Rapid Sequence Intubation: Medications, dosages, and

recommendations


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1. 56$,+6+3"(& - Assemble all necessary equlpmenL, drug, eLc.

2. 56$(789$&+3"(& - 8eplace Lhe nlLrogen ln Lhe paLlenL's funcLlonal reserve wlLh oxygen - nlLrogen wash ouL -
oxygen wash ln"

3. 56$36$+3#$&3 - Anclllary medlcaLlons are admlnlsLered Lo mlLlgaLe Lhe adverse physlologlc consequences of
lnLubaLlon

4. 5+6+%8:": ;"3< "&-013"(& - AdmlnlsLer sedaLlve lnducLlon agenL vla lv push, followed lmmedlaLely by admlnlsLraLlon
of paralyLlc vla lv push

!" 5(:"3"(&"&9 - oslLlon paLlenL for opLlmal laryngoscopy, Selllck's maneuver, lf deslred, ls applled now

6. 5%+1$#$&3 ;"3< ,6(() - Assess mandlble for flaccldlLy, perform lnLubaLlon, conflrm placemenL

7. 5(:3="&304+3"(& #+&+9$#$&3 - Long-Lerm sedaLlon/analgesla/paralysls as lndlcaLed

Zero Mlnus
3 MlnuLes
Zero Mlnus
3 MlnuLes
Zero

Zero plus 20-
30 seconds
Zero plus
43 seconds
Zero Mlnus
10 MlnuLes
1. reparaLlon 2. reoxygenaLlon 3.
reLreaLmenL
4. aralysls/
lnducLlon
3. oslLlonlng 6. lacemenL
wlLh proof
7. osL-
lnLubaLlon
managemenL

56$=36$+3#$&3 > +9$&3: :<(0%- 4$ 9"?$& @ #"&03$: ,6"(6 3( "&304+3"(& A1+& 4$
9"?$& "& +&8 (6-$6B
C609 C(:$ 2&-"1+3"(& D3<$6 &(3$:
Lldocalne 100 mg Pead ln[ury, LraumaLlc
braln ln[ury, unknown
mechanlsm of ln[ury,
elevaLed lC
Lldocalne wlll help
proLecL Lhe paLlenL
from lncreases ln
lnLracranlal pressure
caused by lnLubaLlon
lenLanyl 2-3 mcg/kg LlevaLed lC,
cardlovascular dlsease
(lschemlc coronary
dlsease, aneurlsmal
dlsease, greaL vessel
rupLure or dlssecLlon,
lnLracranlal
hemorrhage)
lenLanyl helps decrease
caLecholamlne
dlscharge secondary Lo
lnLubaLlon, Lhus
decreaslng Lhe rlsks
assoclaLed from 8
lncreases ln pLs wlLh Cv
dlsease, aorLlc
dlssecLlons, eLc. 8e
careful lf Lhe paLlenL ls
already hypoLenslve
8ocuronlum
(defasclculaLlon)
0.1 mg/kg
(e.g., 7 mg ln a 70 kg pL)
Pead ln[ury, LraumaLlc
braln ln[ury, unknown
mechanlsm of ln[ury,
elevaLed lC
uefasclculaLlon no
longer rouLlnely
recommended. May
conslder lf pL. w/head
ln[ury Lo be paralyzed
wlLh succlnylchollne
(SCh). SCh causes
LranslenL muscle
fasclculaLlon (LwlLch)
whlch LheoreLlcally may
lncrease lnLracranlal
pressure.




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1hlopenLal 3 mg/kg lv <30 3-10 aLlenLs wlLh
elevaLed lC or
sLaLus epllepLlcus
who are
hemodynamlcally
sLable
PlsLamlne
release
Myocardlal
depresslon
venodllaLlon
PypoLenslon
noL rouLlnely
used

Avold lnLra-
arLerlal
ln[ecLlon (may
cause
gangrene)
regnancy
caLegory C
Mldazolam 0.2-0.3
mg/kg lv
60-90 13-30 noL rouLlnely
recommended for
8Sl.
May use for posL-
lnLubaLlon
managemenL

8esplraLory
depresslon
Apnea
aradoxlcal
aglLaLlon
noL
recommended
for 8Sl.
aLlenL
response may
be exLremely
varlable
LLomldaLe 0.3 mg/kg
lv
10-13 4-10 used ln almosL all
paLlenLs for
emergency 8Sl.
May conslder
alLernaLlve agenL lf
paLlenL ls sepLlc or
ln sLaLus epllepLlcus
-Adrenal
lnsufflclency
-aln on
ln[ecLlon
-Myoclonlc
acLlvlLy

CommunlcaLe
Lo subsequenL
provlders LhaL
paLlenL
recelved
eLomldaLe lf
paLlenL sepLlc
keLamlne 1.3 mg/kg
lv
43-60 10-20 Cood opLlon for
paLlenLs wlLh
reacLlve alrway
dlsease or who are
hypovolemlc,
hemorrhaglng, or ln
shock
lncreased:
8
P8

lnLraocular
pressure
noL
recommended
ln hyperLenslve
or
normoLenslve
paLlenLs.
use cauLlon ln
paLlenLs wlLh
cardlovascular
dlsease
ropofol 1.3 mg/kg
lv
13-43 3-10 Pemodynamlcally
sLable paLlenLs wlLh
reacLlve alrway
dlsease or ln sLaLus
epllepLlcus
PypoLenslon
Myocardlal
depresslon
8educed
cerebral
perfuslon
pressure
aln on
ln[ecLlon
ulLra-shorL
acLlng

negaLlve Cv
effecLs llmlLs
use for
lnducLlon ln 8Sl


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Succlnylchollne 1.3 mg/kg lv
lncrease Lo 2
mg/kg lv ln
myasLhenla
gravls
4 mg/kg lM
(only ln llfe
LhreaLenlng
slLuaLlons)
43 6-10 LssenLlally all
paLlenLs excepL
Lhose wlLh:
MallgnanL
hyperLhermla
Pyperkalemla
->3d afLer
burn, crush,
denervaLlon,
severe
lnfecLlon

Pyperkalemla

Muscle
fasclculaLlons

LlevaLed lC
8radycardla
may occur
afLer repeaLed
doses, have
aLroplne ready
ln Lhe evenL lL
occurs
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8ocuronlum 1 mg/kg 60-73 40-60 8Sl when
succlnylchollne
conLralndlcaLed
no,
cllnlcally
slgnlflcanL
AuLs
Lnsure
conLlngency
plan ln place ln
Lhe evenL of
falled alrway
vecuronlum 0.01 mg/kg
prlmlng dose
followed 3
mlnuLes laLer
wlLh 0.13
mg/kg
120-
180
43-63 noL recommended
for 8Sl unless a
nondepolarlzlng
agenL ls lndlcaLed
and rocuronlum ls
noL avallable
no
cllnlcally
slgnlflcanL
AuLs
Lnsure
conLlngency
plan ln place ln
Lhe evenL of
falled alrway