Well, I may do an 'end around' answering this question. Trismus may be experienced by the patient during 'traditional' RSI, utilizing Etomidate as your induction agent; however, we do not typically witness trismus, as the administration of the paralytic negatives this.
Personally, I have never practiced 'facilitated' intubations with a sedative only, therefore I'm not certain if trismus is experienced with patients receiving Benzo's. Robert Breese would most likely know the answer to this question.
Oh, I see. Gotcha. So, without the paralytic to avoid/release the pt's trismus, you have few options. You can't continue to push sedatives. As I see it, 'hopefully' BNTI, and if that doesn't work, surgical airway, with whatever protocol-approved device/procedure you're REMAC utilizes. Apply diesel.
An article in the Emergency Medical Journal (http://emj.bmj.com/content/22/6/456.full) states,"In adults, succinylcholine can also produce transient masseter spasm that resolves when fasciculation stops." It can also happen in peds with SUX and co-administration of halothane gas. Again, it's a failed airway requiring surgical cricothyroidotomy. Luckily, I've never experienced this with SUX administration. I know you weren't asking about this specifically, but I thought it notable to mention.
Other than neuromuscular blockades what other treatments do you recommend for patients with a Trismus?
ReplyDeleteWell, I may do an 'end around' answering this question. Trismus may be experienced by the patient during 'traditional' RSI, utilizing Etomidate as your induction agent; however, we do not typically witness trismus, as the administration of the paralytic negatives this.
DeletePersonally, I have never practiced 'facilitated' intubations with a sedative only, therefore I'm not certain if trismus is experienced with patients receiving Benzo's. Robert Breese would most likely know the answer to this question.
DeleteSorry for the confusion. I'm asking if a patient presents with a trismus and you do not have RSI capabilities, what would be treatment options?
DeleteOh, I see. Gotcha. So, without the paralytic to avoid/release the pt's trismus, you have few options. You can't continue to push sedatives. As I see it, 'hopefully' BNTI, and if that doesn't work, surgical airway, with whatever protocol-approved device/procedure you're REMAC utilizes. Apply diesel.
DeleteAn article in the Emergency Medical Journal (http://emj.bmj.com/content/22/6/456.full) states,"In adults, succinylcholine can also produce transient masseter spasm that resolves when fasciculation stops." It can also happen in peds with SUX and co-administration of halothane gas. Again, it's a failed airway requiring surgical cricothyroidotomy. Luckily, I've never experienced this with SUX administration. I know you weren't asking about this specifically, but I thought it notable to mention.
DeleteJust throwing this out here: the Gold Standard in airway control is "a cuffed tube in the trachea." (Walls, R.) I sincerely concur.
ReplyDelete