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.
?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.
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