Pre-Quiz: Rapid Sequence Intubation

A 35-year-old man with a prior history of asthma is brought in the emergency department experiencing severe respiratory distress. He is intubated and ketamine is elected for induction anesthesia. In this situation, what is the approximate duration of action of ketamine?

A 33-year-old man with a history of IV drug use and hypertension is brought to the emergency department after being found minimally responsive at a homeless shelter. His temperature is 96.6°F (35.9°C), blood pressure is 84/44 mmHg, pulse is 150/min, respirations are 17/min, and oxygen saturation is 98% on room air. Despite administering 3L of fluids, the patient remains hypotensive. Physical examination reveals multiple antecubital fossa abscesses and a heart murmur. His lab results indicate a spike in white blood cells and acute kidney injury. The physician decides to intubate as his Glasgow Coma Scale has reduced to 6. Subsequently, his blood pressure severely drops until rapidly corrected post-administering stress doses of steroids.

Which induction agent is most likely to have exacerbated this patient’s hypotension post-intubation?

A 22-year-old male presents after a severe asthma exacerbation. He is in respiratory distress with oxygen saturations of 78% on 15L nasal cannula. Peak expiratory flow rate is 25% of predicted. He becomes obtunded requiring emergent intubation. Which of the following induction agents would be most appropriate for this patient?

A 65-year-old male with a medical history of alcohol abuse and hypertension is transported via emergency medical services (EMS) to the emergency department (ED) due to shortness of breath and difficulty breathing. His Glasgow Coma Scale (GCS) score has progressively worsened, he is more altered, and is increasingly difficult to arouse. His current vital signs are: heart rate 121 bpm, blood pressure 167/98 mmHg, respiratory rate 27 breaths per minute, SpO2 of 84%, and a GCS score of 6. He weighs 85 kg. As the medical team is preparing for intubation, they ask for rapid sequence induction (RSI) medications to be drawn up for administration. A neurological evaluation is planned immediately after intubation.

A 52-year-old male is brought via EMS to the Emergency Department (ED) presenting with altered mental status. Head CT scan and lab results including glucose, sodium, and toxicology screen are unremarkable. The patient’s wife states that he has a history of hypertension and is a non-smoker. His vital signs on presentation are: temperature of 37.2 degrees Celsius, pulse of 90 bpm, respiration rate of 16 breaths per minute, blood pressure of 139/78 mmHg, and oxygen saturation of 98% on room air. Given his unresponsiveness, the decision to secure his airway is made and the patient is intubated with etomidate and rocuronium, a non-depolarizing neuromuscular blocker. As the Neurology team prepares for a comprehensive neurological exam, they request for the reversal of the paralytic agent. Which of the following medications would be most appropriate to reverse the effects of rocuronium on this patient?