Etomidate for RSI: Seizure Considerations

Download PDF Introduction Rapid sequence intubation (RSI) is a process whereby an induction agent and a neuromuscular blocking agent are given in rapid succession to facilitate endotracheal intubation The selection of a specific sedative depends on multiple factors: the clinical scenario, which includes patient factors (includes cardiorespiratory and neurologic status, allergies, comorbidity) and the clinician’s […]

Cannabinoid Hyperemesis Syndrome (CHS)

Introduction  1. Commonly identified as symptoms, including nausea, cyclic vomiting and abdominal pain, that are refractory  to available antiemetics and analgesics.   2. Patients tend to take compulsive hot baths/showers for symptom relief.  3. Characteristically distinguished from cyclic vomiting syndrome, these symptoms are usually preceded by years  of chronic cannabis use and symptoms are typically resolved […]

Concomitant Parenteral Benzodiazepines and Olanzapine

Introduction Intramuscular olanzapine and parenteral benzodiazepines are commonly used agents in the ED for acute agitation. An FDA warning states that potentially fatal respiratory depression can occur when olanzapine and parenteral benzodiazepines are administered concomitantly stating “concomitant administration of intramuscular olanzapine and parenteral benzodiazepine has not been studied and is therefore not recommended.” This warning […]

Ketamine for Refractory Status Epilepticus

Introduction Status epilepticus (SE)* is characterized by: ≥5 minutes of continuous clinical and/or electrographic seizure, OR Recurrent seizure activity without recovery to baseline between seizures. Thirty-day mortality in convulsive SE is 19 to 27%, while non-convulsive SE rates reach 65%. In one study, patients with treated and resolved SE within 10 hours had 10% mortality […]

Benzodiazepine Pharmacokinetics and Routes of Administration

Introduction Benzodiazepines are used for numerous acute states in the emergency department, especially seizures and agitation  IV access is often not available for patients with seizures or agitation and alternative routes must be considered; the drug of choice may change depending on the route of administration  This handout will focus on the pharmacokinetics of the […]