Question

You are preparing to initiate a rapid sequence intubation on a pediatric patient who is exhibiting a borderline hypotensive state with a decreased level of consciousness and hypoventilation. He is quickly becoming hypoxic with a SpO2 of 77% and a delayed capillary refill.

Which medication would be most effective in sedating this patient for the procedure?

A. Succinylcholine

B. Midazolam

C. Ketamine

D. Propofol

Answer 1

For a pediatric patient showing signs of hypotension and hypoventilation requiring rapid sequence intubation, Ketamine (option C) is recommended for sedation as it preserves cardiovascular stability.

Step-by-step explanation:

In the case of a pediatric patient with borderline hypotension, decreased level of consciousness, and hypoventilation, sedation for rapid sequence intubation must be carefully selected to avoid further cardiovascular compromise. Among the options provided, Ketamine is most effective as it has the unique property of providing sedation, amnesia, and analgesia without significantly decreasing blood pressure; in fact, it can even cause an increase in blood pressure and heart rate, which may be beneficial in this scenario. Medications like Propofol and Midazolam may cause further hypotension, and Succinylcholine, while not a sedative, is often used as a paralyzing agent in rapid sequence intubation but does not provide any sedation or pain relief. Therefore, in a hypotensive patient, Ketamine could be considered the first-line sedative agent for rapid sequence intubation.