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Our service is a dedicated interhospital ground based operation along
with a helicopter operation for scene and interhospital missions.  We
have been using Lidocaine, Mivacron, and Etomidate as our RSI
protocol, with Atropine for children, for the past 2 years with good
success.  We have had two occasions where intubation was not
successful after RSI, one which resulted in a needle cric and the
other with BVM ventilations for a patinet who was clenched and began
to compromise his airway with blood and vomitus.  In both cases the
patient maintained an adequate saturation on pulse ox.