All patients who respond to noxious stimuli should be sedated and paralyzed prior to endotracheal intubation. In RSI, the induction agent is dosed to provide a deep level of sedation (induction) and is rapidly followed by a paralytic agent which is necessary to both allow for optimal intubating conditions and improve the chance of a successful intubation. The specific induction and paralytic agents should be chosen based on the clinical scenario, taking into consideration pharmacokinetics, pharmacodynamics, indications, contraindications, and side effects which will be discussed in this module.
After successful intubation, post-intubation management should begin with implementing a plan for analgesia and sedation, when indicated. Addressing analgesia and sedation improves patient comfort and decreases the sympathetic response to the endotracheal tube.1 Details of post-intubation management will be addressed in a separate module.
Learning Objectives
Describe the medications that can be used for induction prior to RSI.
Compare the pharmacologic properties of succinylcholine and rocuronium including contraindications for succinylcholine.
Based on a simulated patient case, select the optimal induction and paralytic regimen for a patient requiring endotracheal intubation.
Authors
Affiliation
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Chris Edwards, PharmD, BCPS
Emergency Medicine Pharmacist, University of Arizona Medical Center
Great question. My assumption is that sepsis in general predisposes to succinylcholine-induced hyperkalemia through prolonged immobility (causing upregulation of acetylcholine receptors), severe metabolic acidosis, and acute kidney injury. So when you give succinylcholine, there’s an extra efflux of potassium. With intra-abdominal sepsis, such as ischemic bowel/rhabdo, I assume this may result in another hyperkalemic insult.
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Is anyone able to explain how sepsis with an intra-abdominal source would lead to hyperkalemia (in regard to succinylcholine)?
Great question. My assumption is that sepsis in general predisposes to succinylcholine-induced hyperkalemia through prolonged immobility (causing upregulation of acetylcholine receptors), severe metabolic acidosis, and acute kidney injury. So when you give succinylcholine, there’s an extra efflux of potassium. With intra-abdominal sepsis, such as ischemic bowel/rhabdo, I assume this may result in another hyperkalemic insult.
very good review
Liked it!
Excellent
Great Class though I think question 4 on the quiz needs fixed. I believe the answer is Ketamine not Propofol.
Disregard – Propofol is correct! AVOIDED
Informative course / Very Helpful
Great course