.

TXA within 3 h of injury if not already given — its own clock on Bleeding / Hemorrhagic Shock.

Every 4 units PRBC: give calcium (gluconate 2 g peripheral or chloride 1 g central). Recheck labs now: ionized calcium, coags/INR, fibrinogen, CBC, ABG.

Repeat labs hourly: PT/INR, PTT, fibrinogen, CBC, BMP, ABG, iCa, Mg.

Vitals every 15 min. Active warming running continuously.

Goal-directed stop points: Hgb ≥10 · INR normalizing or aPTT <35 s · platelets >150 · fibrinogen >200 mg/dL.

Tell Blood Bank MTP is terminated — within 1 hour.

Fingerstick glucose — treat if <60 mg/dL (thiamine first/concurrently in at-risk adults).

Lorazepam 4 mg IV q2min PRN, max 10 mg — preferred first-line if IV access is present.

Midazolam 10 mg IM — if no IV access yet; fastest time-to-drug per RAMPART.

Alternative: IV lorazepam 0.1 mg/kg, max 4 mg · diazepam 0.2 mg/kg, max 10 mg.

Levetiracetam 60 mg/kg IV, max 4500 mg.

Valproate 40 mg/kg IV, max 3000 mg — not in pregnancy or liver disease.

Fosphenytoin 20 mg PE/kg IV, max 1500 mg PE — not with an unstable rhythm.

Prepare to intubate: seizing >30 min, GCS <8 post-ictal, or airway compromise.

RSI with ketamine if available — see the RSI checklist.

Refractory → start the transfer call to a Neuro ICU.

Eclampsia in pregnancy — give magnesium sulfate.

Tap START at seizure onset (≥5 min continuous, or ≥2 seizures without return to baseline = status epilepticus).

Phases: <5 min STABILIZE — ABCs, glucose check; 5–20 min BENZODIAZEPINE; 20–30 min 2ND-LINE — levetiracetam / valproate (or fosphenytoin); ≥30 MIN — prepare to intubate (ketamine preferred); anesthetic infusion if refractory; STAT transfer to Neuro ICU.

DISCONNECT FROM VENT — BAG WITH 100% O₂

D — check: both axillae, chest rise, depth at the teeth, waveform capnography.

D — fix: right mainstem → deflate, pull back, re-secure. Esophageal → pull and reintubate.

O — check: can a suction catheter pass? Look for a kink or bitten tube. High peak, NORMAL plateau.

O — fix: suction, unkink, remove the bite block, bronchodilators. Will not clear? Replace it.

P — check: one-sided breath sounds, sudden hypotension, distended neck veins. High peak AND high plateau.

P — fix: if compromised, needle or finger decompression, then a tube.

E — check: trace the circuit end to end. O₂ source, wall pressure, tank, vent power and alarm log.

E — fix: reconnect, swap the vent, or change the O₂ source. Hand-bag on known-good 100% until verified.

High peak, normal plateau (<30) = resistance → OBSTRUCTION. High peak AND high plateau = compliance → PNEUMOTHORAX, auto-PEEP, edema, mainstem. Low peak and low plateau = lost seal → DISPLACEMENT or disconnection.

Moderate: accessory muscle use, incomplete sentences, SpO₂ <92%. Silent chest, confusion, gasping = impending arrest.

Oxygen: NRB mask at 15 L/min; target SpO₂ >90%.

Nebulized albuterol 5 mg q20min ×3, then continuous as needed.

Nebulized ipratropium 0.5 mg q20min ×3.

IV steroid: methylprednisolone 125 mg IV, or dexamethasone 10 mg IV.

Magnesium sulfate 2 g IV over 20 min if refractory.

Severe: epinephrine IM 0.3–0.5 mg q15 min. Hypotensive: 10 mcg IV, then 1–4 mcg/min.

BiPAP (Vision 2000 Ventilator): Mode Spontaneous (S). IPAP: 10–15 cmH₂O (increase to 20 if no improvement). EPAP: 4–6 cmH₂O. Backup RR: 10–14/min. FiO₂: 100% initially, then titrate to SpO₂ >90%. Rise time: 0.2–0.4 sec.

Intubate for: failure on BiPAP · altered mentation or fatigue · pH <7.25 · silent chest.

Ketamine 1–2 mg/kg — it bronchodilates. See the RSI checklist.

Not midazolam (worsens hypercapnia), not propofol alone (drops pressure).

Fluids 250–500 mL if dry. Norepinephrine for shock despite fluids.

Discharge only if symptom-free ≥4 h. Still needing BiPAP or repeat nebs = admit.

Histaminergic (allergic) or bradykinin (hereditary / ACE-inhibitor)?

Two suctions + Yankauer · VL · fiber-optic if available · cric kit at the bedside · large-bore IV.

Intubate early for stridor, progressive swelling, muffled voice, or lost secretions.

Not standard RSI — awake fiber-optic is preferred. Avoid paralysis. Cric is the backup.

Epinephrine IM 0.3–0.5 mg (1:1000) — repeat q5–15min if needed.

Diphenhydramine 50 mg IV. Famotidine 20 mg IV. Methylprednisolone 125 mg IV.

Antihistamines and steroids are unlikely to be effective here.

Icatibant 30 mg SC if available.

FFP 2 units IV if icatibant unavailable.

C1-esterase inhibitor 20 U/kg IV if hereditary angioedema is suspected.

Nebulized epinephrine 5 mL of 1:1000 if the upper airway is worsening. Fluids for pressure.

Reassess the swelling every 5–10 min.

Ask out loud: "has this patient had a laryngectomy?"

Apply high-flow oxygen to both the face and the stoma until laryngectomy status is confirmed.

Pass a suction catheter. Resistance = obstruction, plug or malposition.

Stoma <7 days: do NOT blindly reinsert. Escalate.

Stoma ≥7 days: reinsert carefully, obturator-guided, right size. Watch the response.

High-flow O₂ by nasal cannula. Intubate orally while oxygenating through the stoma.

Laryngectomy: bag the stoma.

Confirm tube position by looking — video scope through the tube. Not chest rise and SpO₂ alone.

CICO = paralyzed, cannot intubate, cannot oxygenate by mask or supraglottic.

Extend the neck. Palpate thyroid, membrane and cricoid BEFORE you cut.

1. Stabilize the larynx with your non-dominant hand (laryngeal handshake grip).

2. Vertical incision through skin with a #10 scalpel blade.

3. Blunt dissection down to the cricothyroid membrane.

4. Horizontal incision back and forth across the cricothyroid membrane.

5. Insert a finger into the hole to confirm the tract and hold it open.

6. Bougie alongside your finger, angled caudally. Feel hold-up on the tracheal rings.

7. Railroad a cuffed 6.0 mm tube over the bougie — just past the cuff. Do not overinsert.

8. Cuff up, ETCO₂ and BVM on, confirm a sustained waveform.

9. Secure the tube with sutures.

Scalpel-bougie-tube is first-line in adults. Needle + jet is for select cases.

FONA kit is on the airway cart. Confirm its exact location and contents locally.

Confirm the VAD hum — auscultate left chest / left upper abdomen.

MAP by manual cuff + Doppler. Target 70–80, minimum 60. NIBP and SpO₂ are unreliable.

Speed (RPM) · Flow (L/min) · Power (W) · Pulsatility Index — write them down.

VAD center + coordinator contact: ___ — fill in locally and call.

Low flow + low power → Hypovolemia, RV failure, tamponade, tension PTX → Fluid bolus 250–500 mL → bedside echo

Low flow + high power = possible pump thrombosis → STAT hemolysis labs → IV heparin → call VAD center

Low flow + normal power → Elevated afterload (HTN) → Check MAP → IV vasodilators → target 70–80

Suction alarm → LV underfilling → Gentle fluids → reduce speed (with VAD team) → echo

Echo: Small/collapsed LV = inadequate preload · Dilated LV = pump malfunction or excessive afterload · Dilated RV + small LV = RV failure · Pericardial effusion + instability = tamponade

GI bleed → hold anticoagulation with the VAD team, transfuse to Hgb >7, GI consult.

Driveline infection → 2 cultures, wound culture, broad-spectrum. Do NOT pull the driveline.

Pump thrombosis: LDH >600, dark urine, power >50% over baseline → heparin, VAD center.

Do not start compressions initially — the pump is running. Search the H's and T's.

VF/VT → defibrillate immediately (safe with an LVAD). Defibrillate normally, standard energy. Pads AP — anterior right parasternal, posterior left infrascapular, at least 2–3 inches from an ICD generator. Do not disconnect the LVAD.

If the aortic valve is oversewn → the patient has zero cardiac output without the pump.

1 Reseat driveline connector into controller firmly; inspect for damage/kinks/cuts (0–30 s)

2 Reseat battery connectors; check charge; replace with fresh batteries (30–60 s)

3 If no batteries → connect to base power unit (wall power) (1–2 min)

4 Swap to backup controller (brief pump stoppage — expected) (2–3 min)

5 Still not running → call VAD center → CPR → consider ECMO/MCS (3 min)

Driveline visibly damaged → do not attempt repair → call the VAD center immediately. HeartMate II/3 pocket controllers have ~15 min backup power if disconnected.

No perfusion → start compressions. Standard ACLS.

If the pump restarts → reassess → stop compressions if MAP >50 mmHg.

Defibrillate normally, standard energy. Pads AP — anterior right parasternal, posterior left infrascapular, at least 2–3 inches from an ICD generator. Do not disconnect the LVAD.

Some perfusion: fluids for preload, norepinephrine first, dobutamine or milrinone to add output.

LBBB — Modified Sgarbossa (Smith): concordant STE ≥1 mm · concordant ST depression ≥1 mm in V1–V3 · discordant STE ≥25% of the preceding S-wave depth.

Brugada — coved STE >2 mm in V1–V2, negative T, no reciprocal change.

Aspirin 160–325 mg PO chewed, non-enteric — 600 mg PR if no PO.

Heparin bolus 60 units/kg, max 4000 · infusion 12 units/kg/hr, max 1000

Enoxaparin instead — age under 75, CrCl ≥30: 30 mg IV bolus, then 1 mg/kg SC q12h, max 100 mg for the first 2 doses. Age 75 or over: no bolus, 0.75 mg/kg SC q12h. Max 75 mg for the first 2 doses. CrCl under 30, any age: 1 mg/kg SC q24h.

Atorvastatin 80 mg PO — start in the ED

Read the TNK band: <60 kg → 30 mg · 60–<70 → 35 · 70–<80 → 40 · 80–<90 → 45 · ≥90 → 50 mg (absolute max). Single IV bolus over 5 s.

Age ≥75: half-dose is not the FDA label — check local protocol.

Norepinephrine first for cardiogenic shock. Rates: Pressors & Inotropes, CARDIOGENIC.

RV infarct is preload-dependent — small repeated boluses. No nitrates, morphine or diuretics.

AIVR after lysis needs no treatment. Treat only if sustained and unstable — give atropine, then pace.

AV block in inferior MI is usually benign and atropine-responsive. Anterior is not — complete heart block there usually needs pacing regardless of the response to atropine.

NSVT — a single brief run needs no treatment. Keep K⁺ >4.5 and Mg²⁺ >2.

Sustained monomorphic VT → sync cardioversion. Polymorphic or VF → defibrillate (Cardiac Arrest).

AIVR — Regular wide-complex (QRS >120 ms) with AV dissociation and fusion or capture beats. ~50–120/min (or ~40–110). 110–120/min overlaps with VT.

STEMI/Chest Pain Box (Omnicell): the response bundle is a premade box pulled from the Omnicell

TNK bands: 30 mg (<60 kg) · 35 mg (60–<70 kg) · 40 mg (70–<80 kg) · 45 mg (80–<90 kg) · 50 mg (≥90 kg — also the absolute max single dose)

ROOM 7 (RESUS BAY) CABINET · GI HEMORRHAGE / BLAKEMORE KIT — balloon-tamponade kit, wrapped in the poster, behind the door label

Two large-bore IVs (16 G+) above the diaphragm, or IO.

Activate MTP — or on the 2nd unit with ongoing bleeding.

Transfuse to Hb ≥7 — or ~8 g/dL if variceal or cirrhotic.

Two tested suctions, rigid tips, both at the head of the bed. Bed up 45°.

SALAD: one suction parked in the left corner as a drain, one in your hand.

Ketamine 0.5 mg/kg (shock dose) + rocuronium 1.5 mg/kg.

Metoclopramide 10 mg IV before endoscopy.

Octreotide 50 mcg IV, then 50 mcg/hr — start on suspicion of varices.

Ceftriaxone 1 g IV for GI bleeding with cirrhosis.

Pantoprazole 80 mg IV bolus, then 8 mg/hr. Never let it delay blood or source control.

Do not give TXA for GI bleeding.

Call GI — variceal within 12 h, non-variceal within 24 h.

If no endoscopy on site, start the transfer call.

Prior aortic graft or AAA repair + GI bleed = aortoenteric fistula. Surgery, not endoscopy.

Balloon tamponade: a bridge when endoscopy is unavailable or failed. Max dwell 24 h.

Intubate first.

IN THE KIT: Sengstaken-Blakemore tube (3-lumen, dual balloon); separate NG/OG tube; two 60 mL syringes; 3-way stopcocks ×2 and luer-lock caps; insufflation manometer; basin of water; lubricant and marking pen; roller gauze / umbilical tape + 1 L IV fluid bag for traction; IV pole or overhead pulley; suction canisters ×2.

Insert to 50 cm at the lips. Confirm past the GE junction before full inflation.

Gastric balloon: 50 mL, then 50–100 mL steps to 250–300 mL. Stop inflating if the patient has pain.

Traction ≈1 kg — a 1 L fluid bag over a pulley. Mark the tube at the lips.

Esophageal balloon only if still bleeding: 30 mmHg, 5 mmHg steps, max 45. Deflate q6–8 h.

Scissors taped within reach for the entire dwell time.

ROOM 7 (RESUS BAY) CABINET · LUNG ISOLATION / HEMOPTYSIS KIT — bronchial blocker, coudé bougie, large ETTs and the nebulized-TXA setup

Patients with massive hemoptysis asphyxiate; they do not exsanguinate. Dead space is only 150–200 mL.

Bleeding lung DOWN — lateral decubitus, bleeding side dependent.

An effective cough is better than an ETT. Intubate for impending respiratory failure, not for the volume of blood.

Two tested suctions at the head of the bed. Two large-bore IVs. O₂ if SpO₂ <90%.

Targets: INR <1.5 · platelets >50 · fibrinogen >1.5 g/L. Low fibrinogen → cryo, not FFP.

Reverse anticoagulation now — Reversal of Anticoagulants. DDAVP 0.3 mcg/kg if antiplatelet or uremic.

Largest available ETT — ≥8.0 mm.

Use direct rather than video laryngoscopy in a bloody airway. Head up 30–45°, suction first. SALAD.

Mark the cricothyroid membrane first. Two attempts, then front of neck — FONA.

LEFT lung bleeding → advance the ETT blindly into the right mainstem.

RIGHT lung bleeding → coudé bougie tip left, head turned to the bleeding side. Advance to resistance, railroad, inflate the cuff, confirm on CXR, then non-bleeding side UP.

One-lung ventilation: 3–4 mL/kg PBW, faster rate.

Nebulized TXA 500 mg three times a day.

IV TXA 1 g over 10 min.

Nebulized beats IV. For a truly massive bleed give both — 2 g IV + 500 mg neb.

Embolization is definitive and is not available here. The transfer call is part of resuscitation.

Emergency resection is 35–40% mortality; after hemostasis about 4%.

ROOM 7 (RESUS BAY) CABINET · EPISTAXIS KIT — speculum, headlamp, pledgets, packing devices and balloons

Unstable, both nares, or oropharynx filling = hemorrhage + airway (Bleeding / Hemorrhagic Shock, Massive Transfusion Protocol).

Upright, leaning forward, blow the clots out.

Pinch the soft cartilage — the alae, not the bony bridge. Hold ≥10 min uninterrupted. Use a clock. Do not release to check.

Oxymetazoline 0.05% — or 1:1 with lidocaine 4% on a pledget.

Alternative: lidocaine 1% with epinephrine 1:100,000, ~3 mL on a pledget.

Topical TXA 500 mg on the pledget — optional, with pressure.

Posterior if: blood down the throat, both nares, no anterior source, or bleeds through a good pack.

Silver nitrate on a DRY field, around the point, seconds only. Never both sides of the septum at once — at least two weeks between sides.

No electrocautery with a pacemaker or ICD unless deactivated — Pacemaker / ICD Emergencies.

Merocel with ointment, or Rapid Rhino 5–5.5 cm. Soak in sterile water 30 s, inflate with air.

Posterior: Rapid Rhino 7.5/9 cm, or Foley 10–14 Fr — 5–7 mL, max 15 mL.

Admit every patient with a posterior pack on telemetry and pulse oximetry. Leave the pack in 48–72 h.

ENT ligation or IR embolization — both are transfer calls.

Antibiotics after packing are optional — treat if the pack stays beyond 72 h (antistaphylococcal: Augmentin or a 2nd-generation cephalosporin).

Reverse for posterior bleed, instability, Hb drop >2, or ≥2 units — Reversal of Anticoagulants.

Over an ICD: suspends tachyarrhythmia detection — no ATP, no shocks — while the device stays on. Pacing mode unchanged.

Over a pacemaker: asynchronous (VOO/DOO) at the fixed magnet rate — roughly 85/min Medtronic, 100/min Boston Scientific, ~98.6/min St Jude.

Magnet rate >10% below the programmed rate = battery depletion.

No magnet if: the shocks are appropriate · pacing-dependent · no pads on.

Magnet: code cart side panel — cart section.

Electrical storm = 3 or more sustained VT/VF episodes or shocks in 24 h.

Esmolol 300–500 mcg/kg over 1 min, then 25–100 mcg/kg/min.

Propranolol 0.15 mg/kg IV over 10 min.

Metoprolol 2.5–5 mg IV q2–5 min, max 15 mg.

Amiodarone 150 mg over 10 min, may repeat once, then 1 mg/min ×6 h, then 0.5 mg/min ×18 h.

Magnesium 1–2 g IV for torsades.

Sedate. Ketamine first-line.

If Brugada or early-repolarization storm: use isoproterenol, not beta-blockers.

Two sequences, differing in which drug comes first. A: beta-blockade first — esmolol or propranolol over ACLS antiarrhythmics. B: procainamide 10 mg/kg IV over 20 min first, amiodarone second-line, beta-blocker alongside.

Failure to capture — spike, no QRS. Fix K⁺/Mg²⁺, interrogate, pace if symptomatic.

PMT — paced at 160–180/min. Magnet, or adenosine.

Runaway pacemaker — ~200/min, falling amplitude. Apply a magnet.

Pacemaker syndrome — VVI, no AV synchrony: neck pulsations, a systolic drop over 20 mmHg native vs paced.

Do not withhold defibrillation. Pads ≥8 cm from the generator, front-to-back.

Compressions continue if the ICD fires.

NOT IN THIS CART — OMNICELL PREMADE BOXES. Anaphylaxis, STEMI, and Stroke response supplies/meds — pharmacy stocks them as premade boxes pulled from the Omnicell.

DRAWER 1 Intubation: Video laryngoscope + backup direct laryngoscope, Mac/Miller blades; ETT 6.0–8.0 with stylet, 10 mL syringe; OPA/NPA assorted sizes, bougie; Waveform capnography adapter, tube-securing device/tape

DRAWER 2 Surgical / Supraglottic: Supraglottic airway (iGel/LMA), assorted sizes; Cricothyroidotomy kit — #10 scalpel, bougie, 6.0 mm cuffed ETT; Surgical airway tray, spare tracheostomy tube/obturator

DRAWER 3 Medications: Code drug tray — epinephrine 1 mg/10 mL prefilled, amiodarone, atropine; Calcium chloride, sodium bicarbonate, dextrose (D50/D10); Naloxone, lidocaine

DRAWER 4 Suction / IV Fluids: Yankauer + tubing, suction canister (tested and positioned); NS / LR 1 L bags, pressure infuser; Blood/Y-type tubing, IV pole

DRAWER 5 I.V. Supplies + Miscellaneous (deep): IV catheters 14–22 G, tourniquets; IO needle + driver (EZ-IO), IO stabilizer dressing; Extension tubing, stopcocks, saline flushes; Tegaderm/dressings, tape, pressure bag; PPE — gloves, gown, eye protection; Sharps container, bandage scissors; Code documentation sheet/clipboard, clock; Spare defibrillator pads, backup batteries

Core temp, not tympanic: mild 32–35 °C · moderate 28–32 · severe <28.

Keep horizontal, handle gently, cut the wet clothes off.

Below 30 °C: one defibrillation attempt. Hold epinephrine; double the interval at 30–35 °C.

Do not pronounce until core >32 °C, non-survivable injury, or K+ >12 mmol/L.

Arrest or refractory instability + severe hypothermia → call for ECMO.

Moderate: forced-air warming, trunk first, plus IV crystalloid warmed to 40–42 °C.

Category D: transient hypotension (D1), or normotensive shock (D2) — lactate >2, rising creatinine, MAP <60.

With a pulse: alteplase 100 mg IV over 2 h — or 50 mg over 15 min if rapidly deteriorating. Stop heparin.

In arrest: alteplase 50 mg IV bolus, repeat once at 15 min. CPR ≥30–60 min after.

Category D: lysis may be considered. C2 or below: lysis causes harm.

Absolute: prior ICH, stroke <3 mo, active bleeding, recent brain/spine surgery or head trauma.

Fluid-restrict — over ~500 mL makes it worse. Norepinephrine early: Pressors & Inotropes, MASSIVE PE.

LMWH unless lysis is imminent or refractory — then UFH 80 u/kg then 18 u/kg/h.

C3–D may transfer. Category E: stabilize while arranging transfer.

Offer a choice first: PO olanzapine 10 mg ODT or lorazepam 2 mg.

Droperidol 5–10 mg IM, may repeat at 10–15 min.

Or midazolam 5 mg IM, or olanzapine 10 mg IM.

Agitation must stop now, if immediate danger to self or staff: ketamine 4–5 mg/kg IM — works in ~5 min.

After ketamine or stacked sedatives: continuous SpO₂, and EtCO₂ if available.

Physical restraint: face-up. Release at the earliest safe moment. Document the restraint now — indication, order, times on and off, q15-min checks.

Tearing pain, pulse deficit, new AI murmur, syncope, or pain + deficit = dissection.

Type A → transfer for surgery. Type B → medical control and arrange transfer.

Ruptured AAA: no imaging. Permissive hypotension (SBP 80–90), blood, vascular OR.

Rate before pressure: esmolol 500 mcg/kg load → 50–200 mcg/kg/min, target HR <60.

Then nicardipine or clevidipine titrated to SBP 100–120. Avoid hydralazine (reflex tachycardia).

Two large-bore IVs, type & cross 4 units, arterial line if it does not delay transfer.

Core temp >40 °C + CNS dysfunction = heat stroke.

Cold-water immersion. If no tub: ice water in a tarp or body bag folded around the torso.

Target ~38.5–39 °C, then stop active cooling. Recheck core continuously or q5 min.

No antipyretics (ineffective, hepatotoxic here); dantrolene has no role. Shivering → small-dose benzodiazepine.

Rhabdomyolysis: crystalloid titrated to urine output 1–2 mL/kg/h; watch K, Ca, CK.

Thiamine 500 mg IV before or with any glucose; check glucose, magnesium, phosphate.

CIWA-Ar only if someone will score it hourly. Otherwise treat the observed signs.

Still uncontrolled after a full escalation regimen → ICU, intubate.

Diazepam 10–20 mg IV q10–15 min, escalating. Liver disease → lorazepam 2–4 mg q15 min.

Crossover: not controlled after ~3 escalations → add phenobarbital, stop escalating.

Phenobarbital 10 mg/kg ideal body weight IV over 30 min — or 130–260 mg aliquots q15–30 min.

Pick ONE ladder and stay on it. Running both at once is what stops the breathing.

Stop the transfusion. Keep the line with fresh normal saline through new tubing.

Re-verify patient ID against the unit label at the bedside.

Fever + flank pain + dark urine = acute hemolytic. Crystalloid for urine 1–2 mL/kg/h.

Hives alone: antihistamine, pause, may resume. Anaphylaxis: epinephrine 0.3–0.5 mg IM, never restart.

New dyspnea: not overloaded → TRALI, supportive, no diuretics. Overloaded → TACO, sit up, diurese.

Vitals q15 min until stable. Complete the reaction workup form.

Bag first, naloxone second.

Naloxone 0.04–0.4 mg IV, titrated to breathing. No IV: 2–4 mg IN/IM.

Recurrent sedation: drip at ⅔ of the wake-up dose per hour.

QRS >100 ms: bicarbonate 1–2 mEq/kg IV push, repeat until it narrows.

Never class Ia/Ic/III antiarrhythmics (procainamide, amiodarone) for tox-wide QRS.

Calcium: gluconate 3–6 g IV (or chloride 1–2 g via good/central line), repeatable.

Beta-blocker: add glucagon 5–10 mg IV (expect vomiting).

High-dose insulin 1 u/kg bolus → 0.5–1 u/kg/h, with dextrose and q30 min glucose/K.

Lipophilic agent peri-arrest: 20% lipid emulsion 1.5 mL/kg bolus, then infusion (Pressors & Inotropes).

Contact Poison Control.

Give the antidote during the code, and do not stop resuscitation early.

Norepinephrine 4 mg / 250 mL (16 mcg/mL) — 0.05 mcg/kg/min start, range 0.01–1 mcg/kg/min. First-line for nearly every shock in the ED.

Epinephrine (infusion) 4 mg / 250 mL (16 mcg/mL) — start 0.05, range 0.01–0.5 mcg/kg/min.

Epinephrine (bradycardia rate) — fixed 2–10 mcg/min, start at 2 mcg/min. (Not per kilogram).

Vasopressin 20 units / 100 mL (0.2 units/mL) — fixed 0.03–0.04 units/min. Added to norepinephrine. No pediatric dose exists (rate withheld below 40 kg).

Phenylephrine 20 mg / 250 mL (80 mcg/mL) — start 0.5, range 0.5–9 mcg/kg/min.

Dobutamine 500 mg / 250 mL (2000 mcg/mL) — start 2.5, range 2.5–20 mcg/kg/min. Raises cardiac output and drops blood pressure.

Milrinone 20 mg / 100 mL (200 mcg/mL) — start 0.125, range 0.125–0.75 mcg/kg/min. Long-acting, renally cleared, vasodilates.

Epinephrine push-dose: 10 mcg/mL — 1 mL of the 100 mcg/mL cardiac syringe into 9 mL normal saline. 10–20 mcg (1–2 mL) IV q2–5 min. Onset ~1 min, lasts 5–10 min.

Phenylephrine push-dose: 100 mcg/mL — 1 mL of 10 mg/mL into a 100 mL normal saline bag. 100–200 mcg (1–2 mL) IV q2–5 min. Onset ~1 min, lasts 10–20 min.

Septic/distributive: MAP ≥ 65 mmHg. Norepinephrine first; add vasopressin second when norepinephrine reaches roughly 0.25–0.5 mcg/kg/min; add epinephrine third. Consider hydrocortisone 50 mg IV q6h for refractory shock.

Post-ROSC: MAP ≥ 65 mmHg · SBP ≥ 90. Norepinephrine first.

Massive PE / RV failure: MAP ≥ 65 mmHg, and do NOT fluid-load. More than ~500 mL of fluid usually makes the RV worse.

Hemorrhagic shock: blood, and control of the bleeding. Norepinephrine as a bridge only.

Neurogenic shock: MAP 85–90 mmHg for spinal cord perfusion (typically held ~7 days) — once hemorrhage is excluded. Norepinephrine first; avoid phenylephrine alone.

BB/CCB overdose: high-dose insulin is the inotrope with calcium and glucagon. It takes ~30 min to work. Consult Poison Center.

Extravasation: stop, aspirate through the catheter, infiltrate phentolamine 5–10 mg in 10–15 mL saline.

Start it peripherally rather than wait — 20 G or larger, antecubital or above, blood return. Name who is watching the site, and have them look every 15 min.

The bag concentrations are this file's SITE CONFIG values, not the label on the bag in your hand — check them against each other.

BVM + PEEP, 100% O₂ · NC on · suction · position

Unresponsive and flaccid → immediate laryngoscopy without medication

Cannot pass the tube → succinylcholine 2 mg/kg total body weight IV, no induction agent

Call for the sized iGel and the cric kit

Succinylcholine for the crash airway: 2 mg/kg total body weight IV, no cap, no induction agent.

Crash airway: agonal, unresponsive, no gag. No time for the full preparation — oxygenate and look now.

If the patient is unresponsive and flaccid, attempt without drugs. If you cannot pass the tube, succinylcholine alone, 2 mg/kg total body weight IV — no induction agent.

If BVM or iGel oxygenation holds and the saturation recovers, there is time: tap Stabilized to return to the routine RSI steps with the weight and the log carried over.

Cooperative, oxygenating, anticipated difficult airway

Sit up · NC O₂ on · suction · glycopyrrolate 0.2 mg IV for secretions (optional)

Choose the route to see the topicalization sequence

Oxymetazoline both nostrils · pick the more patent side

4% lidocaine gel on the tongue, 2% lidocaine nebulized or in the nostril

ETT one half-size below the oral size, pre-loaded on the scope · warm and lubricated

Anxiolysis only if not tolerating: midazolam 1 mg or ketamine 20 mg, titrate · do not dissociate

Scope through the nostril → cords → carina · railroad the tube · withdraw the scope · inflate · ETCO₂

4% lidocaine atomized: tongue base, posterior pharynx, cords · gargle if able

Bite block or intubating oral airway · ETT loaded on the scope (or VL if preferred)

Anxiolysis only if not tolerating: midazolam 1 mg or ketamine 20 mg, titrate · do not dissociate

Scope midline over the tongue → cords → carina · railroad the tube · withdraw the scope · inflate · ETCO₂

Anxiolysis, only if not tolerating: midazolam 1 mg IV or ketamine 20 mg IV aliquots, titrated — never dissociate.

For the anticipated difficult airway in a cooperative patient who is oxygenating: angioedema, neck mass, prior difficult airway, fixed flexion. Not for the agitated patient — an awake technique is unlikely to succeed and dissociative ketamine is not recommended to force compliance.

Topical anesthesia is the primary anesthetic. Use sedation only to treat anxiety, in the smallest doses: midazolam 1 mg or ketamine 20 mg aliquots, titrated. Midazolam is favored.

Once the tube is confirmed visually and with capnography, induce with an intubating dose of etomidate, ketamine or propofol. A paralytic is not generally needed. Then sedation and analgesia as for any ED intubation.

Adult (at the 40 kg boundary and above): ETT 7.5 mm cuffed with 7.0 and 8.0 on the tray; depth at the lip 21 cm under 70 kg, 23 cm at 70 kg and above; a nasal tube one half-size smaller; Mac 3–4 or VL; OPA 90–100 mm; adult mask.

iGel by weight: size 1 under 5 kg · 1.5 from 5 kg · 2 from 10 kg · 2.5 from 25 kg · 3 from 30 kg · 4 from 50 kg · 5 from 90 kg.

Bougie by tube: the 15 Fr adult bougie for a 6.0 mm tube and above, the 10 Fr pediatric bougie for 4.0 and above, a stylet below that.

Mask by weight: infant under 10 kg · child from 10 kg · small adult from 30 kg · adult from the 40 kg boundary.

Under the 40 kg boundary the tube, the blade and the oral airway are the Broselow band's own; depth at the lip is three times the tube's internal diameter. A child above the last band is sized by age.

Stabilize the larynx · localize · incise · blunt dissect · find the cricothyroid membrane

Incise the membrane · bougie in · tube in, only until the balloon is in

Confirmation — waveform capnography, chest rise · secure the tube

Above 35 kg the three-step front-of-neck airway. At 35 kg and below the pediatric CICO routes instead, and the screen asks two questions: can you feel the cricothyroid membrane — feeling it means the membrane, not feeling it means the trachea below the cricoid — and then needle or scalpel. The weight is the case's own, the Broselow color or the keypad, never an age.

Call for expert help — ENT · keep oxygenating the whole way: four-handed facemask or a supraglottic airway, high-flow O₂ · foreign body suspected: look, suction, remove it under direct laryngoscopy first · then find the airway with your hands before anything is cut

Under 8 years the cricothyroid membrane is usually too small to find or to cut, and a tube wider than 2.5 mm outer diameter will not pass a neonate's, so a small child so often ends up below the cricoid. Palpation is unreliable below about 8.

Why a weight gate and then two questions: the case has a weight — the Broselow color or the keypad — and never an age. 35 kg is the median of a 10½-to-11-year-old and above the 97th percentile of an 8-year-old, so every child who could need these routes is included; below the gate the screen stops using numbers and asks two questions the operator can answer at the bedside.

Two questions decide the route, and both are answered with your hands. FIRST — can you feel the cricothyroid membrane? Feeling it means the membrane; not feeling it means the trachea, below the cricoid. SECOND — needle or scalpel? The classic teaching is the needle when you cannot feel it, and the scalpel when you can, but both stay offered either way. The child's age is evidence for the first answer, never the question itself.

The introducer is a RAILROAD ONLY — DO NOT INSUFFLATE DOWN IT, whatever oxygen connectors come in its package. No Venturi or Ventrain is carried, and in a can't-oxygenate airway gas pushed down a catheter has nowhere to leave: barotrauma and tension pneumothorax at 2–4 L/min within seconds. Today the introducer is a 10 Fr tube exchanger, which takes a 4.0 tube and up, on both scalpel routes: from 12 kg the band's cuffed tube goes over it, and at 11 kg and under the band's cuffed tube goes straight in — into the opened trachea, or along the blade through the membrane — with no introducer. A pediatric bougie and an 8 Fr Frova are both on order, and either one replaces the exchanger on both routes; the 8 Fr Frova takes a 3.0 tube, so with it an infant gets an introducer too. The tube is CUFFED at every size, advanced only until the cuff is just inside, then inflated.

Kit — tracheostomy: 11 blade scalpel · retractors · skin marker · 10 Fr tube exchanger, the introducer for tubes 4.0 and up · gauze · from the airway cart: the band's cuffed tube (lubricated), light, suction, capnography, bag-mask

Kit — cricothyroidotomy: 10 blade scalpel · 10 Fr tube exchanger from the pediatric eFONA kit, the introducer for tubes 4.0 and up · cuffed tube, lubricated

Neck extension · avoid hyperextension in infants, which may flatten the airway

Identify the midline · marker pen to nose, chin, sternal notch, xiphisternum

Vertical skin incision · stabilize the larynx with the non-dominant hand · avoid the lower quarter of the neck; stay in the midline

Assistant retracts the wound laterally · maintain good light, suction, retraction

Cut down to the trachea · keep retracting laterally to keep the strap muscles and vessels away

Cut 1–2 anterior tracheal rings vertically · to allow space for the tube

Introducer in, then cuffed tube · not too far: cuff just inside, then inflate the cuff

Cuffed tube straight in, no introducer at this size · not too far: cuff just inside, then inflate the cuff

Ventilate and check ETCO₂ · secure the tube — don't let go · consider stay sutures · control bleeding with gauze pressure

Laryngeal handshake — the larynx between thumb and middle finger, the index finger down to the cricothyroid membrane · transverse stab through the membrane, 10 blade · turn the blade 90°, sharp edge caudad

Introducer along the blade into the trachea, advance caudally · cuffed tube over it, only until the balloon is in

Cuffed tube straight in along the blade, no introducer at this size — only until the balloon is in

Confirmation — waveform capnography, chest rise · secure the tube · a temporary airway: one person holds it through every move until ENT's tracheostomy

Laryngeal handshake · larynx between thumb and middle finger, index finger down to the cricothyroid membrane

14G cannula-over-needle · on a syringe with 2 mL saline

Through the cricothyroid membrane · at 45°, caudad

Aspirate air freely · free air confirms the cannula is in the trachea

14G cannula-over-needle on a syringe with 2 mL saline · midline, just below the cricoid, into the trachea at 45° caudad · aspirate the whole way in — free air confirms the cannula is in the trachea

Cannula in, needle out · hold it — it kinks and dislodges

Connect the jet insufflator · or oxygen tubing with a Y-piece

Jet: 1 s on, 4 s off · watch the chest rise and fall · oxygenation only, not ventilation — the definitive airway is next

Needle jet is oxygenation, not an airway, and doubtful under 8 years: the membrane is often too small, failure and injury are frequent, the cannula kinks. It provides time for the scalpel approach.