# Which client should NOT receive succinylcholine for rapid-sequence intubation?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391878&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

Which client should NOT receive succinylcholine for rapid-sequence intubation?

## Option

1. A client with major burns >24 hours old, spinal cord injury >72 hours, or rhabdomyolysis — risk of life-threatening hyperkalemia **✔ Correct answer**
2. A client with hypertension on lisinopril
3. A client with appendicitis and normal labs
4. A client with mild seasonal allergies

**Correct answer: 1**

## Explanation

Correct (2): Succinylcholine causes potassium efflux from muscle. In conditions with upregulated extra-junctional acetylcholine receptors — major burns >24 hours, spinal cord injury >72 hours, prolonged immobility, denervation injuries, muscular dystrophy, rhabdomyolysis — hyperkalemia surge can cause cardiac arrest. Use a non-depolarizing NMBA (rocuronium) instead. (1,3,4) Not contraindications.

## In-depth explanation

Memory Tip Succinylcholine hyperK risk = "Burn·SCI·Stroke·Dystrophy·Denervation·Rhabdo." Safe alternative = rocuronium. Avoid if K already >5.

## Clinical scenario

Scenario ED needs rapid-sequence intubation for a critically ill client; succinylcholine on hand.

## Key concepts

- **Depolarizing NMBA** — Succinylcholine; only depolarizing agent; rapid onset/short duration.
- **Hyperkalemic conditions** — Burns, SCI, rhabdo, prolonged immobility, denervation — avoid succinylcholine.
- **Non-depolarizing NMBA** — Rocuronium, vecuronium, cisatracurium; longer onset/duration than succinylcholine.

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