Chemically paralyzed in the ICU? What a nurse needs to know.

#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:

  • Monitoring
  • Sedation
  • GI tract
  • Skin breakdown

Monitoring:

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.

Sedation:

The 1st rule of chemical paralysis is sedation. Sedate first, then induce paralysis. Period. No exceptions.

GI tract:

Contrary to popular belief, just because we have used a chemical paralytic medication, does not mean the GI tract is not working.

Skin Breakdown:

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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The views and opinions expressed on this website, videos or posts on this channel are that of myself and not of any educational institution. In compliance with HIPAA and to ensure patient privacy, all patient identifiers in all content have been deleted and/or altered. The views expressed on this website and/or in the videos on this channel are personal opinions only, not intended as medical advice. The information I present is for general knowledge purposes only. 

*may contain affiliate links*   

Find all of my recommended products and the gear I used in my videos at www.amazon.com/shop/seanpdent

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Taking care of the frequent flyer patient

We’ve all taken care of the ‘frequent flyer’ patient. Oh, you know who I’m talking about. The non-compliant repeat-offender patient that just can’t seem to get a grasp on self-care. They seem to have a permanent residence in your facility. It becomes a self-defeating act of caring for them and we sometimes grow weary of the repeat cycle. Admitted for the same chronic diagnosis and medical condition because they failed to care for themselves (for one reason or another). Fail could mean many things, the least of which is purposeful refusal to adhere to their medical therapy that has been reviewed with them a dozen times before. But, this could also be the patient that is not understanding of their condition and treatment. We try to ignore our thoughts. We sometimes think don’t care about their own health, because they know if (and when) they fail to care for themselves appropriately… all they have to do is show up in the hospital (again). It’s not a positive or supportive thought… but it’s not something I’m going to deny. Yep, I’ve thought it. Wash – Rinse – Repeat **sigh** I’m here to suggest an alternative way of thinking when caring for that returning repeat re-admission:
Practice makes perfect
Every time something seems ordinary, repetitive or mundane, it’s just more practice to sharpen your skills for that next patient. Do not take this job lightly. Ever. This is supposed to be hard. Lives are at stake. Because the day you let your guard down is when the grim reaper taps on your patient’s window. You will need to coordinate. You will need to calculate. You will need to be aware. You will need your sixth sense. You will need to hustle. You will need to have laser focus on the details without losing sight of the bigger picture. Every time something seems ordinary, repetitive or mundane, it’s just more practice to sharpen your weapons. Learn something every day. Get better at every task you perform. Master the medicine. Manage the mess better than anyone else. Practice makes you better. And perfect practice gets you close to perfect performance. Become efficient. Become resistant. Become resilient.

Someday that next patient will need your A-game. They’ll need your instinct. They’ll need your reflexes. They’ll need your sharp weapon. They’ll need your steadfast spirit. They’ll need you to chew through nails, because the grim reaper will push you to perfect. Be as close to perfect as you can get by grinding it out every single day you are in charge of that next patient’s care… that next patient’s life. Sooner or later that chronic diabetic is going to be in DKA. Sooner or later that chronic kidney disease patient will be in full renal failure. Sooner or later that heart failure patient with be in shock. Sooner or later that next patient is going to need your ‘A’ game. Sooner or later you will be the only thing standing between your patient and the grave. — Keep practicing.
DON’T FORGET TO SIGN UP FOR EMAIL UPDATES –> HERE! If you found this valuable, maybe you’ll buy me a cup of coffee? http://bit.ly/seanscoffee You know how much I love coffee.
Check out all my videos on my YouTube channel. Almost 500 free videos http://bit.ly/seanpdenttv
**Follow me on Instagram: @seanpdent **Let’s continue the conversation: http://bitly.com/thenursetribe **Have a question? http://bit.ly/askheysean
The views and opinions expressed on this website, videos or posts on this channel are that of myself and not of any educational institution. In compliance with HIPAA and to ensure patient privacy, all patient identifiers in all content have been deleted and/or altered. The views expressed on this website and/or in the videos on this channel are personal opinions only, not intended as medical advice. The information I present is for general knowledge purposes only. may contain affiliate links Find all of my recommended products and the gear I used in my videos at http://www.amazon.com/shop/seanpdent

Happy re-birthday to me. The day I should have died. 17 years later.

“Never be ashamed of a Scar. It simply means you were stronger than whatever tried to hurt you.” Scars are tattoos with better stories.

17 years ago I was given the greatest gift of my life.

A second chance

I know the value of my life and continually appreciate it, no matter how ‘tough’ things may get. Today is my re-birthday.

On September 15, 2001 someone made attempt on my life.

I’ll admit it. Before that fateful day, I was just as jaded, jagged and miserable as many other human beings who occupy this earth are.

I was always pissed off at the world. I continually wanted to know when the universe would stop shitting on me. I bitched at everything and everyone. My temper roller-coastered like it was my full-time job. I had your typical bad luck, bad girlfriends, bad relationships, bad jobs, etc, etc.

Yeah, I was a mean ole’ cuss. I can’t say ‘positivity’ was part of my repertoire. I was going nowhere fast, and I just couldn’t seem to get a leg up. I was simply treading water.

Then someone tried to kill me.

https://media.giphy.com/media/CDJo4EgHwbaPS/giphy.gif

I needed someone to try and steal my most prized possession (my life) for me to truly appreciate its merit.

Yes. You read that right.

I first blogged about it in 2008 (hard to believe). Every year I re-share the original blog post. It’s cathartic for me and my loved ones. It’s important to me because I want the reminder. I want to remember and never forget my gift.

And I’d like you to have the reminder too, because life is fleeting.

Let me tell you a story (in the original words that I wrote several years ago)…

It’s been 7 years.

This time of the year always has a special place in most of America’s hearts. September 11, 2001 is a date none of us will soon forget. It changed the face of our nation and impacted our world in a way none of us could have ever imagined. Emily (crzegrl) shared here views of how it impacted her.

At the risk of diminishing or making that day any less than it really was. This time of the year has a very different meaning for me. I do remember September 11th. I do remember what I was doing that day. I do remember how I felt and how the world around me changed. But it’s not what is in the forefront of my mind.

September 15, 2001

My Re-Birthday.

It’s been 7 years.

It was a Saturday. (Yes I remember it that well)

There was a time in my life when I was not active in healthcare (It was a short time). I had stepped away from the healthcare setting and returned to my career in retail. Retail had helped pay my way through college, and then it was the way to put food on the table after college was over. My career in healthcare wasn’t paying the bills, and retail was a better option (at the time).

It was a typical Saturday night. I was one of the midnight managers on duty. Part of my responsibility as a manager was to hold the night-shift meeting with the over-night employees.

This particular night we decided to have an open forum concerning the difficulties people may or may not be having with the current state of affairs. The terrorists attacks were affecting everyone, and we wanted to let our employees know we cared.

I can’t say I remember how it happened.

I can’t say I was prepared for it.

It happened in time ‘slices’.

I was talking with the over-night group of employees. It was me in front of approximately 20 others. Half-way through the meeting and in mid-sentence I can vaguely remember an ‘itching’ or ‘biting’ feeling on my neck.

….??

It wasn’t anything out the ordinary. I chalked it up to one of the bodily aches or pains I have no explanation for. (Like when I get a shooting pain in my finger that comes a goes in a matter of 7 seconds)

It got more quiet. It was like I could only hear the fans of the air conditioning running. I guess the only way to explain it… is things seemed to slow down.. immensely. Like the slo-mo option on a VCR/DVD player.

I don’t know what happened next. Or should I say I don’t know which came first. The banshee-like shrieking screams or the shadow of a person coming out of my left peripheral vision. All I know is that it was a startling moment.

The Scream.

The Shadow.

And I reflexively look to my left.

I remember saying to my self, “Hmm, why is Jane (we’ll call her Jane for identity purposes) standing so close to me. She should be sitting out in the crowd with the rest of the group.”

She’s now advancing towards me. “What is she doing?”

Her left arm is raised in the air. I think she’s going to take a swing at me. So out of reflex, I block her left arm. I block her arm with my R arm and grab her swinging arm with my L hand. Then I grasp her swinging arm with both hands.

I can’t quite figure out why she’s trying to hit me?

Another handful of screams.

Through the tussle and wrestling of her arm I realize my hand is full of blood??? In fact I have blood on both my hands?

“OK. Who’s blood is this?”, I blurt out with a sense of sarcasm.

… ??

More screams.

… ??

Wait a minute.

What’s that in Jane’s hand?

Is that..?

No way.

Wholly SH#T. Jane has a knife in her hand.

“The blood is YOURS! She cut your throat. Your bleeding from your neck!!!!!!”, a voice from the crowd cries out hysterically.

Now, I’m no idiot. I know the inner workings of the human body. I’m pretty well versed in what anatomical structures are located in the neck.

I know I’m still breathing. I’m not chocking. Not having any trouble moving air.

???

At the same time Jane is tackled by a single employee from behind. Then another, then another. And then more. It takes close to 5 people to get her down.

I put my hand on my neck.. and sure enough … nothing but blood.

Yep. It’s a true story. I was attacked from behind with a swiss army knife by an employee of mine, in front of approximately 20 people. She sliced my neck almost from ear to ear.

Here are the finer points of the story:

– she used a very dull and old swiss army knife

– she did not use the blade side of the knife and drag it across my neck to cut me. She used the knife in a stabbing motion and scraped the tip of the knife across the length of my neck

– she never spent a night in jail. She had a psychiatric evaluation. Her medications were adjusted. And that’s the last thing I was told (Please don’t ask.. I don’t know what the heck happen concerning her lawful conviction)

– Yes, I have a Keloid scar that has taken 7 yrs to slowly diminish on my neck. (The intent of the ED physician was to use the smallest/thinnest suture possible so to NOT leave a scar, and it did the exact opposite)

-The only entertaining piece of all this was that when the 911 call was made. All the EMS arrived expecting to see a decapitated man. And I mean ALL of the EMS. For the small town I was in, I think I counted 4 Ambulances and 6 marked Police and 2 unmarked Police cars.

There isn’t a day that goes by that I don’t think about that day. It changed my life. We always whine and complain about some of the most ridiculous things in life that seem so very important at the time. Everything from being late for work, being stuck in traffic, having to wait in line in the grocery store, having a poor wait staff wait on you at the restaurant, or having to sit in coach for a 4hr flight… the list is endless. Everyone hates having a bad day.

I touched on my theory about life and how bad your day really was in a previous blog post: Blinking & Breathing, I can’t complain.

I’m not perfect. I do have stress in my life. I do have those ‘Pull out your hair’ moments and those “all I wanna do is scream” moments. But I’m always grounded and reminded by my profession and by my past that maybe you and/or I not having THAT bad of a day.

September 15th is my Re-Birthday. I was given a second chance at life. For some strange reason, I survived that incident. I will never know why. I questioned it for a long time, and never got the answer I wanted until I realized there was no answer. I’m here. I’m staying here. I’m not going anywhere. And while I’m here, I’m making the most of my stay.

Here’s what scares me sometimes when I think about my attack.

As an employee for the retail store I worked for, each employee is issued a box cutter. The only reason I’m still here is because Jane had bad aim, and a dull swiss army knife.

What if she would have used the box cutter instead of her swiss army knife?

Nope.

I don’t have bad days anymore.

Carpe Diem

Via Happy Re-Birthday To Me | My Strong Medicine


Fast forward to 2013…

We moved to a new city. With the move came new friends. When my face was still new, I had a friend comment on my ‘positivity’ and being ‘always happy’. I told her there was a story behind my obsessive passion for being happy, but that I’d explain it to her later. I shared this post with her.. (Thanks, Allison).

This is the reason I’m always positive. Why I greet every morning with my:

“Gewwwwwwd morning”

I get to be here another day.

Many great things have happened to me since that scary day.

I became a Registered Nurse, I met and married my soul mate, and now I’m working as an Acute Care Nurse Practitioner, a job I truly love.

I’m here. I’m staying here. I’m not going anywhere. And while I’m here, I’m making the most of my stay


I’m not too sure where I’d be today had I not gone ‘under the knife’ so-to-speak. I can admit that I wouldn’t have the abundance of happiness I possess now.

What I do know is that I took a tragic, frightening and possibly life-paralyzing event and turned it into something positive. Positive for me, and hopefully positive for anyone who’s around me.

This might sound a bit cliche’… or it might sound a bit phony…

but I needed someone to try and steal my most prize possession (my life) for me to truly appreciate its merit. And for that, I couldn’t be happier.


I continue to value the gifts I’ve been given. I’ve met more amazing people both online and in person. Every so often I take my life for granted by complaining a lil’ too much, but I still cherish every second I’m still here.

Thank you all for being a part of my life.

Sean

How does a nurse not get attached to their patient?

How do you avoid emotional transference? Are nurses supposed to not ‘care’ about their care? How much is too much?

And is there a drawback to allowing emotional transference?

Will you miss or make a mistake if you get too attached to your patient?

I offer my thoughts.


**IMPORTANT NOTICE** This was a recording from my ‘old’ Snapchat account, so it’s not the highest quality (wonky formatting). Some of the video content and conversation is out of context, but I thought the information was valuable and wanted to share it here. I hope you don’t mind. Oh, there might be some colorful language.

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DON’T FORGET TO SIGN UP FOR EMAIL UPDATES –> HERE!
If you found this valuable, maybe you’ll buy me a cup of coffee? http://bit.ly/seanscoffee
You know how much I love coffee.
________________________________________
Check out all my other videos on my YouTube channel. Almost 500 free videos http://bit.ly/seanpdenttv
________________________________________
**Follow me on Instagram: @seanpdent
**Let’s continue the conversation: http://bitly.com/thenursetribe
**Have a question? http://bit.ly/askheysean
________________________________________
The views and opinions expressed on this website and/or in the videos on this channel are that of myself and not of any educational institution. In compliance with HIPAA and to ensure patient privacy, all patient identifiers in all content have been deleted and/or altered. The views expressed on this website and/or in the videos on this channel are personal opinions only, not intended as medical advice. The information I present is for general knowledge purposes only.
*may contain affiliate links*
Find all of my recommended products and the gear I used in my videos at www.amazon.com/shop/seanpdent

What are some tips for difficult IV starts?

There is no 100% guaranteed method to successful IV starts, but I share some things that might get you close to that.

This was a YouTube Live broadcast, so pull up a chair.

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DON’T FORGET TO SIGN UP FOR EMAIL UPDATES –> HERE!
If you found this valuable, maybe you’ll buy me a cup of coffee? http://bit.ly/seanscoffee
You know how much I love coffee.
________________________________________
Check out all my other videos on my YouTube channel. Almost 500 free videos http://bit.ly/seanpdenttv
________________________________________
**Follow me on Instagram: @seanpdent
**Let’s continue the conversation: http://bitly.com/thenursetribe
**Have a question? http://bit.ly/askheysean
________________________________________
The views and opinions expressed on this website and/or in the videos on this channel are that of myself and not of any educational institution. In compliance with HIPAA and to ensure patient privacy, all patient identifiers in all content have been deleted and/or altered. The views expressed on this website and/or in the videos on this channel are personal opinions only, not intended as medical advice. The information I present is for general knowledge purposes only.
*may contain affiliate links*
Find all of my recommended products and the gear I used in my videos at www.amazon.com/shop/seanpdent