![]() Succinylcholine produces superior intubating conditions when comparing 1 mg/kg succinylcholine versus 0.6 mg/kg rocuronium, succinylcholine is that at 45 seconds.82% of RSI in the ED used succinylcholine (According to the National Emergency Airway Registry, in 2005).The succinylcholine versus rocuronium debate… It rapidly provides sedation and analgesia, and supports hemodynamic stability by blocking the reuptake of catecholamines. The consensus recommendation for the induction agent of choice for sepsis in children is ketamine.Įtomidate is perfectly acceptable, but ketamine is actually a superior drug to etomidate in the rapid sequence intubation of children in septic shock. Just keep track of the number of syringes you use – it is the fastest way to get a meaningful bolus in a small child.Īlternatively, 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. Here’s an easy tip: use the sterile flushes in your IV cart and push in 20, 40, or 60 mL/kg NS. We have a few minutes to optimize, to resuscitate before we intubate. Is this child stable enough for intubation? She is in respiratory failure from bronchiolitis and likely viral sepsis. 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 has fine tissue-paper like rales throughout her lung fields. Her heart rate is 160, RR 50, oxygen saturation is 88% on RA. On arrival she is in severe respiratory distress with nasal flaring and intercostal retractions. Laura is a 2-month-old baby girl born at 32 weeks gestational age who today has been “breathing fast” per mother. 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. Tim Horeczko on twitter airway management is a skill that integrates the three types of knowledge as described by the ancient Greeks: Episteme - theoretical knowledge Techne - technical knowledge Phronesis - practical wisdom - also called prudence. ![]() ![]() Originally published at Pediatric Emergency Playbook on November 1,Ģ015 – Visit to listen to accompanying podcast. Reposted with permission.įollow Dr. ![]()
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