Ep 106 - Succ vs Roc in Hyperkalemia

About this episode

Dr. Jarvis discusses the implications of using succinylcholine versus rocuronium in hyperkalemic patients based on recent research.

We were all taught succinylcholine is contraindicated in hyperkalemia because it can cause potassium release, exacerbating the problem. But does it? Does it really? Dr. Jarvis discusses a recent paper that seems to compare mortality within 24 hours of RSI in hyperkalemic patients between those intubated with succ or rocuronium. And then we discuss methods.. including the Table 1 Fallacy. Citations: 1. Simmer PE, Perza M, Cho YD, et al.: Hyperkalemic emergency department patients intubated with rocuronium or succinylcholine: Retrospective study of clinical outcomes. The American Journal of Emergency Medicine. 2026; February;100:154–64. 2. Cole JB, Knack SKS, Driver BE: The value of P-values in “Table 1.” The American Journal of Emergency Medicine. 2026; February;100:182–6. 3. Pappal RD, Roberts BW, Mohr NM, et al.: The ED-AWARENESS Study: A Prospective, Observational Cohort Study of Awareness With Paralysis in Mechanically Ventilated Patients Admitted From the Emergency Department. Ann Emerg Med. 2021;77(5):532–44. 4. ‘Rick & Jerry’ Pass the Baton | Emergency Physicians Monthly. Available at https://epmonthly.com/article/rick-jerry-pass-the-baton/ . Accessed January 25, 2026.

People in this episode

Guest: Dr. Jarvis

Topics covered

• hyperkalemia
• succinylcholine
• rocuronium
• RSI
• mortality
• emergency medicine

Keywords

• hyperkalemia
• succinylcholine
• rocuronium
• RSI
• mortality
• emergency medicine
• potassium release
• clinical outcomes

Mentioned in this episode

Organizations: The American Journal of Emergency Medicine, Emergency Physicians Monthly

Books & works: Hyperkalemic emergency department patients intubated with rocuronium or succinylcholine: Retrospective study of clinical outcomes, The value of P-values in “Table 1.”, The ED-AWARENESS Study: A Prospective, Observational Cohort Study of Awareness With Paralysis in Mechanically Ventilated Patients Admitted From the Emergency Department

More episodes of The EMS Lighthouse Project

• Ep 111 - The TOWAR Trial w Dr Frank Guyette, Part I · May 26, 2026 · 39 min
• Ep110 - Smida Defends Resuscitation, Part II · May 3, 2026 · 51 min
• Ep109 - Smida Defends Resuscitation, Part I · April 12, 2026 · 59 min
• Ep108 - 3 Pods In 1 · March 18, 2026 · 51 min
• Ep107 - 3 Papers With Dr Crowe · February 15, 2026 · 57 min
• Ep 105 - The RSI Trial · December 14, 2025 · 40 min