Trismus

[NomadicMedic]

If the pt is getting inflations down into the chest without an airway and you place a surgical airway and then resuscitate, won't it blow out the oro-nasopharynx instead of inflating the pt's lungs?

No. You place an ET tube with a cuff to keep ventilations from escaping and to hopefully prevent further aspiration.

 

[mycrofft]

Oh, I was still thinking "Father Mulcahey and Radar" cric. Good!

 

[triemal04]

Unless you've had the sux out for quite a while, I would expect it to work, and especially with a 2nd dose. It's not like it just suddenly stops working at X number of weeks after taking it out of cool storage. It loses potency slowly. There's no telling how long our pre-filled sux syringes stay on our anesthesia carts. They're stored at room temp for long periods of time and would only be tossed if they pass the manufacturer's expiration date on the label. I have far more problems with lousy roc than I ever have issues with sux.

Sure, I get that, and with a couple doses given I agree that not having ANY change would be odd. It just seems that the first thing to consider in this case would be the simplest and easiest correctable solution, which would be that, for whatever reason, the sux isn't working, and to try something new. As the OP described it the pt was allready apneic, so you can't even gauge if there'd been an effect by looking at their respiratory rate/pattern.

I don't know if there's more info out there, but the abstract I linked to, while only showing pretty small decreases in strength after 4-6 weeks at 25C did mention that at 40C the rate was higher. I don't know how the OP's department works, but it's far from unheard of for rigs parked in an apparatus bay to get damned hot during the summer months. Hitting 100F might be pushing it, but over 75F would be pretty routine until the engine was turned on. For people keeping sux uncooled until the manufacturers expiration (as it appears the OP does) something to think about.

And I'm still very curious if/when the ER doc pushed his own paralytic, and what it was.

 

[sleepless near seattle]

Sure, I get that, and with a couple doses given I agree that not having ANY change would be odd. It just seems that the first thing to consider in this case would be the simplest and easiest correctable solution, which would be that, for whatever reason, the sux isn't working, and to try something new. As the OP described it the pt was allready apneic, so you can't even gauge if there'd been an effect by looking at their respiratory rate/pattern.

I don't know if there's more info out there, but the abstract I linked to, while only showing pretty small decreases in strength after 4-6 weeks at 25C did mention that at 40C the rate was higher. I don't know how the OP's department works, but it's far from unheard of for rigs parked in an apparatus bay to get damned hot during the summer months. Hitting 100F might be pushing it, but over 75F would be pretty routine until the engine was turned on. For people keeping sux uncooled until the manufacturers expiration (as it appears the OP does) something to think about.

And I'm still very curious if/when the ER doc pushed his own paralytic, and what it was.

No further paralytic in the ER. Just the prying with tongue blades as described originally. The jaws then stayed right where he put them without the aid of a bite block. Although not unheard of, it rarely reaches 80F on the Pacific Northwest Coast.