Sedation/RSI

Question 1

ETOMIDATE (Amidate)

Answer 1

Description:
Etomidate is an ultra–short-acting nonbarbiturate hypnotic with no analgesic effects and limited cardiovascular and respiratory effects.

Indications:
Induce sedation for rapid sequence intubation.

Contraindications:
None.

Precautions:
Head Injury if no paralytics used, marked hypotension, severe asthma, or severe cardiovascular disease.

Dosage/Route:
Adult: 0.1 to 0.3 mg/kg IV over 15 to 30 sec.
Pedi: children > 10 years, same as for adults

Question 2

HALOPERIDOL (Haldol)

Answer 2

Description:
Haloperidol is believed to block dopamine receptors in the brain associated with mood and behavior,is a potent antiemetic, and impairs temperature regulation.

Indications:
Acute psychotic episodes.

Contraindications:
Parkinson’s disease, seizure disorders, coma, alcohol depression, CNS depression, and thyrotoxicosis, and with other sedatives.

Precautions:
Orthostatic Hypotension

Dosage/Route:
2 to 5 mg IM. Normally mixed with Benadryl to avoid EPS Reactions

Question 3

PANCURONIUM (Pavulon)

Answer 3

Description:
Pancuronium is a nondepolarizing neuromuscular blocker that causes paralysis without bronchospasm or hypotension, it does not cause the fasciculations associated with polarizing agents.

Indications:
To facilitate endotracheal intubation.

Contraindications:
Tachycardia.

Dosage/Route:
Adult: 0.04 to 0.1 mg/kg IV.
Pedi: same as adult.

Question 4

SUCCINYLCHOLINE (Anectine)

Answer 4

Description:
Succinylcholine is an ultra–short-acting depolarizing neuromuscular blocker.

Indications:
Facilitated endotracheal intubation.

Contraindications:
Family history of malignant hyperthermia, penetrating eye injury,
narrow-angle glaucoma. Hyperkalemia, Crush Injury, burns over 24 hours, Mystina Gravitas, MS, ALS

Precautions:
Severe burns; spinal cord injury;

Dosage/Route:
Adult: 1 to 1.5 mg/kg IV/IM.
Pedi: 1 to 2 mg/kg IV/IM.

Question 5

VECURONIUM (Norcuron)

Answer 5

Description:
Vecuronium is a nondepolarizing skeletal muscle relaxant similar to pancuronium with minimal cardiovascular effects.

Indications:
Facilitated endotracheal intubation.

Contraindications:
None.

Precautions:
Hepatic or renal impairment, impaired fluid and electrolyte or acid/base balance, severe obesity, myasthenia gravis, elderly, debilitated patients, or malignant hyperthermia.

Dosage/Route:
Adult: 0.1 mg/kg IV.
Pedi: same as adult.

Question 6

ROCURONIUM BROMIDE (Zemuron)

Answer 6

Description:
Antagonizes acetylcholine at the motor end plate producing skeletal muscle paralysis.

Indications:
Rapid sequence intubation

Precautions/Side Effects:
Bronchospasm, wheezing, rhonchi, respiratory depression, apnea, dysrhythmias, tachycardia.

Dosage/Route:
Adult: 0.6-1.2 mg/kg IV, IO
Pedi: Same

Question 7

PROPOFOL (Diprivan)

Answer 7

Description:
Produces rapid and brief state of general anesthesia

Indications:
Anesthesia induction, anesthesia maintenance, sedation for mechanically ventilated patients.

Contraindications:
Hypovolemia, known sensitivity including soybean oil, peanuts, and eggs.

Precautions/Side Effects:
Seizure, apnea, dysrhythmias, asystole, hypotension, hypertension.

Dosage/Route:
Adult: Induction dose: 1.5-3 mg/kg IV, IO. Maintenance infusion: 25-75 ug/kg/min IV, IO.

Pedi: Induction dose: 2.5-3.5 mg/kg IV, IO. Maintenance infusion 125-300 ug/kg/min IV, IO