Bored Review 8/5/14: Succ sucks! (only sometimes).

by sbogoch • August 5, 2014 • 1 Comment

A brand-new CCT senior is notified by EMS triage, the attending, the bat phone, his junior, the nurse, the PCA and the stocking people that he should probably intubate his patient- the 38-year-old patient with sickle cell disease with ESRD on hemodialysis who presents weird and vomiting and is found to have a large intracranial hemorrhage. After the group stops yelling at the panicked “senior”, he meekly calls for etomidate and succinylcholine as his RSI medications. The group (now including the UCG-performing PCT) collectively gasps. What are the side-effects of succinylcholine and why is it the wrong choice for this patient?

Answer

Known side effects of succinylcholine are increased ICP/intraocular pressure, fasciculations, malignant hyperthermia, and the dreaded…..hyperkalemia. This hyperkalemia is concerning for certain “at-risk” patients. These are patients with kidney disease (like our patient), crush injuries, burn injuries, multiple trauma, neuromuscular diseases (ALS/muscular dystrophy), denervated skeletal muscle (strokes, spinal cord injury <6 months old), and abdominal sepsis. Our patient has ESRD and is dialysis dependent meaning that he likely ALREADY has hyperkalemia. Avoid dysrrhythmias due to hyper-K. Know when to hold the succ and try rocuronium instead.

By Sally Bogoch and Andrew Grock

Reference: Rivers

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.