Tag Archive for: Paralytics High

Dosing Sedatives Low and Paralytics High in Shock Patients Requiring RSI

06 May
May 6, 2018

Background: A series of tweets I sent out recently generated a visceral response from critical care clinicians the world over. I summarized my strategy of shock dose RSI as sedatives low and paralytics high (low dose ketamine, high dose rocuronium along with cardiovascular resuscitative strategies of push dose pressors and peripheral vasopressors). It seems that the visceral response and argument stems from EM’s desire to avoid peri-intubation arrest, and anesthesia’s equally strong desire to avoid awareness/suffering in the peri-intubation period.  Typically ketamine is dosed at 1 – 2mg/kg IV followed by a paralytic agent prior to RSI. I have written a blog post on how to manage hypotension prior to RSI in shock patients HERE, but I wanted to write a separate post on this topic as it is difficult to carry on a meaningful conversation with the character limitations of twitter. Read more →