Roc

I had a doc order the paralytic first once. His rationale was that the onset of the paralytic was longer than that of the sedative, so that if we gave the paralytic first and then the sedative, they would be taking effect simultaneously and he could intubate sooner.

Yes, typically its' for speed in takedown more than anything. Etomidate has such a short half-life its concerning. I prefer Roc because its half-life is 45-60 minutes. It provides such a better control as a paralytic especially if the pt is aggressive or high as a kite. If this is simply your little old COPD-er who isn't combative, then definitely sedate before you intubate. It truly is more humane, but only if this scenario is possible. I understand the need and rationale for sedative, but if the patient is violent and needs a rapid takedown, Rocuronium (Zemuron) or Vecuronium is certainly a nicety. Our local flight crew will use Vec for all pt transports to ensure the patient is down for the count and will not lead to any movement in flight. Simply put...Roc is beautiful!

I've been told also regarding succ vs roc that succ increases ICP, whereas roc does not. Anyone know if that's true?