Question about drugs used

[DancingFajitas]

I had a question regarding what drugs anesthesiologists use in these situations:

1-when someone has to be emergently intubated, like in the ER or on the floor or during a code
2-when you need to cardiovert someone

thanks!

 

[smq123]

I had a question regarding what drugs anesthesiologists use in these situations:

1-when someone has to be emergently intubated, like in the ER or on the floor or during a code
2-when you need to cardiovert someone

thanks!

During a code, aren't patients generally unresponsive? And therefore there is no need for paralytics? 😕

 

[thegasman]

For an intubation, assuming drugs need to be given, usually a sedative-hypnotic (propofol or etomidate) with a neuromuscular blocker (succinylcholine or rocuronium for example) are given. I'm not sure what you mean by cardioversion, we sometimes sedate patients with a little midazolam and fentanyl or propofol for the cardiologists. We also sometimes cardiovert patients ourselves in the or with a variety of drugs (or electricity) for different reasons. These are just a few simple examples, there are many drugs/combos that could be chosen.

 

[Bertelman]

During a code, aren't patients generally unresponsive? And therefore there is no need for paralytics? 😕

Not always. Some are true codes, i.e. asystole, PEA, chest compressions. Some are soft codes, like resp. distress, or pt. obtunded but not completely unresponsive. I've been to codes where we didn't need to give anything, and I've been to codes when we gave half-doses.

 

[LongSnow]

I used to do alot of anesthesia for cardioversions - oddly enough we did them on our regional rotation, mostly because the block room was a good place to do them in the early afternoon. But I would usually just give 1 mg/kg propofol. That would usually keep them breathing, the patient would react just a little bit to the cardioversion, and wake up nice and quick. But, of course, many different ways to do this. For a TEE, same way, but add a diprivan infusion 50-100 mcg/kg/min.

 

[Licoricestick]

I had a question regarding what drugs anesthesiologists use in these situations:

1-when someone has to be emergently intubated, like in the ER or on the floor or during a code
2-when you need to cardiovert someone

thanks!

Go do an anaesthetic rotation - cause the list is a mile long! Just off the top of my head, I have used (or seen others use) the following drugs for emergency intubation - either to achieve an aim or deal with other issues at the time

oxygen
fluids
Propofol
Thiopentone
Ketamine
Midazolam
Fentanyl
Morphine
Sevoflurane
Suxamethonium
Rocuronium
Vecuronium
Lignocaine
beta-blockers
ephedrine
metaraminol
adrenaline
atropine
glycopyrrolate

No one can possibly go through all the stuff that dictates our choice in the individual patient on a forum like this - but there is a lot of physiology and pharmacology behind individual drug choice and a lot of personal preference/availability/what your boss says to use type issues also.