Category: Critical Care Nursing A history of malignant hyperthermia is an absolute contraindication to the use of succinylcholine. Malignant hyperthermia is a myopathy characterized by a genetic skeletal muscle membrane abnormality of the Ry (ryanodine) receptor.
Category: Critical Care Nursing Patients with the following conditions are at risk of succinylcholine-induced hyperkalemia: Burns, denervation (spinal cord injury or stroke), crush injuries, severe infections, myopathy (muscular dystrophy) and pre-existing hyperkalemia.
Category: Critical Care Nursing Under normal circumstances, serum potassium increases minimally (0 to 0.5 mEq per L) when succinylcholine is given. However, a rapid and dramatic increase in serum potassium can occur in receptor upregulation and rhabdomyolysis.
Category: Critical Care Nursing The side effects of succinylcholine include fasciculations, hyperkalemia, bradycardia, prolonged neuromuscular blockade, malignant hyperthermia and trismus/masseter muscle spasm.
Category: Critical Care Nursing In the rare circumstance when succinylcholine must be given intramuscularly because of inability to secure venous access, a dose of 4 mg/kg IM may be used. Absorption and delivery of drug will depend on the patient’s circulatory status.
Category: Critical Care Nursing The recommended dose of succinylcholine for RSI is 1.5 mg/kg IV. When residual muscular tone and impaired circulation may be present, it is recommended to increase the dose to 2.0 mg/kg IV to compensate for reduced IV drug delivery.
Category: Critical Care Nursing Succinylcholine is the most commonly used NMBA for emergency RSI because of its rapid onset and relatively brief duration of action. A history of malignant hyperthermia is an absolute contraindication to the use of succinylcholine.
Category: Critical Care Nursing Neuromuscular blocking agents are either agonists (“depolarizers” of the motor endplate) or antagonists (competitive agents, also known as “nondepolarizers”). Agonists work by persistent depolarization of the endplate.
Category: Critical Care Nursing Neuromuscular blocking agents do not provide analgesia or sedation. As a result, they are paired with a sedative induction agent for RSI. Similarly, appropriate sedation is essential when maintaining neuromuscular blockade post-intubation.
Category: Critical Care Nursing Neuromuscular blockade is the cornerstone of rapid sequence intubation, optimizing conditions for tracheal intubation while minimizing the risks of aspiration or other adverse physiologic events.
Category: Fundamentals Central cyanosis is often secondary to the shunting of venous unsaturated hemoglobin into the arterial circulation or the presence of abnormal hemoglobin. Central cyanosis is best seen on perioral skin, oral mucosa, or conjunctivae.
Category: Fundamentals Cyanosis is a blue or purple appearance of the skin or mucous membranes. This clinical finding is caused by inadequately oxygenated blood perfusing peripheral tissues or the presence of abnormal hemoglobin forms.
Category: Fundamentals There are a number of physiologic considerations for a patient with weakness and they include alterations in plasma volume, decrease in red cell numbers or cardiac function, drop in systemic vascular resistance and increased metabolic demand.
Category: Fundamentals Temperatures higher than 41.0°C can result in damage to neuronal tissue and require prompt and vigorous treatment with antipyretics and external cooling measures. Heat illness can result in extreme hyperpyrexia and lead to heat stroke.
Category: Fundamentals The two most useful ancillary tests, especially in older patients, are urinalysis and chest radiography. Chest radiographs are helpful in the diagnosis of pulmonary infection. Urinalysis is highly accurate for detecting urinary tract infection.