🫁 RSI Calculator
⚠️ Clinical Disclaimer: Verify all doses with pharmacy. Doses are guidelines only — clinical judgment required. All weights should be actual body weight unless noted.
Pretreatment (optional — give 3 min before induction)
Fentanyl — opioid blunting
Pretreatment
Dose
—
Range
—
Route / Onset
IV slow push
1–2 min
1–2 min
Blunts sympathetic response to laryngoscopy. Use in ICP elevation, aortic dissection, severe HTN. Give slowly over 30–60s to avoid chest wall rigidity.
Induction Agent (choose one)
Etomidate
Induction
Dose
—
Total (mg)
—
Route / Onset
IV push
15–45 sec
15–45 sec
✅ Hemodynamically neutral — preferred in hypotensive/shocked patients. Single dose adrenal suppression — generally acceptable for RSI. Duration 3–10 min.
Ketamine
Induction
RSI Dose
—
Total (mg)
—
Route / Onset
IV push
45–60 sec
45–60 sec
✅ Preferred in bronchospasm, reactive airway, hemodynamic instability. Dissociative at RSI doses. Maintains airway reflexes less than other agents — give full dose. Catecholamine release → BP/HR ↑ (caution in fixed CO states).
Propofol
Induction
Dose
—
Total (mg)
—
Route / Onset
IV push
15–45 sec
15–45 sec
⚠️ Significant hypotension risk — avoid in hemodynamically unstable patients. Best for controlled intubations (e.g. status epilepticus, awake/stable patient). Reduce dose in elderly/frail.
Midazolam
Induction
Dose
—
Total (mg)
—
Route / Onset
IV push
2–3 min
2–3 min
⚠️ Slower onset than other agents — less reliable for RSI. Use as adjunct or when other agents unavailable. Hypotension risk. Reduce dose in elderly, renal/hepatic impairment, or with opioids.
Paralytic Agent (choose one)
Succinylcholine — depolarizing
Paralytic
Dose
—
Total (mg)
—
Onset / Duration
45–60 sec
~10 min
~10 min
⚠️ CONTRAINDICATED: Burns >24h old, crush injury >3 days, prolonged immobility, hyperkalemia, personal/family hx of malignant hyperthermia, myopathies, UMN/LMN lesions >3 days. Use actual body weight (not IBW) in obese patients.
Rocuronium — non-depolarizing
Paralytic
RSI Dose
—
Total (mg)
—
Onset / Duration
60–90 sec
30–60 min
30–60 min
✅ Preferred when succinylcholine contraindicated. High-dose (1.2 mg/kg) gives near-identical onset to succinylcholine. Reversible with sugammadex (16 mg/kg for immediate reversal). Use IBW in obese patients.
Vecuronium — non-depolarizing
Paralytic
RSI Dose
—
Total (mg)
—
Onset / Duration
3–5 min
25–40 min
25–40 min
⚠️ Slower onset than rocuronium — not ideal for traditional RSI. Use when rocuronium unavailable. Onset can be shortened with priming dose (0.01 mg/kg given 3 min before).
Post-Intubation Sedation & Analgesia
💤 Sedation DripsStart immediately after intubation
Propofol
10mg/mL standard. Preferred ICU sedation (RASS-guided)
10mg/mL standard. Preferred ICU sedation (RASS-guided)
—
Midazolam
1mg/mL standard. Use if propofol unavailable or hemodynamically unstable
1mg/mL standard. Use if propofol unavailable or hemodynamically unstable
—
Ketamine
2mg/mL. Good opioid-sparing option, bronchodilator
2mg/mL. Good opioid-sparing option, bronchodilator
—
💊 Analgesia DripsAnalgesia-first approach
Fentanyl
50 mcg/mL standard. Preferred — hemodynamically stable, titratable
50 mcg/mL standard. Preferred — hemodynamically stable, titratable
—
Morphine
1mg/mL standard. Avoid in renal failure (active metabolite accumulates)
1mg/mL standard. Avoid in renal failure (active metabolite accumulates)
—
🚨 Difficult Airway Alerts
⚠️ Obesity (BMI ≥30)
• Use IBW for rocuronium/vecuronium
• Use actual body weight for succinylcholine
• Ramped positioning — ear to sternal notch
• Pre-oxygenate longer (↓ FRC, ↓ apneic time)
• Video laryngoscopy preferred
• Have bougie ready
• Use IBW for rocuronium/vecuronium
• Use actual body weight for succinylcholine
• Ramped positioning — ear to sternal notch
• Pre-oxygenate longer (↓ FRC, ↓ apneic time)
• Video laryngoscopy preferred
• Have bougie ready
🤰 Pregnancy
• Left lateral tilt (15°) — relieve aortic compression
• Rapid desaturation — ↑ O₂ consumption
• Difficult airway more likely (airway edema)
• Full stomach — highest aspiration risk
• Succinylcholine safe in pregnancy
• Avoid prolonged apnea — fetal hypoxia risk
• Ketamine safe; avoid large propofol doses
• Left lateral tilt (15°) — relieve aortic compression
• Rapid desaturation — ↑ O₂ consumption
• Difficult airway more likely (airway edema)
• Full stomach — highest aspiration risk
• Succinylcholine safe in pregnancy
• Avoid prolonged apnea — fetal hypoxia risk
• Ketamine safe; avoid large propofol doses
🚨 Predicted Difficult Airway
• Call for backup / senior now
• Prepare video laryngoscope as primary
• Have bougie, smaller ETT (6.0–6.5), LMA ready
• Cric kit open and at bedside
• Consider awake intubation if time allows
• LEMON assessment: Look, Evaluate 3-3-2, Mallampati, Obstruction, Neck mobility
• Don't paralyze if unsure you can intubate
• Call for backup / senior now
• Prepare video laryngoscope as primary
• Have bougie, smaller ETT (6.0–6.5), LMA ready
• Cric kit open and at bedside
• Consider awake intubation if time allows
• LEMON assessment: Look, Evaluate 3-3-2, Mallampati, Obstruction, Neck mobility
• Don't paralyze if unsure you can intubate
Toggle flags above the weight input to show alerts.
🔄 Sugammadex (Rocuronium Reversal)
Routine reversal
— (4 mg/kg)
— (4 mg/kg)
Immediate reversal (can't intubate/oxygenate)
— (16 mg/kg)
— (16 mg/kg)
Onset ~3 min for routine, ~1.5 min for high dose. Only reverses rocuronium/vecuronium — does NOT reverse succinylcholine.
📏 ETT & Equipment Guide
Adult male ETT
7.5–8.0 mm
7.5–8.0 mm
Adult female ETT
7.0–7.5 mm
7.0–7.5 mm
Difficult airway ETT
6.0–6.5 mm
6.0–6.5 mm
Insertion depth (lips)
Male: 23 cm | Female: 21 cm
Male: 23 cm | Female: 21 cm
Confirm with
Waveform capnography + CXR
Waveform capnography + CXR
Initial vent settings
—
TV 6–8 mL/kg IBW, RR 12–16, FiO₂ 100% initially, PEEP 5
—
TV 6–8 mL/kg IBW, RR 12–16, FiO₂ 100% initially, PEEP 5
🔪 Surgical Cric — Can't Intubate / Can't Oxygenate
1
Call for help. Position neck extended.
2
Identify cricothyroid membrane — midline, between thyroid and cricoid cartilage.
3
Scalpel: Horizontal stab incision through skin and membrane. Hook — tracheal hook to stabilize trachea, pull caudally.
4
Bougie: Insert bougie through incision, advance into trachea (feel rings).
5
Tube: Railroad 6.0 cuffed ETT over bougie. Inflate cuff. Confirm with waveform capnography.
6
Ventilate. Secure tube. Reassess. Call surgery for definitive airway.