Intubation Preparation

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Specializes in Emergency Nursing / CV/STICU.

For possible and certain intubations, I was just curious as to how much of each medication do you draw up? What medications do you use? I know we have a kit containing all the neuromuscular blockers that needs to be used in an intubation. What does your kit contain? I'm also still trying to understand the medications and how they work...one is a muscle paralyzer...lidocaine is for something else...please fill me in on this ASAP. I don't get much experience as to seeing what medications come into play. Thanks.

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Specializes in ED, ICU, PSYCH, PP, CEN.

Every case is different. The best way to learn this is to find out which drugs your facility most commonly uses. Most places have only a few choices. Then look each of these drugs up and make a list of what they are, and what the min and max dose of each is.

Then of course you will want to make note of what the reversal agent is for each one.

Once in a while you will have a doctor ask for a med that you have no idea about. If you have time you must look it up before you use it. If not, be sure and ask the doctor about it.

I always carry a drug book with me.

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Specializes in EMS, ER, GI, PCU/Telemetry.

my most common cocktail (in the ER and my preference in EMS also) was succs and etomidate.

succs is a neuromuscular blocker: (http://en.wikipedia.org/wiki/Suxamethonium_chloride)

etomidate is an anesthetic to induce concious sedation:

(http://en.wikipedia.org/wiki/Etomidate)

depending on the size of the patient, for a RSI on an adult, i would usually draw up 20mg etomidate and 100mg of succs. alot of docs prefer pavulon now i think, because it lasts longer, but i like succs the best.

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Specializes in ER.

our facility uses mostly succinylcholine, etomadate and neurcuron. our RSI kit also has versed, lidocaine and other drugs. i have found its vital to know both the trade amd generic names for these meds. if you are in an emergent situation, and a doctor wants you to give vecuronium (we call it 'vec') and your vile is labled 'neurcuron' then you know what drug to give. and each and every doctor is different, some of them like the drugs given rapid push, and others like to give it over 30-40 seconds. i always ask how fast to push it. we have one doctor that changes his way all the time. sometimes he wasnts vec and other times he wants neurc (same drug!!) and sometimes he wants to give it rapid push and other times slow. one of out doctors likes to give the succs after intubation (for safty reasons in case he cannot get the pt tubed, they are not paralized....) and other doctors give the succs in order to intubate. it gets much easier when you work with the same doctors for years and know how they like things done.

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Specializes in Anesthesia.
For possible and certain intubations, I was just curious as to how much of each medication do you draw up? What medications do you use? I know we have a kit containing all the neuromuscular blockers that needs to be used in an intubation. What does your kit contain? I'm also still trying to understand the medications and how they work...one is a muscle paralyzer...lidocaine is for something else...please fill me in on this ASAP. I don't get much experience as to seeing what medications come into play. Thanks.

Like others have said most of the time in the ER you are going to do a Rapid Sequence Intubation/RSI d/t the high probablity of a full stomach. Traditionally, RSI is usually done with succinylcholine/sux and some kind of induction agent (etomidate is often used in the ER because it is considered to have lesser effect on the cardiovascular system than other induction agents...ie. it is good for MI, CAD, CHF pts etc.). The problem with sux is that it is the only neuromuscular blocking agent used in the U.S. that can trigger malignant hyperthermia. Etomidate's big problem is that it has the highest incidence of nasuea and vomiting among induction agents. The other thing to know about sux is that it has the shortest paralytic time (3-5 min or so) compared to others which usually have a minimum of 30 mins before they wear off. This is very important to know if you think you are going to have trouble intubating someone...ie. no/short necks, morbidly obese, poor mouth opening etc.

The drugs I would know for ER intubations are:

Succinylcholine

Rocuronium

Vecoronium

Etomidate

Diprivan

Ketamine (Diprivan and Ketamine are often added to together to offset the unwanted side-effects of each)

Versed

Fentanyl

Morphine

Each of these can play a role in intubations, but a lot of it is going to be up to the preference of the provider.

Good Luck! I hope this helps a little.

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Specializes in ED, ICU, Heme/Onc.
For possible and certain intubations, I was just curious as to how much of each medication do you draw up? What medications do you use? I know we have a kit containing all the neuromuscular blockers that needs to be used in an intubation. What does your kit contain? I'm also still trying to understand the medications and how they work...one is a muscle paralyzer...lidocaine is for something else...please fill me in on this ASAP. I don't get much experience as to seeing what medications come into play. Thanks.

{{Please}} push your sedative first. Find out which one is the sedative (we use etomodate, versed, or rarely ketamine in our ED), and make sure it's given and the patient is down before giving the paralytic. Otherwise, you have paralyzed an awake and aware human being. Not a good thing at all.

Blee

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Specializes in Cardiac, ER.

Blee I'm glad you mentioned pushing the antesthetic first!! That is a huge parinoia that I have. I am terrified of the thought that a pt under my care might be "aware" of the paralytic even for a moment! I can't imagine how scary that would be!

To the OP,.our RSI kit has Vec, Etomidate, Versed, Succs and Lido (we don't often use). We almost always use Vec and Etomidate, depends on the situation and the Dr.

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. one of out doctors likes to give the succs after intubation (for safty reasons in case he cannot get the pt tubed, they are not paralized....)

Why would you give succs after intubating? It is a very short acting paralytic, not something you give after the tube is in to keep them relaxed.

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Why would you give succs after intubating? It is a very short acting paralytic, not something you give after the tube is in to keep them relaxed.

Typo I suspect.

Now, it looks like a new drug of the month may change some of our RSI modalities. It looks like sugammedex may be hitting the market soon. I know of a few places that no longer even use sux and simply use roc for every RSI.

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one of out doctors likes to give the succs after intubation (for safty reasons in case he cannot get the pt tubed, they are not paralized....)

:nono:

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Specializes in ER, Outpatient PACU and School Nursing.
my most common cocktail (in the ER and my preference in EMS also) was succs and etomidate.

we use this also and have a intubation kit with these 2 drugs..

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Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.

Ares get premedicated with Lido and benadryl, then they get versed, then morphine, fentanyl, or demerol drops down the line, then they get either sucs or vec, and then there tubed, then there put on a propofol drip or a versed gtt.

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