Versed dosing for RSI

who actually carries the drug to reverse sux in the field?
 
maybe? im not sure what it is. the cct medic at my squad down at school doesn't like to use succs for RSI because he said that the companies he works for dont have the drug to reverse its effects
 
EMT B said:
maybe? im not sure what it is. the cct medic at my squad down at school doesn't like to use succs for RSI because he said that the companies he works for dont have the drug to reverse its effects
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To my knowledge, there isn't a drug to reverse succinylcholine... Suggamadex is the reversal agent for agents like Vec and Roc, but I don't know how readily available it is (or if its even FDA approved yet...).

I hope nobody is carrying Romazicon...
 
well theres the answer. my mom said there is no antidote. it is metabolized by an enzyme called pseudocholinesterase. one of the reasons she things sux is dangerous and doesnt like to use it is because if someone is pseudocholinesterase deficient, the drug doesn't get metabolized for a LONG time.

Edit: Shes a former Critical Care Tech, current CRNA
 
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EMT B said:
well theres the answer. my mom said there is no antidote. it is metabolized by an enzyme called pseudocholinesterase. one of the reasons she things sux is dangerous and doesnt like to use it is because if someone is pseudocholinesterase deficient, the drug doesn't get metabolized for a LONG time.

Edit: Shes a former Critical Care Tech, current CRNA
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The worst side effect of succinylcholine is malignant hyperthermia. Antidote? Dantrolene. Where can you get Dantrolene? Surgery. Can't use Succs in surgery without it.
 
Perhaps he meant neostigmine (and subsequently glycopyrrolate ) for ndnmba like rocoronium? It has to already be wearing off before you can reverse it.
Suggamedex is also for roc and rapid acting (and I think expensive), maybe we will see it. It's used in some provinces here I think (by anesthetists)
 
maybe antidote was the wrong word. i was thinking more along the lines of naloxone reverses narcotics
 
triemal04 said:
Somebody needs to brush up on their pharmacology...:rofl:
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I doubt very seriously Chase confused the two, instead asking a different question to make a point.

Besides I do not believe there is a reversal agent for succ akin to sugammadex for roc. Edrophonium and neostigmine can indirectly shorten succ time (phase II issues if memory serves), but nothing like sugammadex.
 
triemal04 said:
Somebody needs to brush up on their pharmacology...:rofl:
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Ya, I was trying to make a point since the original topic was Versed. I do not think there is a need for it in EMS but I was curious if anyone carried it. It usually causes more problems than it solves but it does have it uses in extreme cases. I guess if you are using high dose Benzos as your main RSI drug then it might be a consideration.

I have only given Romazicon once during a code.
 
I'll say this with the disclaimer that I'm well aware there are numerous exceptions to the rule, BUT

If you're going into a field RSI and "let the patient wake up and breathe on their own" is a viable option for a failed intubation I SERIOUSLY worry about your candidate selection.
 
MSDeltaFlt said:
The worst side effect of succinylcholine is malignant hyperthermia. Antidote? Dantrolene. Where can you get Dantrolene? Surgery. Can't use Succs in surgery without it.
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While probably not considered a "side effect", in my mind the most dangerous effect of succs would be death in patients who are already hyperkalemic prior to administration, as evidenced by lab values or burns over 24 hours, evidence of rhabdo, etc.. (in fairness, I've heard anecdotally that this is blown out of proportion)

But alas, somehow this discussion has led us to succs. Since it has, can I get a "goooooooo rocuronium" and a "down with succs" from my homies? :)
 
blindsideflank said:
We aren't talking versed only are we?

Versed and opiates have a synergistic effect so that 4 of versed used for cath is different. I've given 30 of morphine for gall stones (I don't believe the biliary spasm) and the person is still conscious but I guarantee if I added 2 of versed he would be out.
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I don't know about that. Their actions are synergistic but it's not necessarily that dramatic. Of course it depends on the patient and the situation, but generally if someone is tolerating 30mg of morphine well, I would probably not expect them to go "out" with the addition of just 2 of versed.

What do you mean you don't "believe" the biliary spasm?


FiremanMike said:
can I get a "goooooooo rocuronium" and a "down with succs" from my homies? :)
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Meh, I think sux is a great drug and the side effects / risks are blown out of proportion.

There are some populations that it shouldn't be used in, but outside of that I think the benefits easily outweigh the risks in the vast majority of emergent patients.

In the OR with an elective patient it's a different ballgame. But in the field with a critical patient, sux is definitely where it's at.
 
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Halothane said:
I don't know about that. Their actions are synergistic but it's not necessarily that dramatic. Of course it depends on the patient and the situation, but generally if someone is tolerating 30mg of morphine well, I would probably not expect them to go "out" with the addition of just 2 of versed..
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Our usual dosing is 2-4mg Versed and 50-100 Fentanyl. Patients are generally very comfortable but arousable enough to answer simple questions. I rarely have patients "go out".


On a side note the CRNA in the Cath Lab seems to have it made. Providing sedation for TEE/Cardioversions all day with the occasional RSI during a Cath.
 
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Halothane said:
Meh, I think sux is a great drug and the side effects / risks are blown out of proportion.

There are some populations that it shouldn't be used in, but outside of that I think the benefits easily outweigh the risks in the vast majority of emergent patients.

In the OR with an elective patient it's a different ballgame. But in the field with a critical patient, sux is definitely where it's at.
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<shrug> to me, succs is a great drug but has scenarios where it absolutely cannot be used. Roc is a great drug that doesn't really have any scenarios where it can't be used (that I'm aware of). I'd rather have a drug that gives me one less thing to think about, and roc does that.
 
Halothane said:
What do you mean you don't "believe"
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Poor wording on my part. I was just mentioning that I feel morphine is appropriate for pain control on gall stones

And I agree, sux effects are overhyped in situations like burns (hyperkalemia) malignant hyperthermia, etc.
 
Ok, since this is my thread I'm going to be snippy and picky. I'm looking for versed doses period. Not opinions on the best RSI drugs or anything else about RSI or sedation. If you use high dose, I especially want to hear from you.
 
blindsideflank said:
Poor wording on my part. I was just mentioning that I feel morphine is appropriate for pain control on gall stones .
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Appropriate, maybe. But most effective or best practice, No.

Why snow a patient with 30mg of Morphine when you can get better pain management with other options? I have had many patients get 1-2mg of Dilaudid from EMS or the ER with minimal relief and then finally get Benytl or IV Toradol on the floor with nearly complete relief.

And if you really want to use Opiods then Dermol is a better choice IMO due to the possible antispasmodic effects.

And if IRRC Morphine may actual increase sphincter tone and cause worsening spasms.
 
Aidey said:
Ok, since this is my thread I'm going to be snippy and picky. I'm looking for versed doses period. Not opinions on the best RSI drugs or anything else about RSI or sedation. If you use high dose, I especially want to hear from you.
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Ok, fair enough..


We used to just use versed and etomidate. Our dose was 2mg of versed followed by 0.3mg/kg of etomidate (max of 20mg......). When it worked, it did fine, when it didn't it was because they were under dosed on etomidate and needed more.

I currently work under a protocol that allows versed as a third line to etomidate and ketamine, it's dose is also 0.3mg/kg (no max).
 
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