1. Rocuronium
New drug authorized to administer by DHS. BUT is limited to use in a successfully intubated patient.
Will only be used for patients being transferred from SEC to other facility.

2. Rocuronium Description: Neuromuscular blocking (paralyzing) agent
Mechanism of action:
Produces neuromuscular blockade by competing with acetylcholine for cholinergic receptors at the motor end plate.
Half-life: Rocuronium has a biphasic distribution. The rapid distribution half-life is 1 to minutes, and the slower distribution half-life is 14 to 18 minutes.
Rocuronium has no effect on consciousness or pain threshold. Therefore, when rocuronium is used, adequate analgesia and sedation should be administered.
Dosage: Intubating (RSI) - 1mg/kg;
Cochrane review indicated several papers that compare the two nondepolrizing agents for intubation. SCh produces slightly better intubation conditions and statistically significantly reduced number of intubation attempts
if rocuronium is used following use of succinylcholine, it should not be given until recovery from succinylcholine has been observed {01})

3. Rocuronium Description: Neuromuscular blocking (paralyzing) agent
Mechanism of action:
Produces neuromuscular blockade by competing with acetylcholine for cholinergic receptors at the motor end plate.
Half-life: Rocuronium has a biphasic distribution. The rapid distribution half-life is 1 to minutes, and the slower distribution half-life is 14 to 18 minutes.
Rocuronium has no effect on consciousness or pain threshold. Therefore, when rocuronium is used, adequate analgesia and sedation should be administered.
Dosage: Intubating (RSI) - 1mg/kg;
Cochrane review indicated several papers that compare the two nondepolrizing agents for intubation. SCh produces slightly better intubation conditions and statistically significantly reduced number of intubation attempts
if rocuronium is used following use of succinylcholine, it should not be given until recovery from succinylcholine has been observed {01})

4. Rocuronium No effects on HR or BP
Reliable and controllable duration of action
Fast onset
Stable hemodynamics/no histamine release
Supplied: Solution as 10mg/cc vials of 50mg. Stable for 60 days at room temperature.

5. Reversal Agent
It’s effects may be reversed by administering an anticholinesterase such as Prostigimine. Which increases the amount of acetylcholine at the receptors to compete with rocuronium.
But not in EMS scope of practice in AZ
Reversal of blockade virtually is never indicated following emergency airway management.
Atropine 0.01mg per kg IV is given to block excessive muscarinic stimulation (SLUDGE syndrome) .
Atropine not in protocols – but if patients starts presenting patch and ask for Atropine!

6. Maintenance/Pain Management
Midalzolam 5mg/PRN
Morphine Same MS protocol for pain
2 mg initial dose mg subsequent doses
max. 20mg
Remember:
None of the previously reviewed medications: Etomidate, Succinylcholine, Versed, and Rocuronium are analgesics. Treat your patients pain!
Evaluate Vital signs before and after each administration

7. Midazolam (Versed) Short-acting sedative hypnotic Benzodiazepine
Water-soluble
CNS depressant and causes significant amnesia following administration
Has some muscle relaxant thus serves to calm and sedate patients, relax skeletal muscles, and, in high doses, causes sleep.
Midazolam DOES NOT have analgesic properties.
Midazolam has been shown to be three to four times as potent per mg as diazepam.
Midazolam may produce partial or complete impairment of recall for up to several hours, depending on the dose
it has been postulated that the actions of benzodiazepines are mediated through the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), which is one of the major inhibitory neurotransmitters in the brain. Benzodiazepines are believed to increase the activity of GABA, thereby calming the patient, relaxing skeletal muscles, and, in high doses, producing sleep.

8. Questions?