One of those rap sequence intubation, this patient is an overdose, so she's not all that the kidney but she's not protecting her airway all that well. So what we're going to do is we're going to intubate her in a protector airway. In preparation for the intubation, what you need to do is make sure that the entire head of the bed is ready to go and that includes, you know, 100% non-regretional in the patient, suction set up so that you can suction the patient, suction should be turned, all the way up to full and should not be on intermittent. In addition, you need vagabond mass set up and with air flowing to it, the capnometer needs to be set up and calibrated so that we know when the tube is in. The whole idea behind the rapid sequence intubation is to be able to get the intracute tube into the trachea and minimize the risk of the patient either becoming hypotic or the patient vomiting and aspirating. So she's not protecting her airway very very rough, she's trekking a little bit and the idea is to follow. What we're going to do is we're going to put an intracute tube into her and we'll protect our airway the rest of the lamp. We'll make sure we can control her about the respiration as well. We've got 100% non-regretional on her because what we want to do is we want to wash all the nitrogen out of her lungs and be able to just have oxygen in there so that'll give us about a minute or two to put the intracute tube in. As soon as we push our meds, she's going to lose the rest of her airway re-blectance because we're going to paralyze her as well as the data a little bit more. As soon as we push the medicine, Kate's going to put some pressure on the glycosyroid membrane and that's going to include the esophageal. She's also going to put a little bit of pressure that's going to push the cracked-arid membrane backwards upward and to the right. So backwards upward rightward pressure burps is a pneumonic cord and that's going to make it a little bit easier for us to see what's going on. In addition we've got the tracheal tube prepared. It's got a syringe on it, a 10cc syringe, we've below the balloon up and we've got our arrangescope already set up to go and we've checked the late one. We're going to do her with row coronium and ketamine and when you use row coronium it's the opposite of what a lot of people think. She pushed the row coronium first which is the paralytic, we wait 15 seconds and then we're going to go ahead and push the sedative agent. Her case we're using ketamine because there's blood pressure a little bit on the low side. Okay go ahead and push the row coronium. The row coronium is going in now. Okay and we're going to wait about 15 seconds and then we're going to push the sedative in this case we're going with ketamine one heart. Okay push the ketamine and what you're generally fine is again push the adenovido, she's waxing and waning a little bit. If you weren't stimulating her she'd go completely to sleep so you're going out to touching her L-A grade. Okay go ahead and put a little bit of tracheal tube pressure on her. Okay you can see how rapidly the medicines work. When the ring scope goes in we're going to sweep the tongue to the left. We've been visualizing the border clearly but we don't release the pressure on the trichot membrane until the balloon is blown up and we're in more weeks to be. We can see the gain from the brach and cylocale 2 is showing here and she's up 43. We got her incubating at a pretty good split. We're going to become high-costic one if it didn't come to my front of the ass. Let's do a little trick question. We have good breath sounds and we're at about 22 at the lip. Our antidal is 41 which is right where we want it to be. Now Kate's got her tube chamber that we're going to put on here to secure the end of tracheal tube. What you do is you take the sticky's off of both of these and you put this around the NG tube that you have to have in. This locks in here. There's a little piece of came here and then but this will do is secure the end of the trichot membrane. We need heat tube in the right position. The only way we know this tube is to go through the base form when it's not non-referent. We don't see that. We don't know what it is. In addition though, by reading the actual number here, body knows exactly how much the ventilator is going to be. We're not hyperventilating her and we're not typo ventilating her. Alright, tubes in place. We got two breast downs both sides. Pulls out to 100% and is a little bit tacked parted and now we're just going to be seeing her blood pressure. With the ketamine in there, her blood pressure should be pretty good so it should not be a problem there. Otherwise, we'll get a chest x-ray confirmed in position and now we can bring the rest of the trichotamine in here because there's usually never enough room to put rest of the trichotamine and ventilator in here at the same time as during the incubation. Alright, that's it guys. Thanks.