Sedation Slang

[Dr.Evil1]

Hey all,

Looking for some good slang for a presentation that I am putting together on pharmocological treatment for the acutely agitated ED patient. I am using the ACEP clinical policy guideline as a jumping off point for my presentation. I am looking for some good slang for drug combinations or techniques. Here are a few I have so far:

B-52 = 5 mg of haldol and 2 mg of ativan.
"snow em and stow em" = technique of sedating an acutely agitated patient then shipping them off to the OCU to await sobriety (etOH) or psych consult. (This one is obviously not the best idea)

Please let me know if you have any others. Thanks alot.

---

Members don't see this ad.

 

[totalbodypain]

Hey all,

Looking for some good slang for a presentation that I am putting together on pharmocological treatment for the acutely agitated ED patient. I am using the ACEP clinical policy guideline as a jumping off point for my presentation. I am looking for some good slang for drug combinations or techniques. Here are a few I have so far:

B-52 = 5 mg of haldol and 2 mg of ativan.
"snow em and stow em" = technique of sedating an acutely agitated patient then shipping them off to the OCU to await sobriety (etOH) or psych consult. (This one is obviously not the best idea)

Please let me know if you have any others. Thanks alot.

I've always understood the B in B52 to stand for Benedryl 50mg then haldol 5mg, Ativan 2mg. Regardless they are going to saw some logs.

 

[Seaglass]

Not exactly sedation related but MTF = metabolize to freedom (for the drunks)

 

[southerndoc]

I like Vitamin H and Vitamin A.

I've heard "knock 'em down," "deagitate," and "time to meet reality."

 

[Apollyon]

10-4, good buddy
Area 51
B52 (but the Benadryl isn't part of it for me)

 

[spyderdoc]

I personally like the term for not using sedation, called BRUTAINE

In context, someone would ask "so what are you going to use to sedate that kid to suture that laceration"? I reply, "just going to use good old-fashioned brutaine".

 

[southerndoc]

I personally like the term for not using sedation, called BRUTAINE

In context, someone would ask "so what are you going to use to sedate that kid to suture that laceration"? I reply, "just going to use good old-fashioned brutaine".

Spyderdoc, something tells me that Santucci just loved that answer.

 

[drewpydog]

The HAM sandwich - haldol, ativan, morphine.

 

[EMIMG]

The HAM sandwich - haldol, ativan, morphine.

Do you therefore get a consent form for procedural sedation with these patients? Using and opiate with a benzo becomes procedural sedation to my understanding.

 

[Seaglass]

Procedural sedation is defined on an institution specific policy. For example if I give a benzo for "anxiolysis" and a narcotic for pain that is not conscious sedation. If I give them specifically to alter mental status for a procedure, that is conscious sedation.

 

[Crypt Abscess]

I think EMIMG is correct. I think at most institutions, giving a benzo and narcotic before a planned procedure qualifies as conscious sedation. On the other hand, if you are giving a benzo and morphine for an agitated patient with pain (without a planned procedure) it is not considered conscious sedation. It seems like a issue of semantics.

Some personal experience- I gave a sick AIDS patient (on the floor) 4 mg of Morphine prior to a bone marrow biopsy. He died during the procedure- I think from a hypoxic PEA arrest (autopsy was negative except for a bad pneumonia) I had to present him at M&M, and I did get criticized for not monitoring the patient more carefully (pulse-ox), and the issue of whether or not I was using "conscious sedation" did come up (since morphine has both sedative and analgesic properties).

Crypt

 

[drewpydog]

I've actually never given the HAM sandwich - a surgeon introduced me to it. I don't give it due to the reasons mentioned above.

 

[dchristismi]

One of my colleagues uses "Hounddawg" as a verb meaning "to give Haldol."

In context: "what shall we do with this psychotic patient?" "Hounddawg him."

I don't know if he also recommends "hogtying'" in conjunction, but it seems an appropriate fit.

 

[roja]

"that patient has a serious vitamin H deficiency" (for those loud, obnoxious, etc patients)

have also used the brutaine.

 

[spyderdoc]

Spyderdoc, something tells me that Santucci just loved that answer.

Yep, one of my favorites over there on the pedi side. Her and Mark H. Those pedi EM folks are just great....

 

[mikecwru]

Yep, one of my favorites over there on the pedi side. Her and Mark H. Those pedi EM folks are just great....

My favorite sedation is 150mg of succinlycholine

Re: the AIDS patient, I don't think you iced them with morphine, unless they were already circling the drain or had an anaphylactic reaction. Don't let this keep you from trying to alleviate pain in someone that is dying.

mike

 

[Tenesma]

wow - 150mg of Succinylcholine... your patients must all be 500 lbs!!!!!

wouldn't it be more appropriate to dose it correctly? (0.6mg/kg)
that dose is already somewhat of an overdose considering the saturation of acetylcholine receptors.

 

[Anuwolf]

Just out of curiosity. Why are their slang words for medications? Doesn't the patient have the right to know what the nurse or doctor are giving to them? Why would you give a patient all 3 drugs of haldol, ativan and morphine at the same time?

 

[SoCuteMD]

Just out of curiosity. Why are their slang words for medications? Doesn't the patient have the right to know what the nurse or doctor are giving to them? Why would you give a patient all 3 drugs of haldol, ativan and morphine at the same time?

There are slang words because it's easier to use an acronym or slang to discuss a dose of 3 medications than it is to list all the medications. Just like police/military/any other occupations uses slang to do the same (10-4?).

Yes, the patient has the right to know what the doctor is prescribing for them, and certainly a patient is told if he or she is in a state that allows for communication.

A patient is given these combinations of drugs to produce "conscious sedation" - a state that allows for a conscious patient who was previously combative (which presents the possibility of harm to both doctors/nurses/aides and the patient) or in severe pain or distress, or any number of states, to be sedated without compromising his/her airway. This allows for them to breathe on their own and avoid intubation, which prevents a number of risks in and of itself. Of course, I would suspect that many patients given this combination would drift off to dream-world for a bit, but the benefit is that they will continue breathing independently.

 

[docB]

Just out of curiosity. Why are their slang words for medications? Doesn't the patient have the right to know what the nurse or doctor are giving to them? Why would you give a patient all 3 drugs of haldol, ativan and morphine at the same time?

For procedural sedation (if you guys don't want JACHO annoying you more than usual get used to calling it "procedural sedation") patients certainly have the right to get info on the drugs and physicians have the duty to provide it. For B-52s and so on, those are used for violent patients who are out of control and dangerous due to psych issues, intoxication or complications of some disease process (eg. encephalopathy). In those cases the patient does not have the right to know about or decline those meds. In the case of a violent patient the safety of the staff and the patient over ride the patient's right to informed consent.

 

[mikecwru]

wow - 150mg of Succinylcholine... your patients must all be 500 lbs!!!!!

wouldn't it be more appropriate to dose it correctly? (0.6mg/kg)
that dose is already somewhat of an overdose considering the saturation of acetylcholine receptors.

No, I routinely use 1-1.5mg/kg.

Nice of you to be condescending, though.. "wouldn't it be... to use is CORRECTLY"

I've used it a few times.

mike

 

[Dr.Evil1]

Just out of curiosity. Why are their slang words for medications? Doesn't the patient have the right to know what the nurse or doctor are giving to them? Why would you give a patient all 3 drugs of haldol, ativan and morphine at the same time?

This board is primarly posted by residents and medical students who are interested in Emergency medicine. When I asked this question I was looking for some fun stuff to put into a presentation on evidence based pharmacologic treatment of agitated patients in the emergency department. I didn't ask the question "Well guys I have no better place in the world then here (like asking one of my attendings, looking in a book or possibly even asking a pharmacist) so I want to know what drugs can be used for sedating an agitated patient". Lighten up.

 

[Dr.Evil1]

wow - 150mg of Succinylcholine... your patients must all be 500 lbs!!!!!

wouldn't it be more appropriate to dose it correctly? (0.6mg/kg)
that dose is already somewhat of an overdose considering the saturation of acetylcholine receptors.

0.6 mg/kg is not the correct dose for the induction of acute paralysis with succinylcholine. Of course Mike was kidding and would never use succinylcholine for the acute management of an agitated patient. If he wanted to intubate that agitated patient though I'm sure he would use between 1 and 1.5 mg/kg (or 100 mg if he didn't have time to ask the guy his weight) as is recommended in almost every EM textbook out there.

There have been multiple studies using non-depolarizing neuromuscular blockers for RSI in which the studies have compared 0.6 mg/kg or 1.2 mg/kg of Rocuronium to standard doses (1-1.5 mg/kg) of succinylcholine and found it was as effective. Maybe you were confusing rocuronium with succinylcholine.

Getting back to Mike though, I actually have heard a story about someone using succinylcholine to control an acutely agitated patient. I guess this guy was a residency director somewhere and the patient had hit or threatened one of the residents. I guess he paralyzed the guy, stood over him and said that if he ever hit one of the doctors again he would kill him. I guess that he was much more under control after that.

 

[bartleby]

That is wrong on SO many levels...

I actually have heard a story about someone using succinylcholine to control an acutely agitated patient. I guess this guy was a residency director somewhere and the patient had hit or threatened one of the residents. I guess he paralyzed the guy, stood over him and said that if he ever hit one of the doctors again he would kill him.

 

[mikecwru]

0.6 mg/kg is not the correct dose for the induction of acute paralysis with succinylcholine. Of course Mike was kidding and would never use succinylcholine for the acute management of an agitated patient. If he wanted to intubate that agitated patient though I'm sure he would use between 1 and 1.5 mg/kg (or 100 mg if he didn't have time to ask the guy his weight) as is recommended in almost every EM textbook out there.

There have been multiple studies using non-depolarizing neuromuscular blockers for RSI in which the studies have compared 0.6 mg/kg or 1.2 mg/kg of Rocuronium to standard doses (1-1.5 mg/kg) of succinylcholine and found it was as effective. Maybe you were confusing rocuronium with succinylcholine.

Getting back to Mike though, I actually have heard a story about someone using succinylcholine to control an acutely agitated patient. I guess this guy was a residency director somewhere and the patient had hit or threatened one of the residents. I guess he paralyzed the guy, stood over him and said that if he ever hit one of the doctors again he would kill him. I guess that he was much more under control after that.

If I had a situation where I could get one IM shot into an extremely violent patient (not your average ED intoxicated dingus) and my or a staff's life was in danger I would give succ without hesitation or remorse.

The original post was a joke, though... it does bring a serene calm to the patient, though.

 

[Anuwolf]

Dr.Evil1 quoted:

Getting back to Mike though, I actually have heard a story about someone using succinylcholine to control an acutely agitated patient. I guess this guy was a residency director somewhere and the patient had hit or threatened one of the residents. I guess he paralyzed the guy, stood over him and said that if he ever hit one of the doctors again he would kill him. I guess that he was much more under control after that.

Wow did this actually happen? After reading this... I nearly cried. Because I could not understand why people can do such thing and to piss off a doctor so much that he goes beyond and did what he did to protect his fellow doctors and nurses and the rest of the staffs.

socuteMD,
When I was at the psychiatric hospital the nurses gave me haldol, not because I was violent but I just could not sleep at all during the night hours (They got tired of seeing me roam up and down the halls I guess).. It knocked me out my socks. I was sleeping like a baby. It’s funny because I didn’t just go into a normal sleep like I always do. It did something because I felt like I was being transported into a galaxy while I was sleeping. I don't understand why you would use Haldol for a "conscious sedation" It seems that you would only focus more to achieve this goal would to use a HIGH dose of Ativan. If the patient is in with a severe injury then morphine would be included. Haldol is more like of a sleep aid, IMO.

DocB,
Don’t most hospitals ER’s have padded rooms for violent type of patients and for psych patients (none OD)? My local hospital has couple installed for those purposes. The thing to do for violent patients is to give them a shot of haldol and when the drug takes effect to take them into the padded room and to restrain them with leather belts. You don’t need to worry about stopping their breathing with haldol.

I hope you socuteMD and DocB didn’t take my posts offensive.

 

[deleted6669]

0.6 mg/kg is not the correct dose for the induction of acute paralysis with succinylcholine. Of course Mike was kidding and would never use succinylcholine for the acute management of an agitated patient. If he wanted to intubate that agitated patient though I'm sure he would use between 1 and 1.5 mg/kg (or 100 mg if he didn't have time to ask the guy his weight) as is recommended in almost every EM textbook out there.

There have been multiple studies using non-depolarizing neuromuscular blockers for RSI in which the studies have compared 0.6 mg/kg or 1.2 mg/kg of Rocuronium to standard doses (1-1.5 mg/kg) of succinylcholine and found it was as effective. Maybe you were confusing rocuronium with succinylcholine.

Getting back to Mike though, I actually have heard a story about someone using succinylcholine to control an acutely agitated patient. I guess this guy was a residency director somewhere and the patient had hit or threatened one of the residents. I guess he paralyzed the guy, stood over him and said that if he ever hit one of the doctors again he would kill him. I guess that he was much more under control after that.

I have seen this too but with pavulon. obnoxious/dangerous/out of control drunk paralyzed and intubated and sent to the unit in restraints. bet he won't do that again.....

 

[kungfufishing]

If I had a situation where I could get one IM shot into an extremely violent patient (not your average ED intoxicated dingus) and my or a staff's life was in danger I would give succ without hesitation or remorse.

The original post was a joke, though... it does bring a serene calm to the patient, though.

people certainly chew plastic for less.

 

[Apollyon]

Nice of you to be condescending, though.. "wouldn't it be... to use is CORRECTLY"

Come on, man. You've been (and admitted, too), on SDN, a condescending prick more than once. It's who you are.

 

[SoCuteMD]

socuteMD,
When I was at the psychiatric hospital the nurses gave me haldol, not because I was violent but I just could not sleep at all during the night hours (They got tired of seeing me roam up and down the halls I guess).. It knocked me out my socks. I was sleeping like a baby. It’s funny because I didn’t just go into a normal sleep like I always do. It did something because I felt like I was being transported into a galaxy while I was sleeping. I don't understand why you would use Haldol for a "conscious sedation" It seems that you would only focus more to achieve this goal would to use a HIGH dose of Ativan. If the patient is in with a severe injury then morphine would be included. Haldol is more like of a sleep aid, IMO.

DocB,
Don’t most hospitals ER’s have padded rooms for violent type of patients and for psych patients (none OD)? My local hospital has couple installed for those purposes. The thing to do for violent patients is to give them a shot of haldol and when the drug takes effect to take them into the padded room and to restrain them with leather belts. You don’t need to worry about stopping their breathing with haldol.

I hope you socuteMD and DocB didn’t take my posts offensive.

While you may or may not have been given haldol inappropriately in a psychiatric hospital, this is not the use we are discussing on the Emergency Medicine forum. The use for these medications in an Emergency Medicine context is procedural sedation. This is done to sedate a patient who is "out of control" or who is in acute pain to allow medical personnel to continue to work for the patient's own good. While the thought of a padded room is nice, you may not be able to wait long enough. You need a sedated patient, and you need him/her now, because you need to rule out (or rule in) an acute, life-threatening injury such as a subdural hematoma or you need to continue working on life threatening issues. The "procedural sedation" protocol may be better than pure Haldol because it eliminates any pain the patient may be experiencing as well. It can be difficult to determine whether a combative response is due to psychosis, pain, or other factors. We are not talking about sedating patients just to sedate them on this thread.

While, I personally have never used Haldol to achieve conscious sedation - as I do not have a drug license, I can explain why. We are not making these protocols up. We, as doctors, rarely "create" new medication combinations. "Conscious sedation" is a well-established regimen, and I'm certain that with a proper literature search you could uncover the reasoning for including Haldol in conscious sedation

And just to clarify, Haldol is not a sleep aid. It is a high-potency typical antipsychotic.

Finally, to address your comments to docB, the procedure we are discussing here is not necessarily for a patient who is purely combative or agitated, or potentially dangerous. The procedure is for someone who is one of those AND in need of medical attention. While putting them in a padded room after a dose of halliperidol is a nice thought, I can imagine docB might have some malpractice attorneys knocking on his door if the patient died due to neglect of his/her other injuries while hanging out in the padded room.

 

[Febrifuge]

have also used the brutaine.

I have been the brutaine.

 

[leviathan]

an acute, life-threatening injury such as a subdural hematoma or you need to continue working on life threatening issues.

Don't want to go off topic, but isn't a subdural hemorrhage more of a chronic grumbling bleed?

 

[SoCuteMD]

Don't want to go off topic, but isn't a subdural hemorrhage more of a chronic grumbling bleed?

It was an example that I pulled out of my you-know-where and to be honest I don't really know because they make everything sound like it's life-threatening to us in class. My (probably wrong) understanding is that an acute SD bleed is a big freaking deal. Sub-acute and chronic buy you way more time.

So you are more than probably right, but I was just trying to make a point. You can't work up an acute injury if you can't get the patient to sit still.

 

[Dr.Evil1]

I was in the ED this AM doing rounds for CCU and there was a guy who was obviously drunk and had gotten his ass kicked the previous night. He had a dislocated finger and was all over the place. When the EM attending started to numb up the finger so that it could be relocated comfortably the patient basically went crazy. When the ortho resident aproached to set the finger he had brought 3 250 lb security gaurds with him. I guess this would be a good example of brutaine in full effect.

 

[Dr.Evil1]

DocB,
Don’t most hospitals ER’s have padded rooms for violent type of patients and for psych patients (none OD)? My local hospital has couple installed for those purposes. The thing to do for violent patients is to give them a shot of haldol and when the drug takes effect to take them into the padded room and to restrain them with leather belts. You don’t need to worry about stopping their breathing with haldol.

No the incidence of respiratory depression is much less with haldol but you do have to worry about dystonic reactions. Haldol and ativan have about equal efficacy in calming an agitated patient, and the combination of the two may work even better. There is a whole policy statement on this from ACEP.

 

[Chronic Student]

Back to the slang,

Milk of amnesia = Propofol

Let's give him some lix = Prolixin decanoate [sp?]

Vitamin K = Ketamine (gotta love the glassy eyeballs when the brain unhooks from the body. I've always wondered where they go to).

-Mike

 

[Tenesma]

mike

This topic has been covered even in your own literature (Emergency Medicine) [Journal Watch Emergency Medicine, May 1, 2000; 2000(501): p16, etc.]

The ED95 (effective dose at which you have 95% depression of neuromuscular function) for most people is about 0.3mg/kg (and this has been studied in both adolescents and in adults, as well as in the non-obese and obese. In pediatrics (primarily under the age of 60 days) the ED95 goes up to 0.5-0.6mg/kg (Anesthesiology 1984 by Liu and Goudsouzian).

So I can see that it would make intuitive sense to err on the paralyzed side by doubling the dose to 0.6mg/kg because that would definitely be beyond the ED100.

There is no literature to support the use of high dose succinylcholine that I know of... In fact your doses have been to show evidence of Phase II neuromuscular blockade which would be a bummer if you wanted to assess neurologic status after intubation (Anesth Analg. 2004 Jun;98(6):1674-5.)

by the way, just because you do it, and because others do it, and because some EM textbooks say it, doesn't make it right. But don't feel bad, anesthesiologists have routinely used 1mg/kg as the gold standard cause it is a lot easier to remember... but still not based on science

 

[leviathan]

It was an example that I pulled out of my you-know-where and to be honest I don't really know because they make everything sound like it's life-threatening to us in class. My (probably wrong) understanding is that an acute SD bleed is a big freaking deal. Sub-acute and chronic buy you way more time.

I agree that an acute subdural hematoma is dangerous, but I thought you meant that subdurals in general are acute, which I didn't know about.

So you are more than probably right, but I was just trying to make a point. You can't work up an acute injury if you can't get the patient to sit still.

I agree. The question was just one out of curiosity, and off topic.

 

[doctor7]

Getting back to Mike though, I actually have heard a story about someone using succinylcholine to control an acutely agitated patient. I guess this guy was a residency director somewhere and the patient had hit or threatened one of the residents. I guess he paralyzed the guy, stood over him and said that if he ever hit one of the doctors again he would kill him. I guess that he was much more under control after that.

as the legend goes...he said (very slowly) something along the lines of "don't ever do that again" ...and paused a few seconds to let the point set in before giving the patient a couple of puffs from the ventilation bag

 

[mikecwru]

mike

This topic has been covered even in your own literature (Emergency Medicine) [Journal Watch Emergency Medicine, May 1, 2000; 2000(501): p16, etc.]

The ED95 (effective dose at which you have 95% depression of neuromuscular function) for most people is about 0.3mg/kg (and this has been studied in both adolescents and in adults, as well as in the non-obese and obese. In pediatrics (primarily under the age of 60 days) the ED95 goes up to 0.5-0.6mg/kg (Anesthesiology 1984 by Liu and Goudsouzian).

So I can see that it would make intuitive sense to err on the paralyzed side by doubling the dose to 0.6mg/kg because that would definitely be beyond the ED100.

There is no literature to support the use of high dose succinylcholine that I know of... In fact your doses have been to show evidence of Phase II neuromuscular blockade which would be a bummer if you wanted to assess neurologic status after intubation (Anesth Analg. 2004 Jun;98(6):1674-5.)

by the way, just because you do it, and because others do it, and because some EM textbooks say it, doesn't make it right. But don't feel bad, anesthesiologists have routinely used 1mg/kg as the gold standard cause it is a lot easier to remember... but still not based on science

A pubmed search for "dose" and "succinylcholine" shows several studies from YOUR literature that insinuate that the dose-response escalates past 0.3mg/kg up to a max of 1.5 mg/kg.

We can sit and argue about this all day.

These studies will be confounded if you use typical RSI combinations.

But you go on enjoying your dose.

mike

 

[Dr.Evil1]

A pubmed search for "dose" and "succinylcholine" shows several studies from YOUR literature that insinuate that the dose-response escalates past 0.3mg/kg up to a max of 1.5 mg/kg.

We can sit and argue about this all day.

These studies will be confounded if you use typical RSI combinations.

But you go on enjoying your dose.

mike

I believe I'm susposed to say "Fatty McFattypants"

 

[irrka]

I believe I'm susposed to say "Fatty McFattypants"

 

[DW3843]

I was in the ED this AM doing rounds for CCU and there was a guy who was obviously drunk and had gotten his ass kicked the previous night. He had a dislocated finger and was all over the place. When the EM attending started to numb up the finger so that it could be relocated comfortably the patient basically went crazy. When the ortho resident aproached to set the finger he had brought 3 250 lb security gaurds with him. I guess this would be a good example of brutaine in full effect.

you sure those guys weren't just some of his resident buddies?

nothing says brutaine like the ortho squad in full effect

 

[LaCirujana]

as the legend goes...he said (very slowly) something along the lines of "don't ever do that again" ...and paused a few seconds to let the point set in before giving the patient a couple of puffs from the ventilation bag

We called that an "a$$hole intubation" where I went to school (meaning the patient, not the attending who ordered it). Saw one w/my own 2 eyes. I was on trauma as an M4 and was trying to get a fem stick on a fresh trauma, still on the board, etc. He managed to punch me anyway. The (very cool) attending said 2 words: "Vec 'im." The ETT and sedation came just enough later to make the point. I miss that attending...

 

[Apollyon]

On the "NCIS" that is on right now, Gibbs needed to be tubed - the doc on the show says, "his GCS is less than 8 - he needs to be tubed. Etomidate, 20mg. Succinylcholine, 100mg". The medicine was right (although I myself would have just called for 'sux'). It's unfortunate that this is a rarity.

 

[Jeff698]

I believe I'm susposed to say "Fatty McFattypants"

I don't agree. Somebody seriously questioned the use of succ at a dose that is recommended in every reference I've ever seen (including the critical care course I'm taking right now, taught, in part, by anesthesiology). It is also the dose that I've seen routinely used in the OR as well as the ER.

If there is useful information indicating that there is a more appropriate dose, I think it is welcome here. It is certainly the first I've ever heard of a different dose.

Now, having personally used the same dose of succ many times, without adverse effect, I'd have to say that if 0.3 mg really is an appropriate dose, there certainly doesn't appear to be any problems with overdose.

Take care,
Jeff

 

[bartleby]

Not exactly. Higher doses of haldol, particularly when given with benzodiazepines, can cause some respiratory depression. Don't forget that regardless of what you do or do not administer to the patient, many of them (particularly those behaving badly enough to require sedation in the first place) have pretreated themselves with various and sundry street drugs and pills from their own stash prior to gracing your ED with their presence.

You don’t need to worry about stopping their breathing with haldol.

 

[NinerNiner999]

Just because a written guidline exists in a textbook (and by the way, there is NEVER such thing as an authoritative textbook) it rarely, if ever correlates directly to clinical practice 100% of the time. That being said, RSI is usually accomplished using 120-150 mg of succ in the average patient. I don't remember the last time I intubated a patient who weighed 65kg or less....

 

[mikecwru]

Just because a written guidline exists in a textbook (and by the way, there is NEVER such thing as an authoritative textbook) it rarely, if ever correlates directly to clinical practice 100% of the time. That being said, RSI is usually accomplished using 120-150 cc of succ in the average patient. I don't remember the last time I intubated a patient who weighed 65kg or less....

Well, hopefully you mean milligrams, not ccs. Because even I would say that's a hefty dose.

mike

 

[BKN]

Well, hopefully you mean milligrams, not ccs. Because even I would say that's a hefty dose.

mike

I guess I'll finally chime in. We started out in the 70's using smaller doses per Tenesma's comments. There was a fear that we would run into folks with cholinesterase deficiencies and get prolonged block. Further getting a CT wasn't as easy or quick and we often wanted the patient back with us real soon so we could follow the exam. We don't care as much today about that.

It was fine most of the time, but these were unprepared airways and not much like the OR. We weren't as good as the gasmen and we weren't putting them on gas immediately.

So, sometimes we didn't get full intubating conditions. Sometimes we got them, but they didn't last long enough to do the job. So the dose went up. Haven't seen anybody with the prolonged block and I really don't care if they're relaxed for 20 minutes versus 5.