Author Question: The therapist is about to perform endotracheal intubation of a patient who has been severely burned. ... (Read 98 times)

mikaylakyoung · **on:** Jul 16, 2018

The therapist is about to perform endotracheal intubation of a patient who has been severely burned. The patient is in distress and agitated, causing the intubation procedure to be difficult. Someone suggests administering the depolarizing neuromuscular blocking agent succinylcholine. What should be the therapist's response to this suggestion?

A. Administer the fast-acting, short-lasting succinylcholine.
B. Avoid using succinylcholine because it will promote body fluid loss.
C. Withhold giving succinylcholine because it may exacerbate hyperkalemia.
D. Refrain from employing succinylcholine because it may cause fasciculations.

Question 2

The therapist is at the bedside of a mechanically ventilated patient with renal disease. Patient-ventilator asynchrony is present. The patient has received analgesics, benzodiazepines, and haloperidol to no avail. The physician suggests using atracurium. How should the therapist respond to this suggestion?

A. Agree to the administration of the atracurium.
B. Refrain from using atracurium because it is toxic to the kidneys and liver.
C. Suggest that vecuronium be administered instead.
D. Suggest that any aminosteroid would be suitable in this situation.

medine · **Reply #1 on:** Jul 16, 2018

Answer to Question 1

ANS: C
A. Incorrect response: See explanation C.
B. Incorrect response: See explanation C.
C. Correct response: Succinylcholine, a depolarizing neuromuscular blocking agent, has an extremely rapid onset of 30 to 90 seconds and a short duration ranging from 3 to 5 minutes, making it an ideal NMBA for emergency use.
Burn patients tend to have increased potassium released into the extracellular fluid compartment. However, succinylcholine can exacerbate that problem by causing further release of intracellular potassium into the extracellular space. The induced hyperkalemia can cause cardiac dysrhythmias and cardiac arrest. Alternatively, the nondepolarizing neuromuscular blocking agent rocuronium establishes neuromuscular blockade within 2 minutes, and seems to be favored during emergencies and for purposes such as endotracheal intubation.
D. Incorrect response: See explanation C.

Answer to Question 2

ANS: A
A. Correct response: In patients with renal disease, caution is warranted in the use of aminosteroids (pancuronium, vecuronium, and rocuronium) because clearance can be greatly reduced and duration prolonged. Similar caution for this class is indicated in patients with cirrhosis. Vecuronium, a benzylisoquinoliniu m, has been reported to be the most associated with prolonged duration of action after discontinuation and should be avoided in these patients. Atracurium and cisatracurium are preferred agents in these patients because their clearance is not affected by real or hepatic dysfunction.
B. Incorrect response: Atracurium is preferred in this case.
C. Incorrect response: Vecuronium is contraindicated in this situation.
D. Incorrect response: Aminosteroids are not advisable for patients with liver and/or renal disease.