Quote from Diprivan/Vented
Is it possible to titrate paralytics so that they can still breathe but remain immobilized?
Holy cow, I know you are just asking a hypothetical question, and I admire your willingness to learn. But this is a great illustration of why these drugs are only for intubated patients, when they are used in the ICU.
Not all muscles respond uniformly to muscle relaxants. My memory is dim (students, help me out here), but I think the respiratory muscles are MORE sensitive to the effects of relaxation. This explains why you can have a patient who looks fully reversed, but has insufficient respiratory effort.
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.
And speaking of insufficient respiratory effort, morphine is a strong respiratory depressant. It is not the first drug I would think of in this scenario, but I know these types of patient are a bear to manage. I remember it well, trying to keep the old lungers off the vent. It is a tribute to great nursing care any time it can be done successfully.
I know you were concerned about safety, and keeping him in the bed. But don't these type of patients need all their strength to keep the respiratory effort going? Sedation in these patients is a real balancing act. I used to really like benadryl in this type of situation. Very calming, but no respiratory depression.
some dumb RT said he might be retainin C02 and suggested I do an abg. His abg was fine.
Well, I guess I am dumb as the RT. If the tidal volume was on the small side, a drop in RR could well lead to CO2 retention, especially if this was a patient already at risk for it. And what if the agitation was a sign of hypoxia? If nothing else, ABGs are a good to CYA that you haven't missed anything.
Sort of a "defensive nursing" practice.
An interesting case discussion, thanks for sharing it.