Succinylcholine vs. Rocuronium: Battle of the RSI Paralytics

You arrive on scene in an apartment to find a 25-year-old female who’s unresponsive and apneic in the bathroom by her roommate, covered in vomitus and surrounded by empty medication containers and a bottle of tequila. The patient’s roommate notes that the patient has a history of depression and drug abuse, takes “some medication every night,” and that the patient had been crying all day after her boyfriend broke up with her. Naloxone was administered by police with no effect, and the patient fails to breathe adequately on her own despite airway repositioning and suctioning. You quickly decide this patient requires intubation for airway protection. You’re deciding which medications to give the patient. You decide ketamine and succinylcholine ... No—wait—ketamine and rocuronium … Rapid Sequence Intubation Rapid sequence intubation (RSI) is a particular type of endotracheal intubation that aims to quickly and effectively induce sedation and paralysis in a patient who’s at high risk for aspiration or impending airway compromise. RSI was first described by Stept and Safar in 1970 and was initially called “rapid sequence induction and intubation.” RSI was created as a response to the deleterious effects of aspiration that were first described by Mendelson in 1946. The purpose of this technique was to decrease the amount of time that a patient’s airway was unprotected during induction.1 RSI is widely considered the safest and preferred method to intubate a cr...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Airway & Respiratory Exclusive Articles Patient Care Source Type: news