Page 172 - PJ MED OPS Handbook 8th Ed

• Dose: 1mEq/kg IV
Contraindications: none in setting of crush injury, metabolic or respiratory alkalosis, hypocal-
cemia, hypokalemia, hypernatremia, pregnancy
• Side-effects/precautions: metabolic alkalosis may occur, may increase intracellular acido-
sis, may cause imbalance, may deactivate catecholamine, large solute load may lead to fluid
overload; precipitates when mixed with calcium chloride or gluconate.

23.4% Sodium Chloride
• Description: Hypertonic saline
• Indications: increased intracranial pressure (ICP)/brain stem herniation associated with mod-
erate to severe TBI
• Adult Dose: 30mL IV/IO over 10 minutes q3h prn
• Pediatric Dose:
Contraindications: hypernatremia, fluid retention
• Side-effects: hypernatremia, acidosis
• Adverse Reactions: cardiovascular shock, central nervous system disorders, osmotic demy-
elination syndrome, extensive hemolysis, cortical necrosis of the kidneys, severe local tissue
necrosis if administered extravascularly
• Other Notes:
○ Excessive administration of potassium-free solutions may result in significant hypokalemia

Succinylcholine Chloride (Anectine)
• Description: depolarizing paralytic agent; secondary choice for paralytic (primary rocuronium)
• Indications: skeletal muscle relaxant during RSI and mechanical ventilation, facilitate tracheal
intubation

Contraindications: Hypersensitivity to succinylcholine, history of malignant hyperthermia,
skeletal muscle myopathies
• Adverse reactions: Apnea, cardiac arrhythmias, increased intraocular pressure and intracra-
nial pressure, muscular fasciculations
• Note:
○ Onset of flaccid paralysis is rapid (<1 minute)
○ Duration of 4–6 minutes.
• Adult Dosage: 1.5mg/kg (maximum of 150mg)
• Approved Drug Route: IV/IO
• Special Information:
○ Succinylcholine has no effect on consciousness, pain threshold, or cerebration
○ Must be used after adequate sedation
○ In elderly patients, time of onset may be delayed due to slower circulation time
○ Good for 14 days after out of refrigerator

Tetracaine 0.5% Drops
Aviation personnel are grounded for 12 hours after the use of local anesthesia and until
symptoms have resolved enough to allow safe performance of duties.
• Description: local anesthetic
• Indications: as a topical optic anesthetic (may aid in ocular exam to relieve blepharospasm);
removal of foreign bodies

170 n Pararescue Medical Operations Handbook / 8th Edition