RSI meds

  1. out of curiosity...

    what meds do your docs like to use for RSI. anybody using ketamine, read that it can be useful in hypotensive pt.s and especially with status asthmaticus.
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  2. 28 Comments

  3. by   NotReady4PrimeTime
    Depending on which of our docs is on, we will use morphine, midazolam or ketamine and rocuronium; we very occasionally will use succinylcholine instead of rocuronium, and even less often we'll use vecuronium. Where I worked before we used a lot more thiopental, but even there they've moved to rocuronium. Ketamine is great because it's a smooth muscle relaxant and has a bronchodilating effect in those wicked bad asthmas. We've even run it as an infusion for a few otherwise unventable patients in addition to salbutamol and midazolam.
  4. by   nursenary57
    Etomidate and sux is what we use on nearly everybody. Not supposed to use sux on burns due to related hyperkalemia (sux combined with cell destruction increases K release 24-48 hours post incident if I recall correctly.) Etomidate is supposedly very good due to it's minimal effect on hemodynamics.

    Never used ketamine before. Need to learn more about it.
  5. by   TraumaInTheSlot
    they recently took away out roc and replaced it with vec. i like them both. ketamine rules!
  6. by   NotReady4PrimeTime
    Quote from TraumaInTheSlot
    they recently took away out roc and replaced it with vec. i like them both. ketamine rules!
    There was a manufacturer's shortage of roc a couple of months ago, lasted several weeks. We switched to pancuronium and occasionally vec during that time, but our roc is back in the fridge again now. I've noticed that lately our docs are using more fentanyl for RSI, but it isn't stocked on our code carts...
  7. by   veetach
    Quote from thanatos
    out of curiosity...

    what meds do your docs like to use for RSI. anybody using ketamine, read that it can be useful in hypotensive pt.s and especially with status asthmaticus.

    our docs like to use either Succ or Vec, when the residents rotate through they call for Etomidate but we dont use it in our hospital I wish we did.
  8. by   zambezi
    Our docs almost always use sux and etomidate it seems. I have seen the vec used on occassion. I have also used versed on occassion for sedation as well.
  9. by   Fly4Life12
    it just depends on what doc is on. usually sux and versed. i've seen etomidate and vecuronium and rocuronium though. never seen ketamine.
  10. by   paraloco
    Quote from nursenary57
    Etomidate and sux is what we use on nearly everybody. Not supposed to use sux on burns due to related hyperkalemia (sux combined with cell destruction increases K release 24-48 hours post incident if I recall correctly.) Etomidate is supposedly very good due to it's minimal effect on hemodynamics.

    Never used ketamine before. Need to learn more about it.
    We use Etomidate and sux also. If we need to re-sedate prior to arrival, we give em another 20 of sux. If its a dialysis patient, and one with burns or crush injuries over 24 hours old(when would we run into this?) we would use vec. I have heard that Ketamine works well.
  11. by   RNCENCCRNNREMTP
    Pick up a copy of "Emergency Airway Management" by Walls. It will answer all of your emergency airway questions and more.

    I like succinylcholine and etomidate for most. Ketamine is great for asthma (bronchodilation).

    Never use vecuronium for initial induction, takes too long, rocuronium is quicker but lasts too long at the dose needed for quick induction.

    Succs is the way to go in the ER even with burns (unless transferred in 2-3 days after event. Would only avoid with globe injury or muscular disease or delayed presentation after trauma or Hx of malignant hyperthermia.
  12. by   Rena RN 2003
    mostly we use succs and versed and then a continued versed gtt.
  13. by   Medic2RN
    Although this happens "in the field", I thought I'd answer because we do RSI. We use Versed, Vec & then Ativan.

  14. by   traumakimmy
    any of your docs giving lido when intubating? we have one that insists on it. just wondering if there were more out there.

    kim

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