Version June 2024
| Clinical scenario | Induction agent* | Neuromuscular blocking agent*¶ | Physiologic optimization (including pre-induction medications)Δ |
| Elevated ICP (head injury, stroke) | Etomidate 0.3 mg/kg IV or ketamine 1 to 2 mg/kg IV (avoid ketamine if signs of cerebral herniation; ketamine preferred in patients with severe hypotension) | Succinylcholine¶ 1.5 mg/kg IV or rocuronium 1.5 mg/kg IV | May give fentanyl 3 mcg/kg IV over 30 to 60 seconds, if time permits and patient is not in shock, for conditions exacerbated by rise in ICP (eg, acute brain injury, ischemic stroke, intracranial hemorrhage, meningitis, encephalitis, cerebral edema) |
| Cardiovascular emergency excluding cardiogenic shock (ACS, aortic dissection) | Etomidate | Succinylcholine or rocuronium | May give fentanyl 3 mcg/kg IV over 30 to 60 seconds, if time permits |
| Shock | Ketamine or etomidate (reduce dose by half for cardiogenic shock; ketamine preferred by some for septic shock) | Succinylcholine 2 mg/kg IV or rocuronium | Pre-RSI management depends on cause and may include:
|
| Reactive airway disease | |||
| Stable blood pressure | Ketamine or propofol 1.5 to 2 mg/kg IV | Succinylcholine or rocuronium | Pre-RSI management may include NPPV, heliox, high-flow oxygen (in addition to albuterol and other standard medical therapy) |
| Hypotensive/unstable | Ketamine or etomidate | Succinylcholine or rocuronium | |
| Prolonged seizure activity | Propofol or etomidate | Succinylcholine preferred (rocuronium may be used if EEG monitoring immediately available) | |
| Geriatric patient | Etomidate preferred (reduce dose by half if frail, hypotensive, or significant comorbidity) | Succinylcholine or rocuronium | Physiologic optimization may include isotonic IVF bolus, blood transfusion, and/or vasopressor (norepinephrine) infusion for hypotensive patients or those at risk of hypotension with RSI |
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
