Succinylcholine - dosed on TBW

Rocuronium - dosed on IBW

RSI in Myasthenia Gravis

Less susceptible to depolarizing-NMB (may need to double the usual dose of succinylcholine)

More susceptible to non-depolarizing NMB (avoid rocuronium, vecuronium, etc)

CDC - Vaccines

INFLUENZA:

a. All persons aged ≥6 months

PNEUMOVAX:

a. All adults 65 years old or older.

b. Other Patients (2 to 64 years old) WITH high risk conditions:

Timing: Usually just one dose in their lifetime. In addition, one-time pneumococcal revaccination recommended for all patients eligible if >5 yrs since last dose and the initial dose was given when patient was less than 64 years old.

Other Patients (2 to 64 years old) WITH following high risk conditions:

1. Diabetes mellitus

2. Chronic disorders of cardiovascular system(CHF)

3. Chronic disorders of pulmonary system(COPD, Asthma)

4. Nephrotic syndrome

5. Chronic renal disease(ESRD)

6. HIV

7 Asplenia

8 Sickle cell disease

9. Chronic liver disease

10. Liver disease as a result of alcohol abuse

11. Immunosuppressive conditions - ≥19 years - (congenital immunodefiency, leukemia, lymphoma, multiple myeloma, Hodgkins disease, generalized malignancy, organ or bone marrow transplantation, chemotherapy with alkylating agents, antimetabolites, high dose long term steroids)

12. Cerebrospinal fluid leaks

13. Cochlear implant surgery

14. Alaska natives, certain American Indian populations

15. Nursing home or long term care residents

Persons who smoke cigarettes

Contraindications/Caution

Pregnancy

Category C - given to a pregnant woman only if clearly needed

Caution when administered to a nursing woman

Pediatric Use

Not indicated in children less than 2 years of age

Meningitis

for meningococcal vaccine with their healthcare provider. In addition, screening for HIV and sexually transmitted diseases (STDs) including syphilis is encouraged for any of these men who have not been tested in the past 6 months.

Meningococcal vaccines protect against N. meningitides serotypes A, C, W135, and Y. Menactra (Sanofi Pasteur) or Menveo (Novartis) conjugate vaccine should be used for adults ≤55 years of age. HIV-infected individuals should receive two vaccine doses, with the second dose administered eight weeks after the first dose and no less than six weeks. For individuals 56 years and older, one dose of Menomune (Sanofi Pasteur) polysaccharide vaccine is recommended.

Medications