Originally Posted by Nooblet
Cool thanks for these teaching points -
Can you guys explain why giving sux doesn't make ventilating easier? It just seems to me that once sux is given and all the muscles are relaxed, resistance to ventilation is now lower. So it would logically follow that if you are able to ventilate them when they aren't paralyzed yet, you should definitely be able to afterwards
I hope an attending will follow up this post to correct my errors and omissions, but in the spirit of Jet mentioning pre-meds and med students do some thinking here as well..
.I'll take a stab here based upon reading everyone's prior sux posts on SDN and time having my ears open in the OR...
Nooblet, I don't think anyone said that sux doesn't make ventilating easier per se. I think the (I said I think twice so I know I'm outta my league but still, I think, I can answer this. 3X) idea is that testing ventilation without
sux is not necessary/time wasting etc. I think (4x) what's being argued here is, "Why test ventilation prior to giving a muscle relaxant, when, if you cannot easily ventilate, you are going to use a muscle relaxant anyway...so why not a) give the muscle relaxant and NOW see where things stand, or, don't, find out that you cannot ventilate without it, and then
give it." Point is, somewhere along the line you may use sux, so, what use carrying out an experiment that is really not giving you any pertinent information?
I think it is safe to say (for me at least, and I stopped counting I thinks) that sux will make the patient easier to ventilate. It's kind of the whole point why you wouldn't test ventilate prior to its use.
In other words, scenario 1: patient induced, you mask ventilate, it's not happening...(I imagine the algorithm brings you to) using a muscle relaxant. So what was the point of testing before sux? You're here now anyway... Testing ventilation without sux is a test to see if you can do something without all the ingredients of what you will ultimately use in case you fail (your test)
. scenario two: you mask ventilate after using sux/roc, ventilation not happening so, a) TOTAL GUESS - you give more sux to make sure they are fully relaxed? b) instead of using sux in the first place you used (past tense) a non-depolarizing relaxant so you reverse and back out, but why would you do that because you want to facilitate ventilation, with nice relaxed muscles, preferably muscles that weren't relaxed by hypoxia, so TOTAL GUESS, can you give sux after Roc? (If not actually, patient is still relaxed, so, we're theoretically where sux would get us). All of the above get you to: having used sux, which I think is the quickest, most effective paralytic (as it's used in RSI). So why test without it, if, should the HITSAY hit the ANFAY, you're going to use it anyway?
I don't know if I thought through this out loud well enough, so I do hope an Attending will follow up with what I'm missing! :thumb up:
Applying flame retardant as we speak...