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JOURNAL ARTICLE
REVIEW

Rapid Sequence Intubation in Traumatic Brain-injured Adults

Nicholas Kramer, David Lebowitz, Michael Walsh, Latha Ganti
Curēus 2018 April 25, 10 (4): e2530
29946498
Deciding on proper medication administration for the traumatic brain injury (TBI) patient undergoing intubation can be daunting and confusing. Pretreatment with lidocaine and/or vecuronium is no longer recommended; however, high-dose fentanyl can be utilized to help blunt the sympathetic stimulation of intubation. Induction with etomidate is recommended; however, ketamine can be considered in the proper patient population, such as those with hypotension. Paralysis can be performed with either succinylcholine or rocuronium, with the caveat that rocuronium can lead to delays in proper neurological examinations due to prolonged paralysis. Recommendations for post-intubation continuous sedation medications include a combination propofol and fentanyl in the normotensive/hypertensive patient population. A combination midazolam and fentanyl or ketamine alone can be considered in the hypotensive patient.

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Bill Anderson wrote:

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And the considerable issue that NMBs can result in CICV. Oops! Think before you act and turn a drama into a crisis.

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