I am a new grad working in an ICU, and I just had a general neuro question.
If a patient is on Diprivan and Nimbex, and their pupils are not reacting to light, is it related to the paralytic/sedation? I always thought that since it was a natural reflex, that it was not related. However, there seemed to be some confusion between what the doctor said and what my preceptor and her other nurse friend told me. The MD said that maybe the reason the patient's eyes weren't reacting was due to the paralytic, but then the nurse told me later that that wasn't true; pupils would react regardless. Any clarification on this???
Thank you in advance :)
P.S. Anyone who wants to cross their fingers for me would be great... NCLEX on 3/22
I'm not too sure what a Ramsay score is. Is it something to do with TOF (Train of Four?) We were titrating the Nimbex up or down to make sure there were 2 out of 4 twitches. ... is this the same as a Ramsay score? And yes, I would love to get to the bottom of this!!
CRNAs.... HELP
To the best of my limited knowledge, a Train of Four is a subjective determination of a response to a paralytic and a Ramsey Score is used as an objective determination of the level of sedation:
Ramsey Scale
1. Anxious and agitated or restless, or both
2. Cooperative, oriented, and tranquil
3. Response to commands only
4. Brisk response to light glabellar tap or loud auditory stimulus
5. Sluggish response to glabellar tap or loud auditory stimulus
6. No response to glabellar tap or loud auditory stimulus
Of course, CRNAs could better tell us the difference HINT...HINT....HINT :confused: :bowingpur :bowingpur :confused:
So, the question now seems to be:
If a patient is producing 2 out of 4 twitches using the Train of Four and/or demonstrating a 5-6 on the Ramsey Scale, should we expect to find unreactive pupils in that patient?
Or: Does oversedation with Diprivan and/or Nimbex cause unreactive pupils?
The Train of Four we used was with a little box that had positive and negative (red and black) cords hooked up to electodes on the patient's temple. I have heard that it can also be used on the wrist. You can dial up a little dial on the side on the box and it sends a small electrical impulse and you see how many times the patient's eye twitches when the impulse is sent. Typically I think you see four twitches, and thats why it's called Train of Four. Again, I'm very new to this as well. Wouldn't this be an objective instead of subjective test though? I would think that the only subjective part about it would be the interpretation of the twitches by the observer. Anyways, yes you have the questions right, those are the main questions I have and hopefully the CRNAs will see this within the next century! haha.
Is there any way we could get this attached to the CRNA thread or something? This is making me crazy!!
Oops :smackingf , You have it right and I said it backwards. I meant that the Ramsey is subjective while the Train of Four is an objective test. Glad you caught that before all the CRNAs out there that are going to help us only focused on my mistake rather than helping us understand this dilemma we are having
loricatus
1,446 Posts
To the best of my limited knowledge, a Train of Four is a subjective determination of a response to a paralytic and a Ramsey Score is used as an objective determination of the level of sedation:
Ramsey Scale
1. Anxious and agitated or restless, or both
2. Cooperative, oriented, and tranquil
3. Response to commands only
4. Brisk response to light glabellar tap or loud auditory stimulus
5. Sluggish response to glabellar tap or loud auditory stimulus
6. No response to glabellar tap or loud auditory stimulus
Of course, CRNAs could better tell us the difference HINT...HINT....HINT
:confused: 
:bowingpur :bowingpur 
:confused:
So, the question now seems to be:
If a patient is producing 2 out of 4 twitches using the Train of Four and/or demonstrating a 5-6 on the Ramsey Scale, should we expect to find unreactive pupils in that patient?
Or: Does oversedation with Diprivan and/or Nimbex cause unreactive pupils?
Did I get the questions right?