Rsi

[PFD2171]

Looking for any agency out there who currently uses Versed as the induction agent for RSI. I recently began working for one who dose which seems odd in addition our ordered dosage is much less that it should be from what I have read for use in RSI.

 

[sir.shocksalot]

We don't RSI where I work but I can say that I haven't seen Versed used by itself as an induction agent. What I have seen is patients get high doses (2-3 mcg/kg) of Fentanyl and high doses of Versed (0.2 mg/kg) together for sedation. Although 90% of the time I see Etomidate used.

This website seems to suggest the ideal dosage for Versed is 0.2 mg/kg:
http://www.uptodate.com/contents/se...gents-for-rapid-sequence-intubation-in-adults

Best bet is to chat with your medical director if you have questions and see what his/her thought process is.

 

[mikie]

Pilot Program in MD

• • (1) Adult:
    Administer 0.05 mg/kg (2-5 mg) slow IVP over 1-2 minutes, while maintaining systolic BP greater than 90 mmHg. (NEW ’11)

this is the dose for Versed for the pilot RSI program in Maryland, used primarily by flight medics (troopers), but a few ground agencies have the capabilities.

 

[Cohn]

Flight crews in Arizona (AirEvac and LifeLine) use it for RSI

 

[fast65]

We use it along with succinylcholine and rocuronium for RSI, but it's not our main induction agent my any means. Our dose is 0.3 mg/kg

 

[usalsfyre]

0.05mgs/kg?!? Let me guess, that's a standard morphine dose too...

Midazolam works as an induction agent. If it's not used with a paralytic (bad idea) it often requires considerable doses, and hypotension is a significant (and deadly) side effect. It's not my first choice as an induction agent but it certainly will do the job.

 

[DESERTDOC]

We routinely used Midazolam as our primary induction agent, coupled with Fentanyl as needed in the setting of burns or other trauma. We had some latitude with our dosing .1MG/KG-.25MG/KG, I had good results at .25 per kilo. While there are better medications out there, Midazolam will work.

 

[Handsome Robb]

We don't do it but what I was taught was Midazolam 0.1-0.2mg/kg for the induction agent, a defasiculating dose of Vecuronium at 0.01mg/kg then Succinylcholine as the paralytic 1.5mg/kg.

Thats a standard RSI. We were taught to do it with other induction agents and non depolarizing paralytics as well.

 

[fast65]

I was taught using Etomidate (0.3 mg/kg) or midazolam (0.1 mg/kg), but where I'm at now, we have the option of using droperidol (0.1 mg/kg) as an induction agent as well.

 

[usalsfyre]

There's a myriad of options avaiable.

Most of your benzos, Ketamine, Etomidate, Droperidol, (formerly) thiopental, you can even do a decent job with a large enough fentanyl dose (preferably su/remifentinal though). All have their place and preferred indications.

 

[mikie]

0.05mgs/kg?!? Let me guess, that's a standard morphine dose too...

The PP allows for either Etomidate OR Midaz. for Inducation, Sux for paralysis, morphine (0.1mg/kg, which is new for 2011) and vecuronium for maintenance of paralysis.

 

[usalsfyre]

The PP allows for either Etomidate OR Midaz. for Inducation, Sux for paralysis, morphine (0.1mg/kg, which is new for 2011) and vecuronium for maintenance of paralysis.

That's a very low dose of midaz, and it's disturbing that the only "sedation" options are morphine and vec. Why do they not trust y'all up there?

 

[mikie]

That's a very low dose of midaz, and it's disturbing that the only "sedation" options are morphine and vec. Why do they not trust y'all up there?

No disagreement here! Compared to everyone else's protocols, it seems maryland uses half if not 1-2x less the dose, further more, to make things more wacky, the Midaz. dose for seizures is 0.1mg/kg

 

[systemet]

Interesting dosing here. When I was working, we used 0.1mg/kg midazolam with 3-5ug/kg fentanyl. We withheld the midazolam if the patient was hypotensive.

They had us limit the single dose of midazolam to 5mg, out of concern for iatrogenic hypotension. Which, actually made the dose only 0.1mg/kg for patients <= 5mg. If the patient was hypotensive on presentation, we withheld the midazolam, and just gave fentanyl. Current practice in that system for these patients is now to use ketamine.

I see people talking about 0.3mg/kg. Is a 100kg patient really receiving a single dose of 30mg midazolam IV? This seems like a lot, especially if there's any alcohol on board.

I don't know that I'd be too comfortable using morphine for maintenance of analgesia either, with the potential for hypotension. But I can see that it would have the advantage of requiring less frequent dosing than bolus fentanyl. What was the rationale for selecting morphine instead?

 

[systemet]

^

Should read "<= 50kg".

 

[Iceman26]

Flight crews in Arizona (AirEvac and LifeLine) use it for RSI

Fire departments and EMS do as well. In Arizona it's Versed, Etomidate, and Succs.

In some Chicago area medical systems they will only go with Versed and Etomidate and not go with the paralytic like Succs.

 

[Shishkabob]

In some Chicago area medical systems they will only go with Versed and Etomidate and not go with the paralytic like Succs.

That's just stupid and dangerous.



We primarily have Fent, Etomidate and Roc as our line drugs, but have Versed and Ativan on the truck as well.

 

[usalsfyre]

That's just stupid and dangerous.



We primarily have Fent, Etomidate and Roc as our line drugs, but have Versed and Ativan on the truck as well.

The last FD I worked for did the same thing. It's a very good way to end up with a hypotensive, hypoxic patient with trismus...

 

[Shishkabob]

Trismus is my major fear with giving Etomidate. I try to get the tube just doing Etomidate, but I do my due prudence and have Roc drawn up next to me (Had to do this to my last RSI when they developed trismus after amidate)


And a King...

And my crich kit...





Is it obvious RSI makes me scurred?

 

[usalsfyre]

If it doesn't give a medic pause at least then that medic scares the caca out of me (and likely has never had an airway go bad).