[interleukin]

That situation is radically different. That doctor and nurse who gave the drug essentially killed a patient who was dying. The difference in huge.
They did not properly prepare the family and have the proper drugs at the ready.
That doc should have been fired.

[Noryn]

Originally Posted by interleukin

That situation is radically different. That doctor and nurse who gave the drug essentially killed a patient who was dying. The difference in huge.
They did not properly prepare the family and have the proper drugs at the ready.
That doc should have been fired.

The same argument can be made with Diprivan, it will cause respiratory arrest as well. What is similar to me is that each were given a drug that typically is not within the standard of care for a dying patient yet each drug is used for anesthesia purposes. I dont think either goal was to "kill" the patient rather alleviate suffering but either way these are generally poor choices as both medications will not treat pain.

The Diprivan at least does have some sedative properties. I dont know what that doctor was thinking by giving a paralytic.

[meandragonbrett]

I think the key word is that propofol CAN cause respiratory arrest but it's not 100% going to cause it running at a few mcgs. Vecuronium will ALWAYS cause resp. arrest 100% of the time.

[Noryn]

Originally Posted by meandragonbrett

I think the key word is that propofol CAN cause respiratory arrest but it's not 100% going to cause it running at a few mcgs. Vecuronium will ALWAYS cause resp. arrest 100% of the time.

Yeah I agree that Diprivan at low doses wont necessarily cause resp depression--I have seen it used in elective cardioversion. But I may be getting senile but when I gave it years ago for the purpose of sedation on the vent, pt generally did not breathe over the ventilator and were pretty snowed. Unless I am missing something I think the same dose used to sedate for the vent was continued on the OP's patient after extubation.

[mommy2BCD]

What do you all think of 1mg Dilaudid q10 min. after extubation on a withdrawl pt????I am a newer nurse and am still very uncomfortable with the whole "withdrawl" process. I feel that ultimately, yes, I should make my pt. comfortable but I, as do all the nurse who push multiple doses of Dilaudid and Morphine know that they can cause severe resp depression and ultimately death. I don't know?? I don't look forward to the day I have to do this. To the OP at out facility we do not leave on Diprivan gtts, we give multiple doses of Dilaudid, Morphine, Robinol etc. Also just wanted to add, Morphine q30 min??? From what I have seen that is a crazy long time! Our orders during extubation never have more than a 5-15 min. time frame. I don't know if this is "right" or not? Like I said I am still in orientation, haven't actually pushed end of life drugs myself.

[NurseCutie]

Thank you for bringing that up. Morphine and other narcotic pain meds can cause resp depression speeding up death. I think other posters were upset because Diprovan does not help with pain. My pt never appeared to be in pain, he was completly unresponsive w/o the Diprovan,but was actively agonal breathing with the vent. That's why the Dr. wanted to leave the Diprovan on. I know 5mg Q 30mins doesn't sound like alot...its actually 10mg every hr. If I had gotten a Morphine gtt the dose he would have provided would be only 3mg/hr...so it was more than the norm for this specific facility.

[nurseabc123]

I haven't read much of this thread, but I have taken care of several patients of which we have withdrawn support on my shift. I did this just yesterday.

I find it extremely rewarding to help someone 'die with dignity' and support a family in a time of terrible grief. It's especially refreshing when a family member actually acts upon their family member's (the patient's) wishes and does withdraw.

I find it more difficult to take care of a patient that did not want to be re-intubated/full-code, etc. and the family goes ahead against his/her wishes.

I have worked with both of these types of situations.. I would rather help someone die, than keep them alive against their wishes.

Upon extubation, I give as much ativian/morphine as I can and as frequently as I can, as ordered.

[newohiorn]

I'm new to neuro ICU but, in my opinion, I don't think you did anything morally wrong but I'm not familiar with the law with regard to Diprivan in this situation.

I do think that Diprivan provides comfort because it is a sedative-hypnotic and this to me indicates that it would help with relaxation, which I consider comfort. I do not think providing comfort always means pain relief as in a narcotic. In fact, to me, if the patient does not appear to be in pain I think it makes more sense to provide comfort in the form of anxiety relief and relaxation than it does to snow someone with narcotics.

My interpretation of the original post was that the patient didn't seem to be in pain, although I realize we can't know that but I think we have to treat as best we can based on our assessment. I don't think we know for sure that dying from withdrawal of care would necessarily be painful but to me it seems that it would be more anxiety and even panic producing, which I think is better controlled with meds for those conditions than meds for pain like narcotics.

Just my 2 cents

[NurseCutie]

My sediments exactly. This is the point I've been trying to get through to everybody else who thinks my position on this was wrong. Thanks

[newohiorn]

NurseCutie,

You're welcome. I wasn't sure I was getting my point across but it sounds like maybe I did.

I formerly worked on a spinal surgery floor where EVERYBODY is in pain. One of my biggest surprises in neuro ICU is how many of the patients deny pain. I realize they have brain issues so maybe they aren't able to express themselves but pain seems to be a relatively rare issue in neuro ICU compared to where I came from where I jokingly described myself as a licensed drug dealer.

I guess my thought is that if I were A&O and having care withdrawn from myself I wouldn't want to be snowed on narcotics but rather I would like anti-anxiety meds so that I'm alert (if possible) but not panic-stricken.