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Generic Roc
- Thread starter drccw
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Been using generic Roc for a week or two. Still have a roll of Zemuron stickers and label the syringe as such. So far, none of my patients have noticed a difference. Im sure this violates JCAHO
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👍 Good.
If I hear one more nurse say to me, "That's a JCAHO violation," I seriously might open fire.
-copro
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When I hear that I ask for the written JCAHO (or JC as its know now) policy. Turns out its more like a JCAHO "concept". It either shuts them up or keeps them out of my hair for a while.
Kind of like the "we have a policy of not doing X here".
Could I see that policy please?
30 minutes later - "I can't find the policy but we've never done it here".
You are now.
David Carpenter, PA-C
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I dont think the stuff is as predictable in both onst and potency
i'll give it some more trials before I commit to the goal of eliminating it from the face of the earth
i'll give it some more trials before I commit to the goal of eliminating it from the face of the earth
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Really? I haven't noticed any difference at all between the generic and zemuron.
What I have noticed is an increased incidence of is attendings that want me to intubate less than a minute after a 0.6mg/kg dose, resulting in my having to hone my ninja quick-strike technique of darting the tube in between oscillating cords. Happened 3 times this last week. Irritating.
And the problem is.....?
As I asked someone in another thread - tell me you don't use a twitch monitor to tell when the twitches are gone and the patient is fully relaxed before you try to intubate.
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What's wrong with using a twitch monitor? I do it occasionally, just to do something different. Although I never wait until the twitches were completely gone -- just significantly decreased from baseline.
One of our ORs has a machine that will generate a graphic display of the twitch response, although you have to attach 4 or 5 leads. Usually if I'm in a room with that machine and have the time to set it up, I'll do it.
I've seen patients react a little when I thought they were fully relaxed and I intubated, but they weren't. However, I haven't seen moving cords after a paralytic in a long time. The last time I recall that happening, I think it was a faulty paralytic vial (yes I drew it up myself).
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The problem, obviously, is that it f^(ks up my laryngoscopy.
Why are we pushing roc in the first place? So the damn cords (and pt) don't move, and you get optimal intubating conditions. If you push a full 1.2/kg, that happens quick. If you push half that, it doesn't happen as quick.
If I'm gonna use a drug to produce paralysis, I'm gonna wait for paralysis. If I'm gonna push the drug and proceed right away with DL, having to bounce the tube around on moving cords, I may as well have not even given the damn roc in the first place.
Many of our attendings require us to use twitch monitoring for induction. When on my own, I will not choose to do this, as I think you can tell by time elapsed and often increased ease of masking when the pt is ready. As it is, I often have to use twitch monitoring, and I don't think there's anything wrong with it. You don't have to wait until all movement disappears, but you don't want to whip out your blade and go to work when there are four strong twitches (as was the case during one of these incidents last week).
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I can't remember the last time I intubated a fully relaxed patient that wasn't an RSI... I think it was in CA-1 year.
If I try to wait an appropriate time for paralysis to set in, my attending will prompt me to proceed early (hand me the laryngoscope or the tube etc.) I guess the relaxants are to keep the patient still in that long lull between intubating and incision when anesthetic levels are minimal and people are splashing the patient with cold disinfectant and stapling drapes to their skin.
Or maybe it is so that tube placement can be easily confirmed by the inevitable cough that happens as the tube passes the cord.
- pod
If I try to wait an appropriate time for paralysis to set in, my attending will prompt me to proceed early (hand me the laryngoscope or the tube etc.) I guess the relaxants are to keep the patient still in that long lull between intubating and incision when anesthetic levels are minimal and people are splashing the patient with cold disinfectant and stapling drapes to their skin.
Or maybe it is so that tube placement can be easily confirmed by the inevitable cough that happens as the tube passes the cord.
- pod
