1. Plan.
2. Preparation (drugs, equipment, people, place)
3. Protect the cervical spine.
4. Positioning (some do this after paralysis and induction)
5. Preoxygenation.
6. Pretreatment (optional; e.g. atropine, fentanyl and lignocaine)
7. Paralysis and Induction.
8. Placement with proof.

How do you give etomidate?

It is administered only by intravenous route. Etomidate has a very favorable hemodynamic profile on induction, with a minimal amount of blood pressure depression, making it an ideal choice for shock trauma, hypovolemic patients, or patients with significant cardiovascular disease.

Can etomidate be given IM?

Etomidate Injection, USP is intended for administration only by the intravenous route (see CLINICAL PHARMACOLOGY).

How fast do you push etomidate?

Administration. IV: Administer IV push over 30 to 60 seconds. Solution is highly irritating; avoid administration into small vessels; in some cases, preadministration of lidocaine may be considered.

How fast do you push rocuronium?

The recommended initial dose of rocuronium bromide, regardless of anesthetic technique, is 0.6 mg/kg. Neuromuscular block sufficient for intubation (80% block or greater) is attained in a median (range) time of 1 (0.4 to 6) minute(s) and most patients have intubation completed within 2 minutes.

Which drug is first in RSI?

Conclusion: Administration of either the neuromuscular blocking or the sedative agent first are both acceptable. Administering the neuromuscular blocking agent first may result in modestly faster time to intubation.

Why do you give etomidate before succinylcholine?

It is usually not of concern when used in paralytic RSI since the rapid administration of Succinylcholine quickly paralyzes the masseter muscles. Etomidate, when used in paralytic RSI, is pushed as rapidly as possible and is immediately followed by the neuromuscular blocking agent.

Is etomidate contraindicated in sepsis?

The most rigorous meta-analysis suggests that etomidate can be safely used in septic patients (19).

Is etomidate a sedative?

Conclusion: Etomidate is a useful agent for carefully conducted procedural sedation because it provides effective, brief, deep sedation with little hemodynamic compromise. Its safety may be jeopardized by the occurrence of respiratory depression in older patients receiving higher doses.

What is the difference between propofol and etomidate?

Propofol (propofol 1%) has a smooth and rapid induction, rapid recovery, cerebro-protective effect but it causes hypotension, bradycardia, respiratory depression pain on injection. Etomidate is a hypnotic agent causing minimal histamine release and very stable hemodynamic profile.

What receptors does etomidate work?

Etomidate acts on the CNS to stimulate gamma-aminobutyric acid (GABA) receptors and, in doing so, depresses the reticular activating system. The electroencephalogram (EEG) changes are similar to those produced by barbiturates as the patient passes rapidly through light to deep levels of surgical anesthesia.

What is the difference between succinylcholine and rocuronium?

Succinylcholine's duration of action is 10—15 minutes, whereas the half-life of rocuronium is anywhere from 30—90 minutes, depending on the dose. However, succinylcholine has major side effects, including hyperkalemia, malignant hyperthermia, fasciculations and bradycardia.

Can you Redose succinylcholine?

If redosing of succinylcholine is required, it is suggested that the maximum safe cumulative dose of succinylcholine is 6 mg/kg. Systemic uptake, time to onset of action, and duration of action will be variable depending on the patient's hemodynamic state and ability to absorb.

What drug should never be given IV push?

The most common medications not provided in ready-to-administer syringes include: Antiemetics Antibiotics with short stability Metoprolol Antipsychotics Opioids Furosemide Benzodiazepines Pantoprazole These medications are available in a prefilled syringe, however supply has been limited.

What IV push meds need to be diluted?

The following medications require dilution: ranitidine, famotidine, pantoprazole, lorazepam, promethazine. In certain settings, the following drugs require dilution in order to give them IV push: Digoxin Immune FAB, ephedrine, phentolamine, phenylephrine, phenytoin, vitamin K, magnesium sulfate.

When should you not use etomidate?

Its use by infusion in trauma patients has been associated with an increase in mortality [16, 17] and has led to recommendations not to use etomidate in trauma patients [18].

Does etomidate lower seizure threshold?

Conclusions: Etomidate has a distinct advantage over thiopental in producing seizures of adequate duration during ECT and should be used as the first-line measure in augmenting seizures in patients who have very high seizure thresholds.

Does etomidate increased ICP?

Conclusions: In pediatric patients with severe traumatic brain injury, single-dose etomidate administration resulted in statistically significant reductions in ICP and improvement in cerebral perfusion pressure without significantly altering MAP.

What is the antidote for etomidate?

Conclusions: Etomidate resulted in stable hemodynamic responses and relatively less adverse effects, and flumazenil antagonized the anesthetic effect of etomidate; thus, etomidate with flumazenil is suitable for performing stem cell transplantation in autistic children.

What is the reversal agent for etomidate?

Calabadion 2 dose-dependently reverses the effects of ketamine and etomidate on electroencephalographic predictors of depth of anesthesia, as well as drug-induced hypotension, and shortens the time to recovery of righting reflex and functional mobility.

What class of medication is etomidate?

Etomidate is a non-barbiturate hypnotic that acts at the level of the reticular-activating system to produce anesthesia. Etomidate is an imidazole compound that appears to depress CNS function via GABA.