Is it possible to titrate paralytics? - page 5

Is it possible to titrate paralytics so that they can still breathe but remain immobilized?... Read More

  1. by   georgia_aa
    do they swipe with alcohol before they start the IV??
  2. by   athomas91
  3. by   bobogirl33
    I guess that I didn't access my search correctly. I was looking for information about titrating off Nimbex in a patient with severe ARDS. He had been on Nimbex for three days and they were wanting to titrate off the paralytic but to stop if he began to desaturate. Of course the patient is intubated with sedation and the ventilator is breathing for him. Just looking for information as to what are the things to look for when taking this medication off. I have dealt with Propofol before in similar situations in intubated patients only. Interesting reading all of your comments on this subject.
  4. by   ssrhythm
    Quote from Diprivan/Vented
    The other day I was doing conscious sedation on a patient with morphine. He was agitated, trying to get out of bed, trying to leave the hospital, but completely confused (didn't know place or date). They had just extubated him, a bit prematurely, and he was having a hard time keeping his airway clear. I tried to educate him on coughing and deep breathing, but he was too confused. So I sedated him on morphine. His breathing dropped from 30's to mid teens, O2 sat remained in the low 90's, so I kept him on 2L NC, and nasally suctioned him, but even then, he could still move as I inserted the catheter. A few hours after I suctioned him, his temp dropped from 38.1 to around 37.2. Oh yeah, and some dumb RT said he might be retainin C02 and suggested I do an abg. His abg was fine.

    That answer your question as to why?
    I will return to read this entire thread when I have the time, so if my comment is beating a horse y'all have already dispatched of, sorry. I'm and RT, RN and soon to be CRNA, and this is precisely why there is such a riff between RTs and RNs and MDs etc in so many institutions. The RT had a very valid point and likely understands pulmonary pathphysiology and ventilation to a much greater degree than the majority of the practitioners in the hospital. From everything you've said, he/she certainly understands it better than you do. While I admire your outside-the-box thinking, follow up on that thinking will absolutely show that titration of paralytics on a non-itnubated patient for the sake of keeping him still is a quick path to disaster for the patient, the hospital, and for you. Now... of the greatest personal attributes one can posses. Humility allows you to understand when you don't know something for certain. It will allow you to open your mind to the fact that others in your work environment may just understand a situation to a greater degree than you despite the fact that they may have what you consider a lesser amount of education. Humility in a team care environment is GOOD FOR THE PATIENT, and everyone on here should realize that ultimately, that is what it's all about.
  5. by   misscece
    I'm sorry I didn't read all the postings that are attached but what do you mean by "he couldn't keep his airway clear"? If his airway could not be kept clear, neither sedation - and definitely a paralytic (which I would never give without an airway) - would help. My other question is, where was the doc in all of this? Why were you and the RT trying to figure this out instead of paging the pulmonologist? And why give a respiratory depressant to someone who is having breathing difficulty? Just wondering....
  6. by   NurseKitten
    Just my 2 cents - the LES opening pressure is ~20 cm H20, so I was taught as long as your PIP is significantly under that, you could use MV on LMA'ed patients. One of my favorite alternatives, personally, is to titrate PIP's on pressure support with IMV, and just augment what they're doing on their own. A little trick I learned from an RT/CRNA. Works like charm.
  7. by   Darkfield
    I'm guessing the original poster doesn't actually know what a paralytic is-it is completely inappropriate to suggest for a post-extubation pt. The fact that the nurse in question's response to confusion is to "sedate" tells me a little bit about his/her knowledge.