Rapid Sequence Intubation Medications

Emergency & Critical Care

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Examples

etomidateketaminepropofolsuccinylcholinerocuronium

Prefix / Suffix: -curonium for some paralytics

Physiology

Rapid sequence intubation uses sedation plus paralysis to secure the airway quickly while reducing aspiration risk. Paralytics do not provide sedation or pain control.

Mechanism of Action

Induction agents reduce consciousness. Neuromuscular blockers prevent skeletal muscle movement by depolarizing or blocking acetylcholine receptors at the neuromuscular junction.

Indications

Impending or actual airway failure
Severe respiratory failure
Low level of consciousness with inability to protect airway
Trauma or emergency procedures requiring controlled airway

Side Effects / Adverse Effects

Hypotension with sedatives
Increased secretions or emergence reactions with ketamine
Hyperkalemia and malignant hyperthermia risk with succinylcholine
Prolonged paralysis
Awareness if sedation is inadequate after paralysis

Contraindications

Succinylcholine: major burns/crush injury after 24–48 hours, neuromuscular disease, hyperkalemia, malignant hyperthermia history
Hemodynamic instability with certain sedatives
Drug-specific allergy

Nursing Considerations

Preoxygenate and prepare suction, bag-mask, monitor, IV access, and backup airway equipment
Label sedative versus paralytic clearly
Never assume a paralyzed patient is sedated
Monitor end-tidal CO2, oxygen saturation, blood pressure, and tube placement
Continue analgesia and sedation after intubation

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Disclaimer: PharmPal Nurse is for education only and is not medical advice. Do not use it to diagnose, treat, prescribe, or make patient-care decisions; always verify with current drug references, your instructor, facility policy, and a licensed provider. In emergencies, call local emergency services.