Delayed Sequence Intubation (DSI) Progression Patient ‘patient equting emergent airway ‘management, but resistant to pre- Intubation preparations because of sltered mental status | Dissociation Adina dlscitive dose of Ketarine by sow 1-Pus mister aston doses um eps isocated 10:15 seconds Preoxygenate Use Non Rebreather Mask pls Nasal Cannula saturation i 95%, stch NNon-Rebresthe for Non-invasive CPAP. Dentrogenat for 3 minutes, 3 minutes Paralyze Administer Succnychoine ‘or Rocuronim | ApOx Perform apt onyenation ‘witha camula 45-60 seconds Intubate Note: From our study, we found most patients wil become dissociated between 1.5 mek, Since the ‘effects of ketamine are almost instantaneous and man side effects suchas hyper-slvation ae dose ‘dependent, tay make sense to administer 2 smaller than sual intial dose (1 ma/k fhe patient doesn achive dissociation with the intial dese, follow with additonal aliquots of 05 mg/kg. Apnea may result from rapid pushes of ketamine, so push slowly or expecta bi, sl-imited pei of ep "Note: Other Procedures such a the placement ofa nasogaste tube may alo be performed during this stage Note: While two patlentsin this cohort were not ntbated after ssoition, we cannot recommend this strategy without further study to establish safety.