Paralytic Question

samiam

samiam

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How quickly and how much effect do the paralytics that you EMT-P's use for RSI etc have on patients. If you were to give it to a conscious standing patient would they just drop to the floor in a matter of seconds?
 
Depends on the paralytic, the patient, and the route of administration.

It usually isn't administered to a patient standing up though. I'm curious where you are going with that one.
 
It is in response to a doc threatening to give a guy a dose of rocuronium to a patient who was going crazy and threatening all of the nurses (he said this to me not to the patient) would it completely paralyze if given IM in the deltoid or does it have a more local effect? When you give it for RSI IV what does it paralyze?
 
give me 5 minutes and Ill tell you, if I can still type. :rolleyes:
 
Paralytics paralyze everything but are poor choices in the situation described for several reasons including liability and ethical issues but especially because for a minute to several minutes you have to deal with a patient who is now even more pissed off.
 
samiam said:
When you give it for RSI IV what does it paralyze?
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Everything. Can't move a muscle, and God forbid if they're still awake, they can't move their eyes or any other muscle in their body for the duration of the drug (Succs mere minutes, Roc and Vec much longer)
 
Succs will be effective in a minute or so. Roc will be effective in 3-5 minutes, I believe. I think IM is probably a poor way to distribute the medication systemically, but maybe that guy wouldn't let them start a line?
 
on a side note, do any of the paralytics have sedative properties? for instance if you give ROC and used amidate or versed to induce ALOC, how do you know when the patient needs to be re dosed with a CNS depressant. in the ER we used succs and amidate, and gave 5mg versed when the patient started to move. propofol was only used in the ICU.
 
Linuss said:
Everything. Can't move a muscle, and God forbid if they're still awake, they can't move their eyes or any other muscle in their body for the duration of the drug (Succs mere minutes, Roc and Vec much longer)
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If I'm correct, this is the reason a sedative/propofol like drug is given directly before the paralytic? To avoid the terrifying feeling of being paralyzed and awake. But if there awake god forbid, they also would be unable to breath correct?

Also question: if someone is already unconscious for an intubation is there not a need for a paralytic?... Being only a paralytic is necessary if the patient is conscious and alert to begin with?
 
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First you should know by the dose and type of medication. 2nd, any patient who is going to be monitored on a paralytic should have an adequate sedation package, meaning ADEQUATE pain control (imo at least 1mcg/kg/hr fentanyl is my fav) plus a little bonus sedation and the paralytic. We monitor our paralyzed patient's for adequate paralysis using a handheld train of 4 device. So you know when your paralysis is ineffective.
 
No paralytic has sedative properties.

We anaesthetise using fentanyl, ketamine and if required post-intubation, midazolam.
 
thanks brown, one would think that they would have tought me that at the paramightbe patch factory.
 
Are you sure the doc wasn't just joking/venting?

1. Its an absurd method of chemical restraint.
2. Its a particularly common joke because its so absurd.


On the topic of sedation, I've noticed some (mostly ICU it seems) docs are of the opinion that the particularly unstable pt will get paralysed without bothering to sedate first. "Sux and an apology" one doc said with a wry smile.
 
Melclin said:
Are you sure the doc wasn't just joking/venting?

1. Its an absurd method of chemical restraint.
2. Its a particularly common joke because its so absurd.


On the topic of sedation, I've noticed some (mostly ICU it seems) docs are of the opinion that the particularly unstable pt will get paralysed without bothering to sedate first. "Sux and an apology" one doc said with a wry smile.
Click to expand...

Yah watched one of my intensivists visualize the cords in a completely axox4 pt. Quite shocking, he didn't even have to apologize we coded him and then withdrew.
 
8jimi8 said:
Yah watched one of my intensivists visualize the cords in a completely axox4 pt. Quite shocking, he didn't even have to apologize we coded him and then withdrew.
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Y'all intubated an awake person, worked them as an arrest and they didn't make it?

Locally here we do a fair number of transfers from ers to other ers or ICUs. The docs were bad about doing the RSI then giving no more sedation or paralytics. We were getting these patients on vents that all over the bed and fighting. We had to resedate and reparalyze alot of folks. Lately everyones been on diprivan and nicely sedated.

I remember being told in medic school it's on the verge of malpractice to paralyze before sedating. Sounded harsh at the time but not so much now.
 
He only visualized he didnt intubate at that time. intubated him subsequently after showing the family 1 code, they decided to withdraw.
 
8jimi8 said:
He only visualized he didnt intubate at that time. intubated him subsequently after showing the family 1 code, they decided to withdraw.
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Makes sense. Figured there was something to it.
 
Melclin said:
Are you sure the doc wasn't just joking/venting?

1. Its an absurd method of chemical restraint.
2. Its a particularly common joke because its so absurd.


On the topic of sedation, I've noticed some (mostly ICU it seems) docs are of the opinion that the particularly unstable pt will get paralysed without bothering to sedate first. "Sux and an apology" one doc said with a wry smile.
Click to expand...

He was joking for sure I was just curious if it would actually work.
 
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