thoughts on only Paralytic while intubated....

1 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.
Wow... thats terrible!I've only seen it done with paralytic and sedation.... I can't imagine not having both.Is it always this way, or was there some reason he couldn't have sedation as well?

Quote from beachbum3Wow... thats terrible!I've only seen it done with paralytic and sedation.... I can't imagine not having both.Is it always this way, or was there some reason he couldn't have sedation as well?

yikes!! i always always do paralytic with sedation/amnestic. i cant imagine being fully alert while being intubated and paralyzed. why couldnt he just give a little versed or valium?? that sounds really uncalled for on the MD's part....

There is something seriously wrong with that. As a matter of fact, I would've had a problem administering the paralytic without sedation. Sounds to me like the Ethics Committee needs to be involved with this practice.

How sad!Drs have tried this with me. After intubation I say, "so, do you want fentanyl or versed?"If they ask why I need sedation, I usually say something like, "because we don't paralyze without sedation here". If I get any static, then I start busting out words like, 'standards of care' ..... If the Dr still says no my next question will be, "who is your attending?"This is actually one thing I really will go up the chain for. My pts will not be without sedation while paralyzed.

that is just outright barbaric.time to vent this md and give him a taste of his own medicine.leslie

I don't know about ER's. I was once tubed, for three days, on a paralytic, without sedation. When I was extubated, I told the senior resident, who I knew, I would kill him if he ever did it to me again. For a patient it is one of the most frightening things that can happen. You are able to think and worry about all the bad things that can happen. I can't imagine anything worse being done to a patient. And it certainly puts a fear into them, the next time they are to undergo it.Woody

I agree with everyone else - how cruel! I often find that docs will only order sedation for vented patients; at times, I have to ask them for a paralytic. But I've never had it the other way around. Of course, in the ED your main focus is to stabalize the patient and get them up to ICU ASAP. You usually don't have the time play around with titrating optimal sedation settings, but to not even attempt to GIVE sedation? That's awful.You should see if there's a P&P regarding this issue. I would have charted "Pt appears uncomfortable, biting ETT, movement noted. Writer notified Dr. Jones regarding pt's appearance and need for sedation; no orders received from Dr. Jones."

Quote from woody62I don't know about ER's. I was once tubed, for three days, on a paralytic, without sedation. When I was extubated, I told the senior resident, who I knew, I would kill him if he ever did it to me again. For a patient it is one of the most frightening things that can happen. You are able to think and worry about all the bad things that can happen. I can't imagine anything worse being done to a patient. And it certainly puts a fear into them, the next time they are to undergo it.Woody

Quote from kmoonshineI agree with everyone else - how cruel! I often find that docs will only order sedation for vented patients; at times, I have to ask them for a paralytic. But I've never had it the other way around. Of course, in the ED your main focus is to stabalize the patient and get them up to ICU ASAP. You usually don't have the time play around with titrating optimal sedation settings, but to not even attempt to GIVE sedation? That's awful.You should see if there's a P&P regarding this issue. I would have charted "Pt appears uncomfortable, biting ETT, movement noted. Writer notified Dr. Jones regarding pt's appearance and need for sedation; no orders received from Dr. Jones."

I know of one pt who just received just a paralytic when he was intubated all night,he had an MI in the morning from the outrageous stress. I don't know why Drs don't always want to order sedation and/or analgesia. It's a cruel thing to do to someone.

Quote from BelleKatI know of one pt who just received just a paralytic when he was intubated all night,he had an MI in the morning from the outrageous stress. I don't know why Drs don't always want to order sedation and/or analgesia. It's a cruel thing to do to someone.