#heysean… my patient is chemically paralyzed on the ventilator. What do I need to know?
In the ICU we often care for some really sick patients that require chemically induced paralysis. We will purposely paralyze them with medication in order to stabilize or improve their condition. For example, research has shown that in severe ARDS chemical paralysis may improve outcomes (limited info).
The term paralyze or paralysis can be taken out of context, so keep in mind this is a response to a medication not that the medical team is intentionally causing harm (or nervous system damage).
I answer another #heysean question from the tribe.
I give you a couple of things to think about:
- GI tract
- Skin breakdown
How do you monitor a patient who is on a continuous chemical paralytic medication? You have 2 options. The TOF peripheral nerve stimulator and/or the BIS monitor.
The 1st rule of chemical paralysis is sedation. Sedate first, then induce paralysis. Period. No exceptions.
Contrary to popular belief, just because we have used a chemical paralytic medication, does not mean the GI tract is not working.
Be mindful of breakdown. Remember, your patient will not be able to ‘wiggle’ around when their backside or elbow have been fixed in one position for hours at a time. They can’t move voluntarily.
Chemical paralysis is an advanced medical therapy that requires additional education and training from ALL members of the medical team who will help manage the patient. It’s a high-risk intervention that is often used because of the severity of illness. Stay up to date so that you can continue to advocate for you patient and provide optimum care.
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