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Cureus. 2018 Apr 25;10(4):e2530. doi: 10.7759/cureus.2530.

Rapid Sequence Intubation in Traumatic Brain-injured Adults.

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Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA.
Office of Faculty and Academic Affairs, University of Central Florida College of Medicine, Orlando, USA.
Clinical Sciences, University of Central Florida College of Medicine, Orlando, USA.


Deciding on proper medication administration for the traumatic brain injury (TBI) patient undergoing intubation can be daunting and confusing. Pretreatment with lidocaine and/or vecuronium is no longer recommended; however, high-dose fentanyl can be utilized to help blunt the sympathetic stimulation of intubation. Induction with etomidate is recommended; however, ketamine can be considered in the proper patient population, such as those with hypotension. Paralysis can be performed with either succinylcholine or rocuronium, with the caveat that rocuronium can lead to delays in proper neurological examinations due to prolonged paralysis. Recommendations for post-intubation continuous sedation medications include a combination propofol and fentanyl in the normotensive/hypertensive patient population. A combination midazolam and fentanyl or ketamine alone can be considered in the hypotensive patient.


emergency medicine; induction agents; intracranial pressure; intubation; ketamine; pretreatment; rapid sequence intubation; rocuronium; succinylcholine; traumatic brain injury (tbi)

Conflict of interest statement

The authors have declared that no competing interests exist.

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