The original use of LOAD has fallen out practice for severe TBIs, but yet, the acronym is still discussed/taught as a part of pretreatment. Out of lidocaine, opioids, atropine, and defasciculation dosing, opioids are the only intervention with consistent data on neuroprotective properties in the setting of RSI and TBI. I have modified the acronym "LOAD" to lidocaine, opioids, access, and down or delay. Consider these questions for each: Is this an indication for topical or nebulized lidocaine for an awake intubation?

• Does the patient need opioids for pain control or neuroprotection?
• What access do I have to get the medications into the patient?
• Does the patient need agents for vasoactive support or delayed sequence intubation? Going through each component allows me to anticipate complications from anticipated airways.

Consider applying it to your practice if you find value in going through pretreatment LOAD this way.

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