Any sedation/intubation specialist here?

[rearviewmirror, BSN, RN]

My question arises from limited understanding of agents used during RSI. Can you explain me the detailed explanations, what to use in what scenario and such? So far this is what I understand and please correct me if I'm wrong or add on.

Etomidate used as sedative in most cases unless pt is hypotensive, bradycardic or unconscious denying need for sedative.

Ketamine: I have seen this used in two occasions so far. One for DSI (delayed sequence intubation) by an emergency MD who claimed ketamine "relaxes" pt, slows their agony breathing, and increases o2 saturation, also in another case when pt had loc, hr in 30s, 60/30, and the doc's claim was that side effect of ketamine was increased bp and hr. Can anyone tell me more about this and tell me little more about ketamine?

Roccuronium vs succycholine vs vecuronium : all I know is that they are paralytics, succ is bad for renal pts, heat stroke, rhabdo, anything that affects potassium, works slower than succ but lasts longer, while succ works faster with shorter half life. I don't know anything about vec but I heard it does not affect bp; usually seen given as booster after rocc or succ is used. By the way how do these agents affect the pt? I.e vitals, labs, etc?

Propofol and versed: seen both used as either drip following intubation or as push to do the intubation. My understanding is that propofol drops pressure so not used in hypotensive pt unless used with levo, meanwhile versed is less potent in lowering bp. Educate me little more about these.

Any other agents you use? Let me know about them and please educate me a bit more on these drugs. Thank you!

[Pheebz777, BSN, RN]

You can read all you want about the different sedatives and paralytics, however the decision of what to use boils down to the doctors' preference and what he/she is most comfortable with.

I would suggest just memorizing the different preparations over and over until you know them by heart. Because during emergent intubations the last thing the MD wants is a nurse that's fiddling over the different vials trying to figure out how much sterile water to mix with Vec after ordering 8mg Vecuronium.

[Pheebz777, BSN, RN]

Here's a detailed summary of the common sedation induction agents used for RSI

Sedation or induction agents for rapid sequence intubation in adults

[hotcoffee]

Wow that's a lot of questions.

you need to look those meds up.

sounds like you already have a handle on the clinical implications/applications

it will help you if you understand the mechanisms of action

get clinical anesthesia by Morgan it's the book you want

[rearviewmirror, BSN, RN]

I will visit the link. Thank you.