Because most instances of cardiac arrest in children are caused by respiratory failure, the ability to intubate the trachea is a skill every pediatrician should have. Except in cases of acute upper airway obstruction with arrest, intubation of the trachea should be a carefully planned and preconceived procedure. All the necessary equipment should be kept available and should be checked regularly. Box 445.1 lists the minimal equipment necessary for intubation.

Ventilatory assistance can be provided for most children with a bag and mask, and while such assistance is being instituted, the physician should give clear, concise commands regarding the orderly performance of procedures and the administration of medications. Semiconscious or alert patients who require endotracheal intubation should receive appropriate sedation and cardiovascular protection, and they should be paralyzed for the procedure (Table 445.1). Use of an intravenous line is recommended with rare exceptions. Typically, the sequence of medications used is as described in the following sections.