RSI meds

Pediatric Critical Care Columnist · Jul 5, 2004

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.

nursenary57 · Jul 29, 2004

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.

TraumaInTheSlot · Aug 29, 2004

they recently took away out roc and replaced it with vec. i like them both. ketamine rules!

Pediatric Critical Care Columnist · Aug 29, 2004

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...

veetach · Aug 29, 2004

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 :rolleyes: I wish we did.

zambezi, BSN, RN · Aug 29, 2004

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.

Fly4Life12 · Aug 29, 2004

it just depends on what doc is on. usually sux and versed. i've seen etomidate and vecuronium and rocuronium though. never seen ketamine.

paraloco · Dec 16, 2004

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.

RNCENCCRNNREMTP · Dec 16, 2004

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.

Rena RN 2003, RN · Dec 17, 2004

mostly we use succs and versed and then a continued versed gtt.

Rena RN 2003, RN · Dec 17, 2004

mostly we use succs and versed and then a continued versed gtt.