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Suxamethonium contraindication — DIPIMC MCQ

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HardPharmacology (Pre-Hospital)Suxamethonium contraindicationDIPIMCDipIMC

A patient with major burns sustained five days ago requires pre-hospital rapid sequence induction, and you are selecting a neuromuscular blocking agent.

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Correct answer: E — Avoid suxamethonium because of the risk of hyperkalaemic arrest and use rocuronium

Explanation lettering: C = shown as B · B = shown as C · E = shown as D · D = shown as E

Suxamethonium causes an exaggerated potassium release and can precipitate a hyperkalaemic cardiac arrest in patients with burns more than about 24-72 hours old, as well as in crush injury and denervating conditions, so a non-depolarising agent such as rocuronium is used instead. Continuing with suxamethonium (A and B) or attempting to mitigate it with calcium (E) does not make it safe in this setting. Established burns are a clear contraindication to suxamethonium.

Reference: JRCALC Clinical Guidelines; pre-hospital RSI guidance