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samiam
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Paralytic Question
- Thread starter samiam
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medic417
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Agreed on all counts usal. As usual, great minds think alike.
Like I mentioned, I am lucky enough ton have never come across a patient I felt was bad enough for immediate paralyzation then intubation and sedation, but I do notndoubt they exist. I just have a good run of luck...which we all know runs out eventually.
As for controlling emesis during intubation, I agree. I realized I didn't mention anything about that after I re read my post. The idea of controlling emesis during the initial visualization and intubation procedure with the paralytic in combination with the sedative is definitely legit, and at that particular moment, would take precedence over respiratory compliance. All protocols I have worked under call for administration of an antiemetic post intubation for emesis control, and call for re paralyzation only to increase respiratory compliance if necessary. Once the tube is secure aspiration becomes less of a concern (not discounting it, but the concern does decrease...)
I considered going back and amending my post, but I had a bit of concern for being mistake as saying paralytics are used as antiemetics (which I guess is literally true, but only in the case of RSI) and also didn't want to muddy the waters any more.
So yeah...this was a good discussion. I hope it really helped some people out. I am probably getting back in with CMCD now that I'm back from Saudi, so one of these days I might actually see you out there in East Texas to have one of these conversations in person!
Like I mentioned, I am lucky enough ton have never come across a patient I felt was bad enough for immediate paralyzation then intubation and sedation, but I do notndoubt they exist. I just have a good run of luck...which we all know runs out eventually.
As for controlling emesis during intubation, I agree. I realized I didn't mention anything about that after I re read my post. The idea of controlling emesis during the initial visualization and intubation procedure with the paralytic in combination with the sedative is definitely legit, and at that particular moment, would take precedence over respiratory compliance. All protocols I have worked under call for administration of an antiemetic post intubation for emesis control, and call for re paralyzation only to increase respiratory compliance if necessary. Once the tube is secure aspiration becomes less of a concern (not discounting it, but the concern does decrease...)
I considered going back and amending my post, but I had a bit of concern for being mistake as saying paralytics are used as antiemetics (which I guess is literally true, but only in the case of RSI) and also didn't want to muddy the waters any more.
So yeah...this was a good discussion. I hope it really helped some people out. I am probably getting back in with CMCD now that I'm back from Saudi, so one of these days I might actually see you out there in East Texas to have one of these conversations in person!
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samiam
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But how do we know that is not just your cover story?
But how do we know that is not just your cover story?
Everything posted is available elsewhere on the internet if you look. I doubt many will accept this level of risk for a "prank". If anything this thread should discourage that entirely. As for murder, I'm fairly certain if they're intent on killing someone they'll find a way to do it, NMBAs or no NMBAs.
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samiam
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Like I said, Google
It's very possible I've had worse luck than most. My luck has been described to resemble this at times:
Zofran, schmoefran...
Agree, I hope no one would take away that NMBAs should be used as an antiemetic, but stranger things have happened. There's a LARGE group (maybe even the majority) of paramedics who really don't understand what they're trying to accomplish with RSI. The more I see, the more I advocate really taking a long hard look at who's performing assisted intubations in any particular system.
Awsome, good to see your back. Hopefully will run into you. I'm also in the metroplex regularly as I have inlaws up there, maybe we can get together for a beer one day. Stay safe.
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I never turn down an opportunity to grab a beer... Patient care he damned! I believe Linuss was wanting to get together too. We could have the first annual meeting of the EMTLife North Texas Chapter...
You are right. It is the majority of paramedics who don't understand RSI, the very fact is evidenced by nearly all of them calling it rapid sequence intubation., as opposed to induction... I have never been an advocate for pulling field intubation and RSI from the scope of practice, however you can tell a big difference between agencies with medical directors who give a damn, and those that don't... Meaning if an agency has RSI, he medical director needs to be very active. I've been lucky enough to have only worked in agencies like this.
So yeah... beer:30. Tell me when and where, I'm there.
You are right. It is the majority of paramedics who don't understand RSI, the very fact is evidenced by nearly all of them calling it rapid sequence intubation., as opposed to induction... I have never been an advocate for pulling field intubation and RSI from the scope of practice, however you can tell a big difference between agencies with medical directors who give a damn, and those that don't... Meaning if an agency has RSI, he medical director needs to be very active. I've been lucky enough to have only worked in agencies like this.
So yeah... beer:30. Tell me when and where, I'm there.
8jimi8
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It's very possible I've had worse luck than most. My luck has been described to resemble this at times:
Zofran, schmoefran...
Agree, I hope no one would take away that NMBAs should be used as an antiemetic, but stranger things have happened. There's a LARGE group (maybe even the majority) of paramedics who really don't understand what they're trying to accomplish with RSI. The more I see, the more I advocate really taking a long hard look at who's performing assisted intubations in any particular system.
Awsome, good to see your back. Hopefully will run into you. I'm also in the metroplex regularly as I have inlaws up there, maybe we can get together for a beer one day. Stay safe.
At least we can hope that if they are foolish enough to try and use a paralytic to stop emesis, they are also foolish enough to chart it.
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Kind of like a Marine and his rifle...it is amazing to see what one paramedic can achieve with a little motivation and a paralytic.
And yes, they would likely chart it proudly and solicit high fives all around for saving some persons life!
And yes, they would likely chart it proudly and solicit high fives all around for saving some persons life!
usafmedic45
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If he's not a good medic or lets his ego get the better of him, the body count is likely to be similar to that of the Marine and his rifle.
lightsandsirens5
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In which case you would also be a combative head injury pt. Right? Well......sort of right?
Smash
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Rapid Sequence Intubation is a perfectly valid term now, as it has evolved from the original 'Rapid Sequence Induction'
I have never met, and struggle to imagine, a patient so in extremis that it would seem reasonable to take the time to establish IV access, draw up and administer paralytics, but somehow not find the time to give a squirt of something to ease them along. Maybe that is just lucky on my behalf, we haven't been carrying out RSI for very long (only 6 years or so) and we don't do that many (I only average a couple a week).