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Checklist teaching phase Step 1

Preparation

Prepare oxygenation, equipment, physiology, RSI medications, and the team before induction.

Airway Checklist: This static page supports simulation, prebriefing, and source review. It does not save encounter state, analyze a patient, or generate a clinical directive.

Discussion points

Oxygenation

  • Pre-oxygenation plan
  • Apneic oxygenation

Equipment

  • Suction ON - two setups available
  • ETT checked and cuff tested
  • BVM ready
  • Stylet ready

Physiology

  • Hypotension addressed
  • Hypoxia optimized
  • Acidosis considered

RSI options

  • IV/IO access confirmed
  • Induction agent drawn up and labeled - 20-mL syringe where locally standardized
  • Paralytic drawn up and labeled - 10-mL syringe where locally standardized

Team

  • C-collar plan addressed
  • PPE donned
  • Roles assigned

Medication monograph link

Published RSI dosing ranges

Open medication monograph

Induction options

Ketamine
1-2 mg/kg
Etomidate
0.2-0.3 mg/kg
Midazolam
0.3 mg/kg
Propofol
1-2 mg/kg

Paralytic options

Rocuronium
1 mg/kg
Succinylcholine (suxamethonium)
1-2 mg/kg

Dose references mirror the updated checklist. Individualize for physiology and local protocol. In patients at increased risk of peri-intubation hypotension, ACEP 2026 recommends ketamine or etomidate and advises avoiding fentanyl, midazolam, or propofol as induction/coinduction agents. ACEP adult ED intubation policy.

Teaching pearls

  • Preparation is a coordinated pre-induction pause: oxygenation, equipment, physiology, medication readiness, and team roles should all be visible before the first drug is pushed.
  • Simulation discussion prompt: Preoxygenation and apneic oxygenation are planned. Suction is on. The tube, BVM, and stylet are ready. Hypoxia, hypotension, and acidosis have been addressed. Access, labeled induction and paralytic medications, PPE, roles, and the C-spine plan are confirmed. START if ready; STOP if a critical item remains unresolved.

Common pitfalls for discussion

  • Suction present but not switched on
  • Medication syringes unlabeled or sequence unclear
  • Hypotension or severe acidosis not addressed before induction
  • C-spine plan, PPE, or team roles left implicit
  • Proceeding past the START/STOP checkpoint while a critical item remains unresolved
  • Treating the listed drug doses as universal defaults rather than physiology- and protocol-dependent references
About this resource
Created by: Kyle Brown MD; Andrew Pirotte, MD; Reba Hodge, MD; Amanda Vanderwerf, PharmD, BCEMP; Morgan Kimball, PharmD, BCEMP; Joshua Mohess Clinical review: EM faculty Reviewed: local ED, ICU, EMS, anesthesia, pharmacy, and pediatric protocol review recommended before bedside teaching rollout. Last reviewed: 2026-07-23 Next scheduled review: 2027-01-23 Designed for: EM residents, emergency physicians, EMS clinicians, airway educators, and simulation faculty Important: Educational resource and clinical-reference guide only; not a bedside order set or substitute for local protocol, medical direction, or clinical judgment. Website contact: kybrown@kumc.edu