RSI / Paralytics

Question 1

Pancuronium

Answer 1

For: RSI (non-depolarizing neuromuscular blocker)

Adult dose: 0.04-0.1mg/kg slow IV, repeated every 30-60min PRN

Ped dose: 0.04-0.1mg/kg slow IV

Newborn dose: 0.02mg/kg slow IV

Contraindications: Inability to control airway and/or support ventilation. Known neuromuscular disease such as myasthenia gravis. Hypersensitivity

Note: Onset of paralysis in 3-5min. Duration: 45-60min

Question 2

Rocuronium

Answer 2

For: RSI (non-depolarizing neuromuscular blocker)

Adult dose: 0.6-1.2mg/kg IV

Ped dose: 0.9-1.2mg/kg IV

Contraindications: Inability to control airway and/or support ventilation. Hypersensitivity to bromides

Question 3

Vecuronium

Answer 3

For: RSI (non-depolarizing neuromuscular blocker)

Adult dose: 0.1-0.2 mg/kg IV/IO

Ped dose: 0.1-0.3mg/kg IV/IO

Contraindications: Inability to control airway and/or support ventilation. Bradycardias, dysrhythmias, hypotension, respiratory depression, muscular disease, malignant hyperthermia. Hypersensitivity

Question 4

Succinylcholine

Answer 4

For: RSI (Depolarizing neuromuscular blocker)

Adult dose: 1-2 mg/kg rapid IV. Repeat once if needed.

Ped dose: 2 mg/kg rapid IV. Repeat once if needed

Contraindications: Penetrating eye injuries; malignant hyperthermia; hyperK (acute injury after multi-system trauma, major burns, or extensive muscle injury that may result in hyperK)

Question 5

Etomidate

Answer 5

For: RSI (Induction agent / hypnotic)

Adult dose: 0.2-0.6mg/kg IV (typical dose is 20mg)

Ped dose: 0.2-0.4mg/kg IV/IO

Contraindications: Septic shock, labor / delivery, hypersensitivity

Question 6

Propofol

Answer 6

For: RSI (Induction agent / hypnotic)

Adult dose: 1.5 to 2 mg/kg

Ped dose: 2.5-3.5mg/kg over 20-30sec

Contraindications: Hypersensitivity

Question 7

Fentanyl (for RSI)

Answer 7

For: RSI

Dose: 50-200mcg (or 1-3 mcg/kg) over ~ 1 minute administered ~3 minutes prior to induction.

Contraindications: Known intolerance

Note: Avoid entirely or use lower doses (eg. 1mcg/kg) in patients with tenuous hemodynamic status. Use higher doses (eg. 3mcg/kg) in patients with elevated ICP

Question 8

Ketamine (for RSI)

Answer 8

For: RSI (Induction agent)

Adult dose: 0.5-2mg/kg IV (reduce to 1mg/kg IV in shock)

Ped dose: 1-3mg/kg IV

Contraindications: Dangerous HTN, pregnancy, hypersensitivity