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In NYC EMS we use 0.3 mg/kg for intubation. No pain management beforehand. Just that and a follow-up of a benzo. We half the dose for synchronized cardioversion.
In the field many services are going away from the traditional etomidate/Sucs/Roc or vec for RSI, because of the numerous contraindications of Sucs. Plus, Ketamine + Roc or Vec route requires one less medication to be carried.
Interesting to know. I never really liked Sucs. I'd prefer Roc any day. Ketamine is starting to see more use in the hospital now too. Definitely a good drug!
Just peeked at your website and had no idea that you were in my neck of the woods! I work up in Scottsdale but have learned so much from your videos. Hoping that eventually I can be an ICU nurse at BUMC or Osborn, but for now I’m still getting my feet wet as I’ve only been a nurse for a year.
Very cool! I actually moved to NC back in May, but I used to work at BUMCP. Great hospital and I'd highly suggest it. Lots of sick patients there. I'd say apply. You've built a good foundation as a nurse and nows a perfect time to move into the ICU if thats what you want. Best of luck to you!
Also, a very interesting side effect: I have found and have confirmed online that if bolused too rapidly, it can actually induce trismus! Making intubation impossible.
You can get myoclonus which is temporary. I haven’t ever heard of a persistant masseter spasm as it’s not a trigger for MH. I’ll have to look into it. Rocuronium will take care of masseter muscle spasm.
What about unstable AFib? I read etomidate... It's used for sedation but I would hope you'd have ketamine or something on board besides that if you're going to cardiovert and not want to tank the BP anymore.
This was such a great video! I haven't checked the notes before, but do they cover the seizure information mentioned in the video? I work in a neuro ICU.
No, I just briefly hit on it in the video. It sounds like Etomidate can be used to lower that threshold in some cases when trying to evaluate for seizures. I didn't look too much into it, but perhaps in a future lesson I may go further down that habit hole.
@@ICUAdvantage I can't imagine this is high on your list but I'm interested in seeing ketamine covered by you guys. It seems to have such a broad swath of applicability! Have a great day Eddie!
@@DavidTiptonJr Actually I do have that on the medications series todo list and was thinking of doing it sooner than later. I tried it briefly earlier this year, but for 2022, I'm really going to try to do the medication series as a 2nd video for the week. I think I have a good schedule now that I may be able to actually keep it up. Fingers crossed!
@icu advantage - yes thank you for bringing this up. Recently my patient, who was having status epilepticus needed to be intubated for airway protection. Instead of giving etomidate, anesthesia told me that it would lower the seizure threshold and we should give propofol instead.
Hello sir, i am from india and i am a new subscriber of your channel, i want to learn from your videos. Can you switch on the "Hindi" language subtitle on your all videos pls???
It should have automatic captions. I know they aren't the best, but theres no easy way to do the manual captions and right now I just don't have time to do them manually myself. So sorry
❤️🙏🏼 Show your support with an ICU Advantage sticker! 👉🏼 adv.icu/support
Notes for this lesson (and all previous lessons) are availably only to UA-cam and Patreon members. Links to join both here ⬇
► UA-cam: adv.icu/ym | ► Patreon: adv.icu/pm
As an icu / ED pharmacist I find these videos really relevant, concise and well produced!
I’m a current paramedic student and I love your videos! They’re easy to understand and break things down well.
Great to hear this Cassidy! Really glad you enjoy the videos. Truly my goal is to make the concepts understandable :)
ER DOCTOR HERE ! I USED THAT TODAY :) GREAT EM DAY TODAY. STAY SAFE EVERYONE ! 👍🚑🙌
I have changed my major to Dental but I still want to say thank you for continuing to put out superior quality videos to help teach the masses💕✨
Very cool! Wishing you all the best and thank you so much Lily!
Summarizes all the high-yield information. Thank you so much!
In NYC EMS we use 0.3 mg/kg for intubation. No pain management beforehand. Just that and a follow-up of a benzo. We half the dose for synchronized cardioversion.
Good to know! Thanks for sharing that. Always good to hear different ways in which things are done. It's a great med though.
You make everything so simple and user friendly !!! Great informations!!! God bless you🙏🙏🙏
Love this channel!! I'm a new ICU RN so this channel is so helpful plus I'm a visual learner! Thank u thank u thank u!!!!
You are very welcome!!! :) Really happy to hear the channel is helping in your new role in the ICU.
Thank you so much, I've learned new things watching this.
Thank you so much ^^
Ty for this series. RSI meds are so key and you explained it so well
Love this link - still waiting for the Ketamine lesson!
New subscriber here, and I absolutely love your content ! Very helpful. Keep up your incredible work 👏🏾👍🏾
Welcome aboard and thanks for the awesome comment!
In the field many services are going away from the traditional etomidate/Sucs/Roc or vec for RSI, because of the numerous contraindications of Sucs. Plus, Ketamine + Roc or Vec route requires one less medication to be carried.
Interesting to know. I never really liked Sucs. I'd prefer Roc any day. Ketamine is starting to see more use in the hospital now too. Definitely a good drug!
@@ICUAdvantage in my area, we have a MASSIVE malignant hyperthermia risk… so Sucs is out for sure!
Thank you si ❤️
Great drug for RSI. Minimizes prop with HD unstable folks.
Just peeked at your website and had no idea that you were in my neck of the woods! I work up in Scottsdale but have learned so much from your videos. Hoping that eventually I can be an ICU nurse at BUMC or Osborn, but for now I’m still getting my feet wet as I’ve only been a nurse for a year.
Very cool! I actually moved to NC back in May, but I used to work at BUMCP. Great hospital and I'd highly suggest it. Lots of sick patients there. I'd say apply. You've built a good foundation as a nurse and nows a perfect time to move into the ICU if thats what you want. Best of luck to you!
Also, a very interesting side effect: I have found and have confirmed online that if bolused too rapidly, it can actually induce trismus! Making intubation impossible.
Interesting! I'll have to look into it more, but good to know and thanks for sharing that info. I guess another reason to add paralytic with RSI :)
You can get myoclonus which is temporary. I haven’t ever heard of a persistant masseter spasm as it’s not a trigger for MH. I’ll have to look into it. Rocuronium will take care of masseter muscle spasm.
@AJohnson0325 by the time the trimus wanes, the effects of the amidate have worn off. I don't have roc or sux in my system, so I'm back to square one.
Thank yoi for this great video from an ED medic!
So cool! Glad you enjoyed it!
i love this
Can you do a video on Amiodarone, and Precedex?
ua-cam.com/video/Fpe6WHq6X20/v-deo.html
And Precedex is coming :)
I Love your lessons they’ve really made me grow as ICU RN
Ketamine next sir
Crystal clear.
Awesome!
What about unstable AFib? I read etomidate... It's used for sedation but I would hope you'd have ketamine or something on board besides that if you're going to cardiovert and not want to tank the BP anymore.
Thanks!
This was such a great video! I haven't checked the notes before, but do they cover the seizure information mentioned in the video? I work in a neuro ICU.
No, I just briefly hit on it in the video. It sounds like Etomidate can be used to lower that threshold in some cases when trying to evaluate for seizures. I didn't look too much into it, but perhaps in a future lesson I may go further down that habit hole.
@@ICUAdvantage I can't imagine this is high on your list but I'm interested in seeing ketamine covered by you guys. It seems to have such a broad swath of applicability! Have a great day Eddie!
@@DavidTiptonJr Actually I do have that on the medications series todo list and was thinking of doing it sooner than later.
I tried it briefly earlier this year, but for 2022, I'm really going to try to do the medication series as a 2nd video for the week. I think I have a good schedule now that I may be able to actually keep it up. Fingers crossed!
@icu advantage - yes thank you for bringing this up. Recently my patient, who was having status epilepticus needed to be intubated for airway protection. Instead of giving etomidate, anesthesia told me that it would lower the seizure threshold and we should give propofol instead.
@@Abbie725 very cool and good to know! I could see this potentially coming up with a lot of different patients
My favorite RSI drug 👏
It's a goodie
Hello sir, i am from india and i am a new subscriber of your channel, i want to learn from your videos. Can you switch on the "Hindi" language subtitle on your all videos pls???
Please add the caption
It should have automatic captions. I know they aren't the best, but theres no easy way to do the manual captions and right now I just don't have time to do them manually myself. So sorry
its not related to propofol
Please do a ketamine video ! You’re great !