![]() ![]() But for your average adult patient, we tend to give 20 mg. Your dose for that, on a weight-based dose, is 0.3 mg/kg. At this institution, our first-line agent, kind of our workhorse, is etomidate. Now our first medication that we'll give will always be the induction agent, like I said, to facilitate us giving the paralytics. So by doing a - with this rapid sequence intubation, we have the patient sedated more quickly, and this is also to improve our chance of first-pass intubation, and also so that we can have decreased side effects such as nausea and vomiting that could cause aspiration down the line. The anesthesiologists have the options of using gas agents for induction. ![]() In the operating room, we have - it's a much more controlled environment, we have more time. When we talk about RSI in the emergency department, that's rapid sequence intubation, that's pretty rapid compared to what we do in the operating room. So an induction agent is given to sedate the patient appropriately so that they can then receive the paralytic that allows the patient to be intubated safely and quickly. I'll start and we'll consider what's going to be our induction agent. So once we've decided that we're going to intubate the patient - we've made our plan, we're starting to get our supplies ready, you know, they're getting the laryngoscope, we have RT at the bedside as well. Part of my job, as well as providing the medications for the initial intubation itself is making sure we have the appropriate analgesic plan, and then the postintubation sedation as well so that we can keep these patients comfortable while we continue with our treatments including imaging and any therapeutics they may need. If we have any inkling - we won't have labs back usually on a trauma patient - but do we have any reason to suspect this patient may have liver or renal dysfunction? And that will help us decide which medications we choose to use. We're going to look at the patient's size. We'll talk about the contraindications we have for certain medications. So first things first, we want to assess the patients themselves, look for any obvious contraindications. Once the team has made the decision that they're going to intubate the patient, whether it's due to the patient's injuries themselves for pain control, or due to altered mental status, I come in and I have my fantastic RSI kit ready to go. So I'll also talk to you guys a little bit today about RSI medications as part of our airway management for our trauma patients. I've been here for about two years, and I've been part of the team for all of our critical patients who come into the emergency department, including but not limited to our trauma patients. I am a clinical pharmacist here in the emergency department at the University of Chicago Medical Center. ![]()
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