> The thought of sux on it's own is a recipe for disaster and likely to land
you in court. It will also do quite interesting things to your patients
potassium in this situation and your (and the patients) cardiac rhythm.
I'm going to nibble at this one just to see what happens :-)
There was clearly a major struggle for IV access. A few minutes for this to
be obtained is the safest approach but I'm assuming that with their best
efforts, this has not been possible. A 30 minute delay is not really on.
The patient has a GCS of 7. Are they going to have awareness of
fasciculation? The ideal would be to use an induction agent and then sux but
we have no IV access. Are you going to wait for adequate absorption of the IM
induction agent before giving the sux?
Concern regarding the effect on ICP? Certainly, but which will cause more
brain injury, the briefly raised ICP or the prolonged hypoxia? I cannot give
a referenced answer, has one been established?
The use of sux without induction in this situation is your opinion, you
haven't provided a reference. Since this has been advocated and taught by a
consultant in emergency medicine and pre-hospital care responsible for an air
ambulance in a capital city, I suspect expert opinion may be divided. I
accept entirely the suggestion that it is not ideal.
The danger of cardiac dysrhythmias related to potassium is not an issue in
the acute setting unless there is underlying hyperkalaemia, raising the
concentration by 0.2-0.4mmol/l. (Lee's Synopsis of Anaesthesia 11th Ed p.208)
Best wishes
Darren
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