MisPandora -> RE: Kidnapping, chloroforming, knocking out...yum (7/22/2007 12:39:35 PM)
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ORIGINAL: Aswad If the idea is to be fully aware but paralyzed, I haven't a clue right now, but will be looking into it. While it is possible to do it, it's just not practical in the environment that we play in. Here's why. There are drugs used for rapid sequence intubation that facilitate paralysis -- it's the induction of general (temporary) anesthesia for the purpose of putting a tube down one's throat. There are 4 pharmacologic components to it -- analgesia, muscle relaxation, amnesia/unconsciousness, and the blockade of autonomic reflex responses to stimuli The neuromuscular blockade drug is used to facilitate relaxation of the airways in order to introduce the endotracheal tube. The antianxiety/amnesic is used to keep people from freaking out that you've paralyzed their ability to move, protect their airway and breathe, as the paralytic also affects the diaphragm and intercostal muscles used to expand and contract the chest! The important part to remember is that it's done by trained medical personnel who are using the very fast acting (within one minute) and short acting hypnotics and paralytics (some only minutes up to 30 minutes or so) AND that they are providing full ventilatory and airway support including oxygen administration in the process AND that they as providers have the capacity to monitor and treat lethal arrhythmias with a cardiac monitor/defibrillator and ACLS meds, provide suction, and monitor pulse oximetry and end tidal CO2 in expiratory air from the ETT. As a paramedic, we do RSI only in the presentation of an absolute medical emergency and there are risks of aspiration, or worse, a failed intubation that winds you up having to surgically intervene to provide an artificial airway (trach or cricothyrotomy.)
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