thoughts on only Paralytic while intubated....

[MassED]

I am just wondering how common and cruel the practice is of using only paralytics while a person is intubated in the ER. I took care of a guy last night that we gave Norcuron 10 mg which wore off in 30 minutes each time... and the doc never ordered anything else, despite my asking.... they don't use Diprivan where I work, which I find odd... only in the units.

So, my question being... how common do ER nurses see this occur? Wouldn't this make for a horror story for the patient, once extubated, being paralyzed and aware??? Yikes... my poor guy. I kept talking to him - I saw tears... really made me mad.

[BrnEyedGirl, BSN, MSN, RN, APRN]

I refuse to give a paralytic without sedation,...period. In the ER where I work, we often hang Diprovan on our intubated patients, so it isn't often a problem. If I have a doc order a paralytic alone, I smile sweetly and ask what sedation would you like with that,..if I get hesitation I smile again and say "that's the stuff that gives me nightmares,..can you just order sedation to keep your nurse happy?",...works every time!

[Anna Flaxis, BSN, RN]

I have never seen this done. We typically use etomidate, sux, then propofol gtt for sedation and fentanyl for pain.

Only once, the doctor (who is no longer working in our ED), ordered the paralytic first, and THEN the sedation. I questioned it, my charge nurse questioned it, and his rationale was that the sux takes longer to take effect, so he wanted to give it first.

[jelly221,RN]

I refuse to give a paralytic without sedation,...period. In the ER where I work, we often hang Diprovan on our intubated patients, so it isn't often a problem. If I have a doc order a paralytic alone, I smile sweetly and ask what sedation would you like with that,..if I get hesitation I smile again and say "that's the stuff that gives me nightmares,..can you just order sedation to keep your nurse happy?",...works every time!

Oh thank god for nurses like you. I'm transferring to our CVICU in a couple of months and this was actually a test ??- NEVER administer paralytics w/o sedation. I try to tell everyone I know that if I'm ever in this situation, I want to be completely gorked on Propofol/Versed/whatever is new.

PS- I might steal your technique!! =P