Podcasts about succinylcholine

*Content warning: birth trauma, medical trauma and neglect, death, infant loss, pregnancy loss, SIDS, postpartum depression. *Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources *Sources:American College of Nurse Midwiveshttps://midwife.org/ American College of Obstetricians and Gynecologists (ACOG)https://www.acog.org/ APGAR Scorehttps://medlineplus.gov/ency/article/003402.htm Birth Traumahttps://my.clevelandclinic.org/health/diseases/birth-trauma Breech Babyhttps://my.clevelandclinic.org/health/diseases/21848-breech-baby Intravenous nutrient therapy: the "Myers' cocktail"https://pubmed.ncbi.nlm.nih.gov/12410623/ March of Dimeshttps://www.marchofdimes.org/peristats/about-us Maternal placental abnormality and the risk of sudden infant death syndromehttps://pubmed.ncbi.nlm.nih.gov/10192307/ Midwifery Education Accreditation Council (MEAC)https://www.meacschools.org/ National Midwifery Institutehttps://www.nationalmidwiferyinstitute.com/midwifery North American Registry of Midwives (NARM)https://narm.org/ Preeclampsiahttps://www.mayoclinic.org/diseases-conditions/preeclampsia/symptoms-causes/syc-20355745 Pseudocholinesterase deficiencyhttps://www.mayoclinic.org/diseases-conditions/pseudocholinesterase-deficiency/symptoms-causes/syc-20354543 State investigating Dallas birth center and midwives, following multiple complaints from patientshttps://www.wfaa.com/article/news/local/investigates/state-investigating-dallas-birth-center-midwives-following-multiple-complaints-from-patients/287-ea77eb18-c637-44d4-aaa2-fe8fd7a2fcef Succinylcholine injectionhttps://my.clevelandclinic.org/health/drugs/20755-succinylcholine-injection Sudden infant death syndrome (SIDS)https://www.mayoclinic.org/diseases-conditions/sudden-infant-death-syndrome/symptoms-causes/syc-20352800 Tawagi, George. "Compound Presentations." Oxorn-Foote Human Labor & Birth, 6e Eds. Glenn D. Posner, et al. McGraw-Hill Medical, 2014, https://obgyn.mhmedical.com/content.aspx?bookid=1247§ionid=75163840. Umbilical Cord Prolapsehttps://my.clevelandclinic.org/health/diseases/12345-umbilical-cord-prolapse Texas Department of Licensing and Regulation (TDLR)https://www.tdlr.texas.gov/ Zucker School of Medicine, Amos Grunebaum, MDhttps://faculty.medicine.hofstra.edu/13732-amos-grunebaum/publications *SWW S22 Theme Song & Artwork: Thank you so much to Emily Wolfe for covering Glad Rag's original song, U Think U for us this season!Hear more from Emily Wolfe:On SpotifyOn Apple Musichttps://www.emilywolfemusic.com/instagram.com/emilywolfemusicGlad Rags: https://www.gladragsmusic.com/ The S23 cover art is by the Amazing Sara StewartFollow Something Was Wrong:Website: somethingwaswrong.com IG: instagram.com/somethingwaswrongpodcastTikTok: tiktok.com/@somethingwaswrongpodcast Follow Tiffany Reese:Website: tiffanyreese.me IG: instagram.com/lookieboo See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

It's the 1990s at a medical center in California, and patients are dying. At first, this doesn't seem strange — it's a hospital, and deaths happen. But then rumors start to circulate about a particular health care worker: Difficult or needy patients in his care are ending up dead. The cops get involved, but there's a huge problem: There's no hard evidence. Until the so-called “Lab of Last Resort” steps in. Crime Junkie host Ashley Flowers joins us as we speak to analytical chemist Armando Alcaraz, former Detective Sergeant John McKillop and Dr. Ian Musgrave.  Find our transcript here: https://bit.ly/ScienceVsSerialKiller In this episode we cover:  (00:00) Deaths at a California Hospital (05:20) Meet Efren Saldivar (10:51) A Shocking Confession (15:40) Pavulon and Succinylcholine (21:00) Searching for Suspicious Cases (25:09) The Lab of Last Resort  (34:21) Testing the Bodies (39:30) The Story Ends  Credits: This episode was produced by Joel Werner and Ekedi Fausther-Keeys, with help from Wendy Zukerman, along with Meryl Horn, Rose Rimler and Michelle Dang. We're edited by Blythe Terrell. Mix and sound design by Sam Bair. Fact checking by Diane Kelly. Music written by So Wylie, Bobby Lord and Bumi Hidaka. Thanks to Roland Campos, Steve Wampler, Audrey Williams, the audiochuck team, Jasmine Kingston, Connor Sampson, Stupid Old Studios, and Penny Greenhalgh. Special thanks to the LA times staff whose very thorough reporting we used to research this episode.  Science Vs is a Spotify Studios Original. Listen for free on Spotify or wherever you get your podcasts. Follow us and tap the bell for episode notifications.  Learn more about your ad choices. Visit podcastchoices.com/adchoices

Let's hear it for the pharmacists who make every emergency medicine shift easier and safer. EMRA*Cast host Dustin Slagle, MD, picks up some pearls from Mike Perza, PharmD, BCPS.

According to the American Association of Nurse Anesthesiology (AANA), approximately 65% of over 50 million anesthesia services in the United States are delivered by certified registered nurse anesthetists (CRNAs) each year, whether in collaboration with a physician or independently. In many rural and underserved areas in America, this percentage is significantly higher at over 90%. Despite this, the profession is still regarded as a “hidden gem” within the nursing domain, given that the general public and patients may not be fully knowledgeable about their scope and even their existence at all. Dating back to the American Civil War in the early 1860s, nurses have been providing anesthetics to wounded soldiers on the battlefield. Now, nurse anesthetists administer both surgical and procedural relief in and out of operating rooms across over 100 countries worldwide. How does the scope of practice of nurse anesthetists differ from physician anesthesiologists? What does the educational and training pathway of CRNAs look like? In what settings and specialties can CRNAs deliver anesthesia?In this episode, we are joined by the co-founders of Confident Care Academy, a comprehensive online educational resource that seeks to empower critical care nurses, nursing students, nurse educators, and future CRNAs through lecture video series and discussion boards. Chrissy Massaro is a Certified Registered Nurse Anesthetist of five years, rooting her near-decade nursing career in the Cardiovascular ICU at the Hospital of the University of Pennsylvania, where she later received her MSN in Nurse Anesthesia. Anna Jobe is a current Resident Registered Nurse Anesthetist with three years of ICU nursing, ranging from Cardiovascular ICU at The Johns Hopkins University Hospital, COVID-19 ECMO units, and travel nursing around the country in both medical and surgical intensive care units.Livestream Air Date: June 30, 2023Follow Christina Massaro, MSN, CRNA: InstagramFollow Anna Jobe, BSN, RRNA: InstagramFollow Friends of Franz Podcast: Website, Instagram, FacebookFollow Christian Franz Bulacan (Host): Instagram, YouTubeThankful to the season's brand partners: Covry, House of M Beauty, Nguyen Coffee Supply, V Coterie, Skin By Anthos, Halmi, By Dr Mom, LOUPN, Baisun Candle Co., RĒJINS, Twrl Milk Tea, 1587 Sneakers

This classic episode of “48 Hours" explores the death of 50-year-old Kathy Augustine, a career politician from Nevada. Questions arose about the cause of her death after police received a tip from her husband's co-worker that she may have been poisoned, and toxicology reports further confirmed the presence of the powerful paralytic drug Succinylcholine. "48 Hours" correspondent Troy Roberts reports. This "48 Hours" episode last aired on 12/20/2008. Watch all-new episodes of “48 Hours” on Saturdays, and stream on demand on Paramount+.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Contributors: Kalen Abbott, MD - EM Physician and Medical Director for AirLife Denver Brendan Reiss - Flight Nurse AirLife Denver Matt Spoon - Flight Paramedic AirLife Denver Jordan Ourada - EMS Coordinator at Swedish Medical Center and Paramedic Summary: In this episode, hosted by Jordan Ourada, Brendan Reiss and Matt Spoon present a first-hand experience case of hydrofluoric acid exposure in a pediatric patient. Commentary and educational pearls are provided by EM Physician, Kalen Abbott. The case:  The patient was a male infant who had spilled a large amount of heavy-duty acid aluminum wheel cleaner on himself while playing in his parent's garage. Unclear if he had ingested any fluid. The cleaning fluid contained a large percentage of hydrofluoric acid. He was brought by EMS to his local hospital, who quickly decided to transport the infant by helicopter to a large Denver hospital. Initial labs were unremarkable and the EKG was normal. Heart rate was in the 140s. Blood pressure was 110/73. Respirations were around 30 and non-labored. Chest and abdominal x-rays were unremarkable. The patient had received a water-based decontamination and 1 gram of calcium gluconate IV. Complications: Immediately before leaving a nurse informed Brendan and Matt that the serum calcium was 6.8 mg/dl (normal range: 8.5 to 10.2). During the flight, the patient went into cardiac arrest. The patient achieved ROSC after CPR was administered in the helicopter. Once on the ground, an I/O line was started and calcium chloride, sodium bicarb, and normal saline were administered. Within the first 2 hours that patient received the equivalent of 310 mg/kg of calcium (the pediatric dose is 20 mg/kg) Care resolution: The patient ended up having a several-week stay in the pediatric ICU. There were some complications such as pulmonary hemorrhage. Calcium gluconate was continued via nebulization for several days. Ultimately, the child was weaned off the ventilator and spontaneous respirations resumed. They were able to wean the child off vasopressors and sedation over the course of several days. A gastric lavage with calcium gluconate was completed as well during the inpatient stay. The child was able to leave the hospital, neurologically intact after about 14 days.  Pearls: Lower concentrations of acids can be more dangerous because they don't immediately burn but rather can be absorbed systemically through the skin. Calcium is the antidote to hydrofluoric acid exposure. Calcium chloride has 3 times the elemental calcium as calcium gluconate. The maximum infusion rate of calcium chloride through a peripheral line is 1 gram every 10 minutes, calcium gluconate can be infused at 1 gram every 5 minutes. When intubating a patient with acid exposure, avoid succinylcholine because of the risk of hyperkalemia. References Caravati EM. Acute hydrofluoric acid exposure. Am J Emerg Med. 1988 Mar;6(2):143-50. doi: 10.1016/0735-6757(88)90053-8. PMID: 3281684. Pepe J, Colangelo L, Biamonte F, Sonato C, Danese VC, Cecchetti V, Occhiuto M, Piazzolla V, De Martino V, Ferrone F, Minisola S, Cipriani C. Diagnosis and management of hypocalcemia. Endocrine. 2020 Sep;69(3):485-495. doi: 10.1007/s12020-020-02324-2. Epub 2020 May 4. PMID: 32367335. Strayer RJ. Succinylcholine, rocuronium, and hyperkalemia. Am J Emerg Med. 2016 Aug;34(8):1705-6. doi: 10.1016/j.ajem.2016.05.039. Epub 2016 May 19. PMID: 27241569. Vallentin MF, Granfeldt A, Meilandt C, Povlsen AL, Sindberg B, Holmberg MJ, Iversen BN, Mærkedahl R, Mortensen LR, Nyboe R, Vandborg MP, Tarpgaard M, Runge C, Christiansen CF, Dissing TH, Terkelsen CJ, Christensen S, Kirkegaard H, Andersen LW. Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2021 Dec 14;326(22):2268-2276. doi: 10.1001/jama.2021.20929. PMID: 34847226; PMCID: PMC8634154. Summarized by Jeffrey Olson MS2 | Edited by Jeffrey Olson, Meg Joyce, & Jorge Chalit, OMSII  

Contributor: Aaron Lessen MD Educational Pearls: Why is airway management more difficult in obesity? Larger body habitus causes the chest to be above the head when the patient is lying supine, creating difficult angles for intubation. Reduced Functional Residual Capacity (FRC) causes these patients to deoxygenate much more quickly, reducing the amount of time during which the intubation can take place. What special considerations need to be made? Positioning. The auditory canal and sternal notch should be aligned in a horizontal plane. Do this by stacking blankets to lift the neck and head. Also, try to make the head itself parallel to the ceiling. Pre-oxygenation. Use Bi-level Positive Airway Pressure (BiPAP) with Positive End Expiratory Pressure (PEEP) or a Bag-Valve-Mask (BVM) with a PEEP valve. PEEP helps prevent alveoli from collapsing after every breath and improves oxygenation. Dosing of paralytics. Succinylcholine is dosed on total body weight so the dose will be much larger for the obese patient. Rocuronium is dosed on ideal body weight, but adjusted body weight may also be used in obese cases.  References De Jong A, Wrigge H, Hedenstierna G, Gattinoni L, Chiumello D, Frat JP, Ball L, Schetz M, Pickkers P, Jaber S. How to ventilate obese patients in the ICU. Intensive Care Med. 2020 Dec;46(12):2423-2435. doi: 10.1007/s00134-020-06286-x. Epub 2020 Oct 23. PMID: 33095284; PMCID: PMC7582031. Langeron O, Birenbaum A, Le Saché F, Raux M. Airway management in obese patient. Minerva Anestesiol. 2014 Mar;80(3):382-92. Epub 2013 Oct 14. PMID: 24122033. Sharma S, Arora L. Anesthesia for the Morbidly Obese Patient. Anesthesiol Clin. 2020 Mar;38(1):197-212. doi: 10.1016/j.anclin.2019.10.008. Epub 2020 Jan 2. PMID: 32008653. Singer BD, Corbridge TC. Basic invasive mechanical ventilation. South Med J. 2009 Dec;102(12):1238-45. doi: 10.1097/SMJ.0b013e3181bfac4f. PMID: 20016432. Summarized by Jeffrey Olson, MS2 | Edited by Jorge Chalit, OMSII  

In Part Two of this "Mini Grand Rounds" series, let's look at the 1 mg/kg dosing of roc. Could it be optimized? Click HERE to leave a review of the podcast!Follow HERE!References:All references for Episode 85 are found on my Read by QxMD collectionDisclaimer: The information contained within the  ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution,  seek medical advice from a licensed physician, and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of,  any medical institutions, educational facilities, or other healthcare programs.Support the show

Sometimes I think study sux

Guidance on Essentially a Copy for 503B Outsourcing FacilitiesLearning Objectives1.   Describe the decision tree to evaluate if a compounded preparation is essentially a copy.2.   Identify, when given a preparation, if the drug shortage exclusion applies.3.   Recognize, when given a preparation, if the Clinical Need exclusion applies.CE accredited for Pharmacists and Technicians. To get credits for this talk go https://compoundingce.com/courses/pharmasalon-guidance-on-essentially-a-copy-for-503b-outsourcing-facilities-evaluation/To watch the accompanying slides go to: https://youtu.be/XYK4OtB3MAsSelf-Assessment Questions  1. Your facility compounds a succinylcholine 20 mg/ml syringe both from API powder and sterile sourced vials. Succinylcholine is not on the FDA drug shortage list.a. The syringes made from either source are essentially a copy of the commercial product.b. The syringes made from both sources are essentially a copy of the commercial product.c. The syringes made from API powder are essentially a copy of the commercial product.d. The syringes made from sterile sourced vials are essentially a copy of the commercial product.2. An outsourcing facility compounds morphine 1 mg/ml syringes from API powder. These are available commercially in the same presentation.  However, morphine is currently on the drug shortage list and the syringes are on backorder.a. The syringes are not essentially a copy of the commercial product at this time.b. The syringes are always essentially a copy of the commercial product regardless of the drug shortage list.c. The syringes are not essentially a copy as long as there is a clinical need for Morphine.d. Morphine is a controlled substance and therefore must not be sourced from API.3. An outsourcing facility compounds preservative free rocuronium from API powder.  Rocuronium is available in preservative free form commercially and is not on drug shortage.  The facility asks you to check a box on its website stating that there is a clinical need for this product.a. The product can be sourced commercially and hence there is no clinical need for the outsourced product.b. The product is only available in vials, hence there is a clinical need for the product in syringes.c. It is the responsibility of the outsourcing facility to determine clinical need, so if they state there is a clinical need, it is okay to check the box.d. The box can only be checked by an OR physician.#compoundingpharmacy #compoundingpharmacists #compoundingpharmacies #pharmacists #pharmacytechnicians #pharmacytechniciansCE #pharmasalon#ACPE #pharmacyCEcredits #PharmacyCE #503b #essentialcopiesSupport the show (https://www.buymeacoffee.com/pharmasalon)

Neuromuscular Blockade: - Facilitates intubation - Facilitates better surgical conditions - Facilitates mechanical ventilation (i.e. ARDS, hyperventilating in increased ICP) Two Categories: - Depolarizing: ex. Succinylcholine (1-1.5mg/kg IV) depolarizes the muscle and prevents repolarization. - Non-depolarizing: ex. Rocuronium (0.6-1.2mg/kg IV) Outcompetes ACh for the receptor on the endplate. Big thanks to Suzanne George MD 2022 Candidate from the University of Calgary for editing the episode script! References: 1. Butterworth J, Mackey D, Wasnick J. Morgan & Mikhail's Clinical Anesthesiology. 5th ed. McGraw-Hill Education; 2013. 2. https://www.openanesthesia.org/aba_phase_ii_depolarizing_blockade/ 3. Zhang Z, Guo Q, Wang E. Hyperventilation in neurological patients: from physiology to outcome evidence. Curr Opin Anaesthesiol. 2019;32(5):568-573. doi:10.1097/ACO.0000000000000764

Show notes at pharmacyjoe.com/episode577. In this episode, I ll compare succinylcholine vs rocuronium with magnesium pretreatment. The post 577: Succinylcholine vs rocuronium with magnesium pretreatment appeared first on Pharmacy Joe.

Join the Med4 podcast and Shock Trauma Physician Dr. Galvagno while he reviews current medical literature. Listen as he comments on the Effect of Rocuronium vs Succinylcholine on Endotracheal Intubation Success Rate Among Patients Undergoing Out-of-Hospital Rapid Sequence Intubation A Randomized Clinical Trial.

This bish... she jokingly referred to herself as Nurse Death. From around 1981-1982, patients under her care seemed to suffer inexplicably from seizures, distressed respiration, cardiac arrest, and death at a rate previously unseen in the small Texas town of Kerrville. The worst part? They were all BABIES. Anywhere from 9-60 infants died under her "care," the exact number unknown because 9,000 lbs of evidence was destroyed by hospital officials.Post note: Succinylcholine is also known as Anectine. It is used as a rapid anesthetic that leads to apnea (absence of breathing), adverse affects can include cardiac arrest, among other things.Info sourced:https://www.google.com/amp/s/www.texasmonthly.com/articles/the-death-shift-2/amp/https://www.kens5.com/mobile/article/syndication/vile-podcast/nobody-reported-the-cases-former-bexar-medical-examiner-speaks-on-jones-case/273-526608583?fbclid=IwAR1lALTo8zCO_7iI1D_wILrYHX32tN5JCHL7luKW-FnAca-70saGXoH4HbQKiller Nurse: Life of Serial Killer Genene Jones by Jack Smithhttps://www.rxlist.com/anectine-drug.htm#side_effectsDocuseries Nurses Who Kill Support the show (https://www.patreon.com/Killerlocalepodcast)

This episode on succinylcholine will unravel the mysteries and controversies around the medication – from it’s molecular shape and how that influences which receptors subtypes and locations it exerts its effects on to practical information on dosing and how to optimize airway management while mitigating the side effects of succinylcholine.  At the time of this […]

Free quiz & full course at https://Simplenursing.com/nursing-school  Pharmacology Master Class - 100 videos not on YouTube - Try it for Free!    Pharmacology Master Class - Try it for Free: https://Simplenursing.com/nursing-school  100 videos not on YouTube    FREE Access to new app + 1,000 videos not on youtube!  https://Simplenursing.com/nursing-school   NCLEX FREE TRIAL:  https://simplenursing.com/NCLEX   STAY IN TOUCH

This is the first episode of SEASON 3 - where we'll be discussing FEMALE KILLERS! Genene Anne Jones is an American serial killer who is currently serving her prison sentence in Texas. In 1985, she was sentenced to 99 years in prison for killing a 15-month-old baby girl with Succinylcholine and an additional 60 years (to be served concurrently) for almost killing a 4-week-old with an overdose of Heparin. As of 2020, there have been developments in this case.Check out our website: https://www.naturevsnarcissism.com to find sources, merch, and much more!Thank you @mackorslash from the @hackorslash podcast for this suggestion!

Succinylcholine

8 spannende Studien haben wir dieses Mal für Euch, hört rein ! Duff, Jonathan P., et al. „2019 American Heart Association Focused Update on Pediatric Advanced Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.“ Circulation 140.24 (2019): e904-e914. Guihard, Bertrand, et al. „Effect of Rocuronium vs Succinylcholine on Endotracheal Intubation Success […] Der Beitrag "titriert" Journal Club Januar 2020 erschien zuerst auf pin-up-docs - don't panic.

We discuss everything you need to know about Succinylcholine and Rocuronium, both our two must trusted NMBAs for RSI in the ED. We discuss why we use paralytics the majority of the time, side effects, differences in practice, and classic board-relevant side toxicity. Website: www.emboardbombs.com

In this 139th episode I welcome Dr. Gillian Isaac back to the show to discuss another 2 ABA keywords, succinylcholine and interscalene brachial plexus block.

We investigate the claim that mask ventilation should be "checked" or "confirmed" before administering paralytics.  My guest is Dr. Daniel Saddawi-Konefka, program director of the Anesthesia Residency Program at Massachusetts General Hospital.  Full show notes available at depthofanesthesia.com.  Connect with us @DepthAnesthesia on Twitter or depthofanesthesia@gmail.com. Thanks for listening! Please rate us on iTunes and share with your colleagues.  Music by Stephen Campbell, MD.  -- References Chingmuh Lee, Jonathan S. Jahr, Keith A. Candiotti, Brian Warriner, Mark H. Zornow, Mohamed Naguib; Reversal of Profound Neuromuscular Block by Sugammadex Administered Three Minutes after Rocuronium: A Comparison with Spontaneous Recovery from Succinylcholine. Anesthesiology 2009;110(5):1020-1025. doi: 10.1097/ALN.0b013e31819dabb0. Drummond GB, Park GR. Arterial oxygen saturation before intubation of the trachea. An assessment of oxygenation techniques. Br J Anaesth 1984; 56:987. Benjamin J. Dixon, John B. Dixon, Jennifer R. Carden, Anthony J. Burn, Linda M. Schachter, Julie M. Playfair, Cheryl P. Laurie, Paul E. O’Brien; Preoxygenation Is More Effective in the 25° Head-up Position Than in the Supine Position in Severely Obese Patients: A Randomized Controlled Study. Anesthesiology 2005;102(6):1110-1115. Jense HG, Dubin SA, Silverstein PI, O’Leary-Escolas U. Effect of obesity on duration of apnea in anesthetized humans. Anesth Analg 1991; 72: 89–93. Min, Se-Hee & Im, Hyunjae & Rim Kim, Bo & Yoon, Susie & Bahk, Jae-Hyon & Seo, Jeong-Hwa. (2019). Randomized Trial Comparing Early and Late Administration of Rocuronium Before and After Checking Mask Ventilation in Patients With Normal Airways. Anesthesia & Analgesia. 1. 10.1213/ANE.0000000000004060. R. Sirian, Jonathan Wills, Physiology of apnoea and the benefits of preoxygenation, Continuing Education in Anaesthesia Critical Care & Pain, Volume 9, Issue 4, August 2009, Pages 105–108, https://doi.org/10.1093/bjaceaccp/mkp018 Roland Amathieu, Xavier Combes, Widad Abdi, Loutfi El Housseini, Ahmed Rezzoug, Andrei Dinca, Velislav Slavov, Sébastien Bloc, Gilles Dhonneur; An Algorithm for Difficult Airway Management, Modified for Modern Optical Devices (Airtraq Laryngoscope; LMA CTrach  ™): A 2-Year Prospective Validation in Patients for Elective Abdominal, Gynecologic, and Thyroid Surgery. Anesthesiology 2011;114(1):25-33. doi: 10.1097/ALN.0b013e318201c44f. Sachin Kheterpal, Richard Han, Kevin K. Tremper, Amy Shanks, Alan R. Tait, Michael O’Reilly, Thomas A. Ludwig; Incidence and Predictors of Difficult and Impossible Mask Ventilation. Anesthesiology 2006;105(5):885-891. Sachdeva R Kannan TR Mendonca C Patteril M. Evaluation of changes in tidal volume during mask ventilation following administration of neuromuscular blocking drugs. Anaesthesia  2014; 69: 826–31

Educational Pearls: RSI includes induction agent (sedative) and a paralytic Succinylcholine is a depolarizing paralytic of rapid onset and short duration with contraindications in hyperkalemic states and muscular dystrophy Rocuronium and vecuronium are longer acting, non-depolarizing paralytic, more commonly Common induction agents are etomidate and ketamine Ketamine can be particularly beneficial for bronchodilator effects in those with reactive airway disease References:   Stollings JL, Diedrich DA, Oyen LJ, Brown DR. Rapid-sequence intubation: a review of the process and considerations when choosing medications. Ann Pharmacother. 2014 Jan;48(1):62-76. doi: 10.1177/1060028013510488. Epub 2013 Nov 4. Review. PubMed PMID: 24259635. Summary by Travis Barlock, MS4  | Edited by Erik Verzemnieks, MD

Will Sugammadex spell the end of Succinylcholine (Aug 2017) by Oregon 1-800-222-1222

Using a case-based approach, Dr. Calvin Brown III and guest presenter, Dr. Brian Driver, introduce the latest published airway research and discuss its impact on clinical practice.

In this episode, I had the privilege of chatting with Michael Mielniczek, BSN, SRNA on an overview of succinylcholine. At the time of this recording, Michael was a second year Student Registered Nurse Anesthetist at the University of Scranton and … #39 – Succinylcholine Overview – Michael Mielniczek, BSN, SRNA Read More »

For those of you still practicing anesthesiology, I thought this brief review may be useful. Subscribe to our mailing list * indicates required Email Address *     For the Full Version, Subscribe to our Premium Subscription via our App, or Download the Full Lecture Library at PainExam.com  PainExam Podcast For Board Review and Practice Management Updates TEXT the word  PAINEXAM to the number 33444  Download our iphone App! Download our Android App! For more information on Pain Management Topics and keywords Go to PainExam.com David Rosenblum, MD specializes in Pain Management and is the Director of Pain Management at Maimonides Medical Center and AABP Pain Managment For evaluation and treatment of a Painful Disorder, go to www.AABPPain.com 718 436 7246 DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment.  You should regularly consult a physician in matters relating to yours or another's health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional.    Copyright © 2017 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.

Today’s shorty discusses which paralytic is preferable to use for RSI? The debate has been going on in emergency medicine and anesthesia for quite some time, and the conclusion tends to boil down to provider preference. Today’s article is “Update: Does Rocuronium Create Better Intubating Conditions Than succinylcholine for Rapid Sequence Intubation?” from the May 2017 Annals of Emergency Medicine by Julie Welch ... Read More The post MSM Shorty- Rocouronium vs. Succinylcholine appeared first on Medschoolmedic.

Hey babies! It's the 9th episode! Wow. In today's discussion, Chris talks about Peter Thomas, the late voice actor and narrator of Forensic Files. Also discussed: meeting Sinbad, female traffic lights, and bad commercials where people laugh whimsically. Chris also makes a pitch to Tide Detergent to let him write, direct, and star in a commercial. Tweet your questions and spread the love using the hashtag #congratulationspod on Twitter and everywhere else.

Author: Peter Bakes Educational Pearls: The Neuromuscular Junction (NMJ) is a neuronal synapse in skeletal muscle mediated by nicotinic acetylcholine receptors. Paralytic agents, commonly used in the ED for intubation, include succinylcholine and rocuronium/vecuronium. Succinylcholine is a depolarizing paralytic while rocuronium is a non-depolarizing agent. A newly developed reversing agent, sugammadex, can be used to counter the effects of curonium based paralytics.  This is especially helpful due to the long duration of action of rocuronium (45 minutes to 1 hour) as compared to succinylcholine (

Episode #2 A knowledge pearl episode with a short case seen during intern year of residency. These three clinical entities all share a common theme; they develop quickly and need definitive management within minutes.    Fentanyl rigid chest syndrome: chest wall/abdominal/masseter rigidity following the administration of fentanyl. More commonly seen with doses >4mcg/kg but can be with ANY dose.  Risk factors: higher doses, fast push rate, extremities of age, critical illness and use of medications that alter dopamine levels. Treatment: Double check your mask seal. Recognize what is going on. Give naloxone. If still unable to ventilate- paralyze with Succinylcholine.    Succinylcholine masseter muscle rigidity (MMR): whereas mild masseter rigidity and jaw stiffness is common up to a minute after giving succinylcholine, MMR presents with severe prolonged jaw stiffness after giving sux. Some of these patients will progress to outright malignant hyperthermia (MH) and management should proceed accordingly.  Risk factors: inadequate dosing of sux (55 mmHg is bad), urine, cpk, abg. Give dantrolene 2.5mg/kg if MH.    Ketamine Induced Laryngospasm: laryngospasm seen after giving ketamine. Results in difficult ventilation. Can often be managed with CPAP or positive pressure ventilation using a BVM.  Risk factors: children

This podcast is a recorded lecture from our conference on why Rocuronium should be the go to drug for RSI in the ED. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_31_0_Final_Cut.m4a Download 2 Comments Tags: Airway, Rocuronium, RSI, Succinycholine Show Notes Sydney HEMS Sux Contraindications Read More: Strayer RJ. Rocuronium versus succinylcholine: Cochrane synopsis reconsidered. Ann Emerg Med 2011; 58(2): 217-8 Strayer RJ. Rocuronium vs. succinylcholine revisited. Ann Emerge Med 2010; 39(3): 345-6. Mallon WK et al. Response to Rocuronium vs. succinylcholine revisited. Ann Emerge Med 2010; 39(3): 346-7. Strayer RJ. (2010, January 14). Screencast: Rocuronium vs. Succinylcholine in 8 minutes. Retrieved from http://emupdates.com/2010/01/14/rocuronium-vs-succinylcholine/

This podcast is a recorded lecture from our conference on why Rocuronium should be the go to drug for RSI in the ED. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_31_0_Final_Cut.m4a Download 2 Comments Tags: Airway, Rocuronium, RSI, Succinycholine Show Notes Sydney HEMS Sux Contraindications Read More: Strayer RJ. Rocuronium versus succinylcholine: Cochrane synopsis reconsidered. Ann Emerg Med 2011; 58(2): 217-8 Strayer RJ. Rocuronium vs. succinylcholine revisited. Ann Emerge Med 2010; 39(3): 345-6. Mallon WK et al. Response to Rocuronium vs. succinylcholine revisited. Ann Emerge Med 2010; 39(3): 346-7. Strayer RJ. (2010, January 14). Screencast: Rocuronium vs. Succinylcholine in 8 minutes. Retrieved from http://emupdates.com/2010/01/14/rocuronium-vs-succinylcholine/...

This podcast is a recorded lecture from our conference on why Rocuronium should be the go to drug for RSI in the ED. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_31_0_Final_Cut.m4a Download 2 Comments Tags: Airway, Rocuronium, RSI, Succinycholine Show Notes Sydney HEMS Sux Contraindications Read More: Strayer RJ. Rocuronium versus succinylcholine: Cochrane synopsis reconsidered. Ann Emerg Med 2011; 58(2): 217-8 Strayer RJ. Rocuronium vs. succinylcholine revisited. Ann Emerge Med 2010; 39(3): 345-6. Mallon WK et al. Response to Rocuronium vs. succinylcholine revisited. Ann Emerge Med 2010; 39(3): 346-7. Strayer RJ. (2010, January 14). Screencast: Rocuronium vs. Succinylcholine in 8 minutes. Retrieved from http://emupdates.com/2010/01/14/rocuronium-vs-succinylcholine/ References Sluga M,

Pediatric airway management is a skill that integrates the three types of knowledge as described by the ancient Greeks: episteme, or theoretical knowledge, techne, or technical knowledge, and phronesis, or practical wisdom, also called prudence. Here we’ll invoke each type of knowledge and understanding as we go beyond the anatomical issues in pediatric airway management – to the advanced decision-making aspect of RSI and the what-to-do-when the rubber-hits-the road. Case 1: Sepsis Laura is a 2-month-old baby girl born at 32 weeks gestational age who today has been “breathing fast” per mother.  On arrival she is in severe respiratory distress with nasal flaring and intercostal retractions.   Her heart rate is 160, RR 50, oxygen saturation is 88% on RA.  She has fine tissue-paper like rales throughout her lung fields.  Despite a trial of a bronchodilator, supplemental oxygen, even nasal CPAP and fluids, she becomes less responsive and her heart rate begins to drop relatively in the 80s to 90s – this is not a sign of improvement, but of impending cardiovascular collapse. She is in respiratory failure from bronchiolitis and likely viral sepsis.  She needs her airway taken over. Is this child stable enough for intubation? We have a few minutes to optimize, to resuscitate before we intubate. Here’s an easy tip: use the sterile flushes in your IV cart and push in 20, 40, or 60 mL/kg NS.  Just keep track of the number of syringes you use – it is the fastest way to get a meaningful bolus in a small child. Alternatively, if you put a 3-way stop-cock in the IV line and attach a 30 mL syringe, you can turn the stop cock, draw up stream from the IV bag into the syringe, turn te stop cock, and push the fluid in the IV. Induction Agent in Sepsis The consensus recommendation for the induction agent of choice for sepsis in children is ketamine. Etomidate is perfectly acceptable, but ketamine is actually a superior drug to etomidate in the rapid sequence intubation of children in septic shock.  It rapidly provides sedation and analgesia, and supports hemodynamic stability by blocking the reuptake of catecholamines. Paralytic Agent in Sepsis The succinylcholine versus rocuronium debate… Succinylcholine and its PROS 82% of RSI in the ED used succinylcholine (According to the National Emergency Airway Registry, in 2005).  We know it, we are comfortable with it. Succinylcholine produces superior intubating conditions when comparing 1 mg/kg succinylcholine versus 0.6 mg/kg rocuronium, succinylcholine is that at 45 seconds. Succinylcholine and its CONs Raises serum potassium in everyone, typically 0.5 to 1 mEq/L.  That is not usually a problem, but for those with preexisting or inducible hyperkalemia, it can precipitate an arrest, as in renal failure, underlying neurologic or myopathic conditions like multiple sclerosis, muscular dystrophy, ALS, or those who had a stroke or a burn more than 72 hours prior. We often have limited information in critical situations. Succinylcholine gives us a false sense of security.  In children, there really is no “safe apnea” period. Succinylcholine’s effect on the nicotinic receptors results in mydriasis, tachycardia, weakness, twitching and hypertension, and fasciculations (Think nicotine overdose: M/T/W/Th/F). Succinylcholine’s effect on muscarinic receptors manifest (as in organophosphate overdose): SLUDGE – salivation, lacrimation, urination, defecation, GI upset or more apropos here: DUMBBELLS – diarrhea, urination, miosis, bradycardia, emesis, lacrimation, lethargy, salivation. Second dose of succinylcholine – beware of the muscarinic effects and bradycardia. Co-administer atropine, 0.01 mg/kg, up to 0.5 mg IV. Coda: succinylcholine is not that bad – we would not have had such great success with it during the early years of our specialty if it were such a terrible drug.  The side effects are rare, but they can be deadly.  So, what’s the alternative? Rocuronium and its PROs It has none of the side-effects of succinylcholine Rocuronium and its CONs Argument 1: the duration is too long if there is a difficult airway, since rocuronium can last over an hour. Still need to intubate, and now your patient is potentially worse. Argument 2: succinylcholine produces better intubating conditions at 45 seconds compared to rocuronium. At 0.6 mg/kg, rocuronium is inferior to succinylcholine at all time intervals. At 1.0 mg/kg, rocuronium is still inferior at 45 seconds.  At 1.2 mg/kg rocuronium – the dose now commonly recommended – there was no difference in intubating conditions, per a study by Heier et al. in Anethesia and Analgesia in 2000. Case 2: Multitrauma Joseph is a 3-year-old boy who is excited that there are so many guests at his house for a family party and when it’s starting to wind down and the guests begin to leave, he is unaccounted for. An unsuspecting driver of a mini-van backs over him. He is brought in by paramedics, who are now bagging him. Induction Agent in Trauma Need something that is hemodynamically stable – agents such as midazolam or propofol would cause too many problems. Etomidate is a short-acting imidazole derivative that acts on GABA-A receptors to induce loss of consciousness in 5-15 seconds. It can cause apnea, pain on injection, and myoclonus. Etomidate reduces cerebral blood flow, reduces intracranial pressure, and reduces cerebral oxygen consumption, all while maintaining arterial blood pressure and cerebral perfusion pressure. Ketamine is reasonable as well: there is no contraindication to ketamine except for known hydrocephalus. It is safe in head trauma. It is a good choice for the hypotensive trauma patient.  TBI is not a contraindication. In the case of the critically injured child who is normotensive, ketamine will raise his blood pressure and perhaps foster further bleeding.  The goal is a good general perfusion and a balanced resuscitation, ensuring enough cerebral perfusion without disrupting nascent clots.  On the other side of the spectrum, permissive hypotension is not described in children, as hypotension is a late and dangerous sign of shock. Paralytic Agent in Trauma Are your surgeons in an uproar about a long-acting agent and the pupillary response?  Relax, it’s a myth. Caro et al in Annals in 2011 reported that the majority of patients undergoing RSI preserved their pupillary response.  Succinylcholine actually performed worse than rocuronium. In the rocuronium group, all patients preserved their pupillary response. In the critically ill, we rethink your dosing of both the sedative and the paralytic. In a critically ill child or adult, perfusion suffers and it affects how we administer medications.  The patient’s arm-brain time or vein-to-brain time is less efficient; additionally, as the patient’s hemodynamic status softens, he becomes very sensitive to the effects of sedatives. We need to adjust our dosing for a critically ill patient: Decrease the sedative to avoid falling over the hemodynamic compensation cliff. Increase the paralytic to account for prolonged arm-brain time. Case 3: Cardiac/myocarditis/congenital heart disease Jacob is a 6-year-old-boy with tricuspid atresia s/p Fontan procedure who’s had one week of runny nose, cough, and now 2 days of high fever, vomiting, and difficulty breathing. The Fontan procedure is the last in a series of three palliative procedures in a child with complex cyanotic congenital heart disease with a single-ventricle physiology. The procedure reroutes venous blood to flow passively into the pulmonary arteries, because the right ventricle has been surgically repurposed to be the systemic pump.  The other most common defect with an indication for a Fontan is hypoplastic left heart syndrome. Typical “normal” saturations are 75 and 85% on RA.  Ask the parents or caregiver. Complications of the Fontan procedure include heart failure, superior vena cava syndrome, and hypercoagulable state, and others. A patient with a Fontan can present in cardiogenic shock from heart failure, distributive shock from an increased risk of infection, hypovolemic shock from over-diuresis or insensible fluid loss – or just a functional hypovolemia from the fact that his venous return is all passive – and finally obstructive shock due to a pulmonary thromboembolism. Types of shock mnemonic: this is how people COHDe – Cardiogenic, Obstructive, Hypovolemic, Distributive. Do we give fluids? Children after palliative surgery for cyanotic heart disease are volume-dependent.  Even if there is a component of cardiogenic shock, they need volume to drive their circuit.  Give a test dose of 10 mL/kg NS. Pressors in Pediatric Shock Children compensate their shock state early by increasing their SVR. Epinephrine (adrenaline) is great at increasing the cardiac output (with minimal increase in systemic vascular resistance; tachycardia)  In children the cardiac deleterious effects are not pronounced as in adults.  Later when the child is stabilized, other medication such as milrinone (ionotrope and venodilator) can be used. Epinephrine is also fantastic for cold shock when the patient is clamped down with cold extremities – the most common presentation in pediatric septic shock. Norepinephrine (noradrenaline) is best used when you need to augment systemic vascular resistance, such as in warm shock, where the patient has loss of peripheral vascular tone. Induction Agent in Cardiogenic Shock A blue baby – with a R –> L shunt – needs some pinking up with ketamine A pink baby – with a L –> R shunt – is already doing ok – don’t rock the boat – give a neutral agent like etomidate. Myocarditis or other acquired causes of cardiogenic shock – etomidate. Case 4: Status Epilepticus Jessica is a 10-year-old girl with Lennox-Gastaut syndrome who arrives to your ED in status epilepticus. She had been reasonably controlled on valproic acid, clonazepam, and a ketogenic diet, but yesterday she went to a birthday party, got into some cake, and has had stomach aches – she’s been refusing to take her medications today. On arrival, she is hypoventilating, with HR 130s, BP 140/70, SPO2 92% on face mask. She now becomes apneic. Induction Agent in Status Epilepticus Many choices, but we can use the properties of a given agent to our advantage. She is normo-to-hypertensive and tachycardic. She has been vomiting. A nice choice here would be propofol. Propofol as both a sedative and anti-epileptic agent works primarily on GABA-A and endocannabinoid receptors to provide a brief, but deep hypnotic sedation.  Side effects can include hypotension, which is often transient and resolves without treatment.  Apnea is the most common side-effect. Ketamine would be another good choice here, for its anti-epileptic activity. Paralytic Agent in Status Epilepticus Rocuronium (in general), as there are concerns of a neurologic comorbidity. Housekeeping in RSI What size catheter doe I use?  If you know your ETT size, then it is just a matter of multiplication by 2, 3, 4, or 5. Remember this: 2, 3, 4 – Tube, Tape, Tap The NG/OG/Foley is 2 x the ETT – tube The ETT should be taped at a depth of 3 x the ETT size – tape A chest tube size 4 x the ETT – tap In summary, in these cases of sepsis, multitrauma, cardiogenic shock, and status epilepticus: Resuscitate before you intubate Use the agent’s specific properties and talents to your benefit Adjust the dose in critically ill patients: decrease the sedative, increase the paralytic Have post-intubation care ready: sedation, verification, NG/OG/foley

Estimate of the Relative Risk of Succinylcholine for Triggering Malignant Hyperthermia