Etomidate for RSI in the Seizing Patient

By Elizabeth Rozycki PharmD, BCPS, Specialty Practice Pharmacist, Emergency Medicine, Ohio State University) // Edited by Michael Barrie MD @MikeBarrieMD, OSUEM Assistant Professor // Zach Adams MD, OSUEM PGY1 Resident

A 61 year old female patient presents after a fall and possible seizure activity witnessed by family members.  The patient has no history of seizures.  On exam the patient has a tongue laceration and apparently lost control of their bladder during the event. The patient has a GCS of 8 and is waxing and waning so the decision is made to intubate for airway protection. Blood pressure is 168/98, hear rate 112 and patient has good oxygen saturation on a non-rebreather.  Your friendly and helpful pharmacist inquires about which medications you would like for induction and paralysis.   Etomidate? The patient seized… will etomidate lower their seizure threshold? 

The Bottom line: Maybe, but the evidence is not great. If possible, use an alternative RSI agent such as propofol or ketamine.

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