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Discussion

Etomidate medication

Just wonder what everyone else does. When they have a pt that needs emergent intubation and the doc orders etomidate, succs or other meds - Are we as ICU nurses allowed to admister them considering the doc it at the pt head and ready to intubate - or are we not allowed to push them?? I work in Pennsylvania and really do not have a straight answer.

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    Etomidate is an anesthetic used as an induction agent prior to intubation. States vary as far laws regarding RN's administering IV push medications that fall into the "anesthetic" category (other drug that come to mind is Propofol as an IV push).

    The Scope of Practice for Registered Nurses in Pennsylvania are outlined in the Pennsylvania Code. Remember that the BON does not make laws but rather, enforce the laws. Sometimes you won't find the actual Scope of Practice in BON websites.

    As far as administration of meds, Pennsylvania is clear about the fact that RN's can administer meds prescribed by a provider but does not specify whether anesthetics are excluded:

    049 Pa. Code 21.14. Administration of drugs.

    The law in PA also adds that in an emergency situation in an institutional setting, an RN can administer therapies under written institutional protocols:

    049 Pa. Code 21.15. Monitoring, defibrillating and resuscitating.

    But the law also contradicts this by saying that only nurses who are CRNA's can administer anesthetics:

    049 Pa. Code 21.17. Anesthesia.

    I think your case falls into an emergency situation, so if you have institutional policy stating that you may administer IVP Etomidate under the direction of a physician because you are trained to do so by the institution, you should be OK.

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    At my old facility, the RN would always push the emergency meds granted the physician was at the head of the bed ready to intubate and RT was prepared as well. We pushed etomidate, succ, vec, atracrium, versed...you name it. The only medication we were not allowed to push was propofol...it was in our hospital's policy. For some reason, the doctor had to be the one to push the medication.

    I would suggest looking up your policy on the matter, that should give you the most accurate information on the subject for your specific institution! Hope this helps!

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    Thanks - that helps a lot - I appreciate it

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    what is the reasoning behind not being allowed to push propofol but you can push paralytics and other anesthetics?

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    what is the reasoning behind not being allowed to push propofol but you can push paralytics and other anesthetics?
    Realistically? Turf....
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    How could you reasonably be expeccted to assist with intubation if you can't push the meds?

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    How could you reasonably be expeccted to assist with intubation if you can't push the meds?

    Stand there and be pretty? Some nurses seem to have nothing else to do when a doctor is in the room ^^.

    In Belgium we're allowed to push anything that needs pushing as long as it is ordered by a physician. Except normal saline we can push that without an order, "yeah we've got the power".

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