Steps for emergency endotracheal intubation of a child

What are the steps for emergency endotracheal intubation of a child? 

Begin bag-valve mask ventilation with 100% oxygen as soon as the need for positive-pressure ventilation is identified. Emergency endotracheal intubations are generally treated as “full-stomach” intubations. The steps for a rapid sequence intubation are as follows:

  • 1. Preoxygenate with bag-valve-mask ventilation with 100% oxygen.
  • 2. Prepare all equipment, including suction, endotracheal tubes, and laryngoscopes.
  • 3. Make certain an IV catheter is functioning well.
  • 4. Administer atropine (for younger children and those receiving succinylcholine), followed by a sedative agent and then a paralytic agent.
  • 5. Perform laryngoscopy once paralysis is complete, and watch the endotracheal tube go through the vocal cords into the trachea.
  • 6. Auscultate for equal breath sounds and check for the presence of CO by capnometry. Observe symmetric chest expansion, misting in the tube with exhalation, and improvement in oxygen saturation by pulse oximetry, and listen for gurgling over the stomach, which suggests esophageal intubation.
  • 7. Secure the tube with tape.
  • 8. Evacuate the stomach with a nasogastric or orogastric tube.
  • 9. Obtain a chest radiograph to check the position of the tube and adjust accordingly.


  • 1. Preoxygenate with 100% oxygen by bag-valve-mask device.
  • 2. Prepare equipment (e.g., suction, endotracheal tubes, laryngoscopes, monitors—electrocardiogram [ECG], pulse oximeter, end-tidal CO detector or monitor).
  • 3. Confirm functioning intravenous (IV) line.
  • 4. Administer medications (atropine for younger children and those receiving succinylcholine, sedative, paralytic agent).
  • 5. Intubate the trachea, observing the tube pass through the vocal cords.
  • 6. Verify proper placement—auscultate the chest, check for CO by capnometry, chest radiograph.
  • 7. Secure the endotracheal tube.
  • 8. Evacuate the stomach with a nasogastric or orogastric tube.


American Heart Association: 2010 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 14: Pediatric Advanced Life Support. Circulation 2010;122(18):876-908. 

King C, Rappaport LD. Emergent endotracheal intubation. In Henretig FM, King C (eds). Textbook of Pediatric Emergency Procedures 2nd Edition. Philadelphia, Wolters Kluwer/Lippincott, Williams & Wilkins 2008;146-190.


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