Category: Critical Care Nursing Rocuronium is the preferred nondepolarizing neuromuscular blocking agent for emergency RSI. If rocuronium is not available, then vecuronium is an alternative, although the longer onset time may be problematic.
Category: Critical Care Nursing Malignant hyperthermia requires monitoring of pH, arterial blood gases and serum potassium. Aggressive management of hyperkalemia with the administration of calcium gluconate, glucose, insulin and sodium bicarbonate may be necessary.
Category: Critical Care Nursing The treatment for malignant hyperthermia consists of discontinuing the precipitant and administration of dantrolene sodium (Dantrium). Dantrolene acts directly on skeletal muscle to prevent calcium release without affecting calcium reuptake.
Category: Critical Care Nursing In malignant hyperthermia, the acute loss of intracellular calcium control results in muscular rigidity, autonomic instability, hypoxia, hypotension, lactic acidosis, hyperkalemia, myoglobinemia and disseminated intravascular coagulation.
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.