Studying for my CRNA school interview on Tuesday and I'm watching a ton of your videos to prepare. Thanks for being awesome! Keep making more ICU medication videos
This is incredibly helpful! You explained this really well and very much nursing focused. I can't find any other channel as good as yours. I am currently in critical care nursing program. Would love it if you could do a video on other paralytics (e.g. sux) as well, if you haven't. Thank you for what you do!
So great to hear this Bonnie! I'm really happy you have found the channel and are finding the videos helpful. I don't have any other paralytics yet as a part of this single med focused "CC Meds" series. I do have a playlist in the "ICU Drips" series, with a 4 (?) part discussion of paralytic infusions. I will be working to cover many more meds individually focused like this over time though. 😊
@@ICUAdvantage thank you I will for sure check those iv drips series out! My colleague did a presentation on CRRT using your videos. Super impressive. Keep up the amazing work and thanks again!
Had my first patient on a Roc drip with pressors/sedation/vented (I’m new to the ICU) and did a neuro exam at the start of shift with no pupillary reflexes and fixed at 4mm bilaterally. I asked my preceptor if that was typical for paralytics and he dismissed it as it wasn’t a big deal. It made me nervous the rest of the day as I had 0 twitches with TOF on his ulnar and facial nerves even between titrating Roc down every few hours. Lo and behold, he coded twice on my shift and I’m wondering if he was already brain dead when I received him.
Great content as always. I'd be interested to hear your real life experiences with these medications, especially in emergency situations. Could be vid's by themselves or tagged onto the end of other ones.
LOL well I'd argue that I'm no different than anyone else who has been doing this for years. I do ensure that I do some research and planning before each video so I can try and hit all the points appropriately 😊
As a student this really enhance my knowledge for a code Thank you Can you be my RN preceptor to finish my last 129 clinical hours if your in the state if California?
Hi Eddie, thanks so much for this video. Can u please do a whole video on TOF. I had a pt in a prone position and Rocuronium Drip started on the pt and whilst get report I said I’m not taking the pt without a TOF and it was a big issue
You're very welcome Agnes. In that situation, why was it a big issue? Its really important to have that done, before hand and then checked regularly to ensure 1) that we are paralyzing too much and 2) that we are paralyzing enough. Not sure why it wouldn't have been being done nor why it was such an issue to have it.
Hi Eddie, I binged watch your videos and I find it very useful especially for a nurse outside the US who seeks a job there. Question, is there any way to check the effectiveness of Roc aside from TOF? Here in our hospital in the Mid East, we are not using that. I feel concerned that I am not helping my patient due to this. 🙁
Hi Cess! Glad to hear these are helpful for you! Sorry for the slow response. To you question, I am not aware of another way to truly check effectiveness. We can kind of assess things like reduction of spontaneous breathing, loss of cough, no observable movements, etc, but I don't know if these would let us know if we've gone too far with blockage.
In our institution , doctors prefer not to dilute Rocuronium or Atracurium when given as continuous infusion, so it will be more effective according to them. What do you think? Does that matter?
and how then its given? I mean just full perfussor with Rocuronium? and secondly,for how long has been given continuous infusion at your place? in my clinic its just always as bolus every 1-2 hours, depends from miorelaxant.
I personally have never heard this. We have always used diluted paralytics without any issue. It seems to work just fine and the doses are as expected. Sometimes we just do repeated push doses, but if that is going to go on, then we move to the drip.
Does Roc or nimbex have an effect on the muscles of the gut and/or bladder? A general concern for patients on a continuous drip over a long period of time:
Great question. So NMBAs should have minimal if any effect on smooth muscle. There doesn't seem to quite be a consensus, but it seems as probably not much impact. That said, the immobility can lead to slowed gastric motility.
