Lecture on Paralytics and ICU Drips

Introduction

• Instructor: Eddie Watson, ICU Advantage
• Topic: Monitoring and care for patients on paralytics
• Importance: Minimizing drug use for quick patient recovery

Previous Lessons Recap

• Anatomy and physiology of paralytics
• Overview of available paralytics and their differences

Monitoring Paralytics

• Goal: Achieve desired effect with minimal drug use
• Peripheral Nerve Stimulation: Method to monitor paralysis

Train of Four (TOF) Stimulation

• Provides four electrical signals to patient
• Muscle Twitching: Indicator of electrode placement
• Common Nerve Sites:
  • Ulnar Nerve: Adduct thumb, flex fingers
  • Facial Nerve: Closed eyelid, furrowed brow
  • Posterior Tibial Nerve: Flex big toe
• Assessment: Number of twitches indicates blockage percentage
  • 1 twitch: ~90% blockage
  • 2 twitches: ~80% blockage
  • 3 twitches: ~75% blockage
  • 4 twitches: Under 75% or none
• Goal: Generally, 2 or 3 twitches for critically ill patients

Common Mistakes

• Forgetting initial TOF due to urgency
• Importance of baseline TOF to confirm electrode placement and appropriate voltage
• Adjusting output due to edema if twitching decreases without medication changes

Patient Care Considerations

• Muscle Weakness: Concern during recovery
  • Larger muscles recover faster than smaller ones
  • Tests: Head/leg lift, eye opening, hand squeeze, tongue protrusion, purposeful movements, cough, bite, swallow
• Prolonged Infusions: Risk of myopathy and disuse atrophy, especially with concurrent steroids

Sedation

• Paralytics require sedation as they don't provide analgesia, amnesia, or sedation
• Deep sedation necessary to prevent patient distress
• Use of monitors like the bispectral index (BIS) is recommended

Additional Care

• Eye Care: Prophylactic eye ointment to prevent corneal abrasions
• Pupillary Reaction: Unaffected by paralytics, check for reactions

Conclusion

• Paralytics in ICU require careful monitoring and patient care
• Importance of sedation and continuous assessment to prevent complications

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