[Doczilla]

Sounds like a shit sandwich, but I can't see it going another way. Bad stuff just happens sometimes. I might have gone for a gum elastic bougie after seeing the swollen cords. I don't see a problem with the ketamine, since it will provide some analgesia as well as settle the kid down. I don't have bad feelings either about a depolarizing paralytic in a head injury. I think the greater risk of a spike in the ICP comes from rooting around in the airway of a patient who is inadequately relaxed. My feeling with the sux is to go with a nice big dose early. I don't give defaciculating doses of nondepolarizing paralytics anymore. If you're that worried about it, you can use rocuronium (if you've got it) instead of the sux, which will have a similar time to onset of action. I agree with Priest about the size of the kid. Average size for that age will be about 35-40kg, with some great variation due to timing of the adolescent growth spurt. Still, that's a big kid. I wouldn't think to pull out the broselow tape on a kid that's 5'7", no matter what the family said about how old he is.

'zilla