Medications in Rapid Sequence Intubation (RSI)

Key Principle

• Sedative before Paralytic: Administer sedative first to avoid the traumatic experience of being awake but unable to move.
  • Rare exceptions based on onset times.
  • Sedatives: Etomidate, Ketamine, Propofol, Versed.
  • Paralytics: Succinylcholine (Sux), Rocuronium (Roc).

Sedatives

Etomidate

• Most Used: Hemodynamically stable (less impact on blood pressure/vital signs).
  • Dose: 0.3 mg/kg.
  • Onset: ~30 seconds.
  • Duration: Up to 10 min.
  • Side Effect: Myoclonus (jerking movements).
• Usage:
  • Unstable patients (e.g., hypotension, head injuries).
  • Seizure patients and heart disease patients.
  • Useful in shock and respiratory patients.

Ketamine

• Useful in Respiratory Issues/Treatment for Shock: Bronchodilatory properties.
  • Dose: 1.5 mg/kg.
  • Onset: ~60 seconds.
  • Duration: Up to 20 min.
  • Properties: Analgesic.
  • Limitations: Not used in cardiac or neurological patients.
  • Special Use: Awake intubations (maintain respiratory drive).

Propofol and Versed

• Rarely Used for Intubation: More common for conscious sedation/post-intubation.
  • Propofol:
    • Dose: 1.5 mg/kg.
    • Onset: ~40 seconds.
    • Duration: Up to 10 min.
    • Side Effect: Cardiovascular depression (hypotension).
  • Versed:
    • Dose: 0.2 mg/kg.
    • Onset: ~60 seconds.
    • Duration: Up to 30 min.
    • Side Effect: Hypotension.
  • Both: Anti-convulsants, post-intubation sedation.

Paralytics

Succinylcholine (Sux)

• Quick On/Quick Off: Preferred for short-term paralysis.
  • Dose: 1.5 mg/kg.
  • Onset: ~45 seconds.
  • Duration: ~10 min.
• Contraindications:
  • Risk of hyperkalemia (renal patients, long down-time, burn/crush injuries).
  • History of malignant hyperthermia.
  • Unknown patient history (e.g., ER scenarios).

Rocuronium (Roc)

• Alternative to Sux: Used when Sux is contraindicated.
  • Dose: 1 mg/kg.
  • Onset: ~60 seconds.
  • Duration: Up to 60 min.
• Considerations: Longer duration increases risk of complications if intubation fails; Ensure backup equipment is ready.

Note on Procedure

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