A patient in the emergency department requires rapid sequence intubation. Succinylcholine 1.5 mg/kg IV is given. Which of the following is a CONTRAINDICATION to its use?
- A Full stomach
- B Hypotension
- C History of crush injury 48 hours ago ✓
- D Anticipated difficult airway
Explanation
Succinylcholine causes depolarization-induced release of potassium from skeletal muscle. In patients with crush injuries, denervation, burns (after 24–48 hours), prolonged immobilization, or upper motor neuron lesions, there is upregulation of extrajunctional acetylcholine receptors, dramatically amplifying potassium efflux and risking life-threatening hyperkalemic cardiac arrest. This risk develops from approximately 24–72 hours after injury and persists for months. Full stomach is actually an indication for rapid sequence induction using succinylcholine, not a contraindication.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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