Sux and hyperK

[Hoya11]

Yes. This. It's a dirty and dangerous drug. Most ICU patients have a contraindication, and usually the short duration and profound relaxation arent desirable or necessary.

Lol dont fear the SUX! Agree to disagree I guess, and after you give etomidate and sux (or prop and sux) the induction agent lasts as long as the paralytic effect, so no you dont have to give sedation. And last time I checked lots of intubated ICU patients are not paralyzed with roc or heavily sedated and dont pull their own tube out.. these fears are unfounded..

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[Hoya11]

Why would you intubate somebody for respiratory failure and then put them on an assisted mode? .

To maintain their resp drive with PSV.. ?? All patients with respiratory failure require completely controlled ventilation now? How do they come off the vent?

 

[pgg]

Why would you intubate somebody for respiratory failure and then put them on an assisted mode?

The vast majority of resp failure patients should not be paralyzed and on a vent mode that doesn't assist spontaneous breaths.

Most non code intubations fit the tired-dude-failing-bipap pattern and sedation & a paralytic are the two last things they really need.

 

[fakin' the funk]

To maintain their resp drive with PSV.. ?? All patients with respiratory failure require completely controlled ventilation now? How do they come off the vent?

Lol dont fear the SUX! Agree to disagree I guess, and after you give etomidate and sux (or prop and sux) the induction agent lasts as long as the paralytic effect, so no you dont have to give sedation. And last time I checked lots of intubated ICU patients are not paralyzed with roc or heavily sedated and dont pull their own tube out.. these fears are unfounded..

It’s not clear to me that you understand the topics at hand.

 

[WholeLottaGame7]

So you have a K of >6. Which according to the logic here is caused by Sch. Then you put a patient on a vent for 10 minutes and correct his Co2 (which was not the primiary cause of hyperkalemia) . You think that K is now 5? With no other correction? No. Something else probably caused the tachycardia.

Say their baseline K+ is 5. They're hypoventilating and now they are acidotic and have a pH of 7.1. Now their K+ is higher, maybe 5.5? Then you give 200mg of sux. Now their K+ is 6, and they go into some unstable arrhythmia. Then you intubate them, correct their respiratory acidosis (plus whatever other anti-hyperkalemic measures you want to take).

I'm also confused as to what the confusion is...

 

[Twiggidy]

Why cis? It's very slow.

Nothing scientific. More habit. A good amount of our unit patients have renal issues so I just tend to use it.

As someone else said, with the sick ones the airway reflexes disappear (usually) with the apneic drug. They’re usually so out of it that I give both one after another and by then I can intubation.

Roc is the better choice. I have big hands and can ventilate most even with a second hand from a RT, so I roc people I don’t use Cis on. Sux is only for my full stomach emergencies.

 

[nimbus]

Why would you intubate somebody for respiratory failure and then put them on an assisted mode? Sux in respiratory failure, IMO, is a relic of olden anesthesia and has no real role in this age. Especially when you think of how serious the harm you can cause with it is.

Yes. This. It's a dirty and dangerous drug. Most ICU patients have a contraindication, and usually the short duration and profound relaxation arent desirable or necessary.

It’s been said many times that sux would not receive F.D.A. approval if it was introduced as a new drug now.

 

[Ronin786]

To maintain their resp drive with PSV.. ?? All patients with respiratory failure require completely controlled ventilation now? How do they come off the vent?

The vast majority of resp failure patients should not be paralyzed and on a vent mode that doesn't assist spontaneous breaths.

Most non code intubations fit the tired-dude-failing-bipap pattern and sedation & a paralytic are the two last things they really need.

If you tube a patient for respiratory failure, putting him on PSV in 15 minutes or 115 minutes isn't going to liberate him from the vent any quicker. I don't see how that's any indication for using sux vs roc.

 

[fakin' the funk]

Also why not stick a needle in his pleura instead of putting him on bipap

Because causing a pneumo in a mucus plugged pt is not optimal?

 

[Psai]

Nothing scientific. More habit. A good amount of our unit patients have renal issues so I just tend to use it.

As someone else said, with the sick ones the airway reflexes disappear (usually) with the apneic drug. They’re usually so out of it that I give both one after another and by then I can intubation.

Roc is the better choice. I have big hands and can ventilate most even with a second hand from a RT, so I roc people I don’t use Cis on. Sux is only for my full stomach emergencies.

Why not use roc in renal patients