Ramblings of an Emergency Physician in Texas
…via the in-house code team…
When your patient is extubated (no longer on the ventillator), make sure to cancel the PRN paralytic order.
No related posts.
… voice of experience? *blink*
That depends on the ‘niceness’ of the patient.
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.”
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.
Please tell me you’re kidding. I mean, we cancel pancuronium orders as routine but… jeez.
I wish I was kidding. Good news it was recognized immediately, but the bad news was a crash reintubation.
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.
Ummmm….and you would paralyze someone who was NOT intubated, why?
Meaning, wouldn’t someone question that order on an extubated patient? Hopefully?
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