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With rocuronium your status patient could be cooking their neurons for half an hour or more while you are blissfully unaware, high-fiving each other for another amazingly successful intubation. Please tell us that succinylcholine is the correct paralytic, just this once. Then you can go back to hating it all you want. Thanks!
I was going to make the same comment - my practice is to scour the chart and history for contraindications to succinylcholine, and if I find none, then use it. I work in a hospital in which we have EEG in neither the ED nor the ICU, so I worry about ongoing seizure activity that I'm unable to detect for the duration of paralysis.
Excellent points Richard and Ben. We'll discuss in a later episode as well. Thanks for bringing this up
Sorry gents. Benzo, Benzo, PHENOBARBITAL children or adults. When I absolutely positively want you to stop seizing NOW. A loading dose of barbiturates! 20 mg/kg!
Benzo, Benzo, Keppra (being made as soon as a status patients presents to ED, no reason to wait as you'll be loading them up anyways), propofol and intubate. Phenobarbital might take time to come from pharmacy -> UNLESS you have an ED satellite pharmacy or ED pharmD has it readily available. Phenobarbital is a great option, but has operational barriers. Otherwise, I would go benzo, bezno, Keppra/Phenobarb, propofol and intubate. Patient already on keppra outpatient? order it anyways but think Phenobarb or Ketamine on step 3.
How long does this treatment midazolam by 2 then propofol rocuronium take to stop the status .
What you do matters.