American Association of Critical-Care Nurses (AACN) Certification Practice Test

Which sedative is approved for rapid sequence intubation in patients with hypotension?

1. Propofol

2. Etomidate

3. Midazolam

4. Ketamine

The correct answer is: Etomidate

Etomidate is the correct choice for rapid sequence intubation in patients with hypotension due to its pharmacological properties that minimize cardiovascular effects. Unlike other sedatives, etomidate primarily acts as a sedative without significantly affecting hemodynamic stability. This is especially important in patients who are hypotensive, as maintaining blood pressure is a critical consideration during intubation procedures. Etomidate is characterized by its rapid onset and short duration of action, making it suitable for procedures where quick sedation is required. Its minimal cardiovascular effects help prevent exacerbation of hypotension, which is particularly beneficial in already unstable patients. Other sedatives, while effective in general, do not provide the same level of safety in terms of hemodynamic stability. For instance, propofol can cause significant hypotension and has a longer duration of action, which makes it less ideal in rapid sequence intubation scenarios. Similarly, midazolam, while it has sedative properties, also may lead to respiratory depression and hypotension. Ketamine can cause increased blood pressure and heart rate, which makes it less preferable for patients experiencing hypotension.