RSI drug choice in head trauma patient – succinylcholine safe?

We use rocuronium + ketamine for most trauma RSIs now. Ketamine's ICP effects have been largely debunked and its cardiovascular stability is useful in hypotensive trauma patients. Avoid etomidate if adrenal suppression is a concern.

The ICP concern with succinylcholine is largely theoretical — the fasciculations may transiently raise ICP but the clinical significance in most TBI patients is minimal. The rapid onset and offset are valuable if you need to reassess neuro status. Rocuronium at 1.2mg/kg is a solid alternative with sugammadex available.