Word to the Wise IV
Posted by GruntDoc on April 25th, 2006
…via the in-house code team…
When your patient is extubated (no longer on the ventillator), make sure to cancel the PRN paralytic order.
Just sayin.
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April 25th, 2006 at 10:11 am
… voice of experience? *blink*
April 25th, 2006 at 10:55 am
That depends on the ‘niceness’ of the patient.
April 25th, 2006 at 11:50 am
Another helpful tip. When you take someone off sedation for a weaning trial and they fail, don’t forget to turn the sedation back on. I can’t tell you the number of times I’ve been called to re-intubate someone (at 2am) who took it upon themselves to remove their ET tube a little early. Then the ICU team tells me “we turned off sedation this morning but they failed the trial and we didn’t put sedation back on.”
April 25th, 2006 at 4:35 pm
No kidding on the paralytic. We don’t use Pavulon in the NICU any more, but a combination of (Thank God ET) CPAP, a new RN and a first year resident made for one really dicey couple of minutes. At least all we had to do was turn the IMV back on. I think the resident eventually went into another specialty. I know the RN didn’t last long in the NICU.
April 26th, 2006 at 12:41 pm
HAHAHAHAHAHAHA. Seriously?
April 27th, 2006 at 12:07 am
Please tell me you’re kidding. I mean, we cancel pancuronium orders as routine but… jeez.
April 27th, 2006 at 2:36 am
I wish I was kidding. Good news it was recognized immediately, but the bad news was a crash reintubation.
April 27th, 2006 at 1:23 pm
The NICU order was “Contact HO before giving.” The nurse did. Doc said OK without thinking. I think we may have gone to a “double-check before giving” all Pavulon orders after that.
May 4th, 2006 at 1:11 am
Ummmm….and you would paralyze someone who was NOT intubated, why?
Meaning, wouldn’t someone question that order on an extubated patient? Hopefully?