Train of Four - Peripheral Nerve Stimulation
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- เผยแพร่เมื่อ 3 ก.ค. 2024
- Let's talk Train of Four, paralytic monitoring! 📝 Free Quiz: adv.icu/3d1AiqR
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For this lesson, we are going to take a good look at our peripheral nerve stimulation and specifically the train of four. We use this for our objective measure of neuromuscular function for patients who are receiving continuous infusions of paralytics. It is an essential tool for us to ensure safety and best outcomes for these patients.
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0:00 Intro
1:22 What is PNS?
2:18 Why do we use PNS?
4:40 What is TOF?
9:27 Preparation
11:45 Supramaximal Stimulation
15:20 Twitch Response
5:54 Sites to use
8:44 Wrap up
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❗️❗️PLEASE NOTE: ICU Advantage medical videos, medical lectures, medical illustrations, and medical animations are for medical education and exam preparation purposes, and not intended to replace recommendations by your doctor or health care provider. The information is present here to give you a starting place to further look in to the proper treatments and recommendations for the care of your patient.
#ICUAdvantage #TrainOfFour #Paralytic
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This guy is a national treasure.
Thanks for the kind words!
Amen
international hahaha from Brazil and it helps a lot! thanks awesome content
I love that you explain in depth, including the physiology behind the concept. Its so in depth, yet clear and concise. I only transferred to the ICU six months ago from Med-surg, and your videos have been instrumental in my learning process! Thank you so much for all the time and effort you put into your videos, rest assured that they are very much appreciated!
This is great to hear Autumn! I was always the type to try and understand what was happening underneath to try and understand the what and why of what I was doing, so I try and do the same. I'm glad that you like it!
He is so good and deserves national award. God bless you
Appreciate the kind words!
thank you so much for what you do honestly
Fantastic video! Thank you!
I love this chanel. You explain everything really well and easy to understand.
Thanks for the great explanation.I Finally understand how TOF works exactly
I got transferred to ICU a month ago and I listened to this video one morning as I got to work early. That day we had to give NMBA to my pt. You don’t know how happy I was to practice the TOF😀. I was sad that we had to paralyze the pt, but your lesson helped me to practice the procedure safely!!!
Thank you so much for making it simple ❤🎉
New grad here in the icu. I've watching you channel for a while. Thank you so much!
Perfect explanation. Thank you!
Appreciate that! Thank you and glad you liked it.
Great video 🙏🏼 ,,, calm voice ! Nowadays medical students are so lucky that people like you exist to show them through videos how medicine works.
Thank you for taking the time to leave a comment! Happy to hear the video was well received!
Thank you so much..
Beautifully explained..... extremely helpful video. Keep up with the great work.
Thank you so much! Really great to hear this!
Thank you for such informative and useful information on TOF. All your hardwork is appreciated.
You are most welcome
So helpful! Thank you!
You're so welcome!
Thank you so much! This is really helping me with my science fair project!!
Glad to help!
Thank you
Stunning! Tks
This channel is really awesome, and thank you for your sharing!
So great to hear this!! Truly my pleasure.
Thank you so much, great video!
You're very welcome!
Would like to share I was in my icu nd my patient needed to be assessed for tof....I earlier was not at all clear About the topic.... luckily ur videos are such good I carry it out in the icu nd I relate the concept so very well nd really it made me so knowledgeable ..ur channel is a blessing for me..thanku so much ❤️
So awesome! Really happy to hear this. Its truly my goal to try and help give people the understanding and knowledge to be able to apply it when working in the ICU, so its great to hear this. Thank you!
Thank you from South Africa 👌👌
So cool! My pleasure!
This video was very helpful. Thank you
You are so welcome!
Great content
Great increase in paralytic use during the Covid waves. A lot of old paralytic policies and techniques surfaced at hospitals. TOF was used by many for the first time. This video is a wonderful resource for all those thrust into titration of paralytics. During that time and in future.
Thank you
Yeah TOF in a lot of places has gone to the wayside for now and just titrating to vent compliance. Unfortunately the risks are still there but its also being used a lot more and not enough equipment often supplied by the hospitals.
After 2 years i finally got it.. thanks
Woohoo!!!
Excellent
Amazing 😊👏 👏 👏
thank you so much for sharing the videos, so easy to understand how it works, love it !!!I am a new anaesthetic nurse, can you please share some how ventilator works and numbers on the monitoring screens. very appreciated !!!🙏
Thanks
From India 🇮🇳
You're welcome!
شكراً الشرح كلششش مررتب❤❤❤
❤️
Soooo good
Can you please review the BIS monitor next?!
I agree!
Hopefully soon. I do have it on the todo list! 😊
Thank You.. I’m not even in my 1st half of Nursing School, but I know this will help in my future🙂
Congrats on starting your program. Lots of good info on this channel with a lot of it applying towards the end of your program.
Ευχαριστούμε!
Thank you so much!
Thx alot
You’re welcome!
Are you planning to do Neuro ICU stuff like EVD management, weaning, ?
Yeah I've got more Neuro (including EVDs) on the todo list.
U are the best
Appreciate that!
Perfect
Thank you
hello thank you for the video
i am actually not a medical student but i'm searching for videos on how the nervous system works and how the sensors of the human body works. so please if you have any video like this in your channel recommend it for me ^^
Can you do a video on ketamine drip? Also can you do a video differentiating different scans and their purpose, for example, ct vs ultrasound , or mri
I do have Ketamine on the todo list. Good suggestion for the scans. I'll add that one. Thank you.
My question is why is the negative distal and positive proximal? i use anode distal and cathode proximal for both ulnar and tibial stimulation.
Your voice is like we are sitting in aeroplan and the pilot is making announcement
Lol thank you?
I maybe getting this soon, has anyone on this post have this done, and does it work well? Thanks
Can we repeat train of four immediately if we are unsure about the result?
Just wondering your thoughts on use of TOF vs simply looking at ventilator compliance? It's quite difficult to get consistent and accurate TOF due to site access caused edema, dressings or proning as well as other nurses who started the TOF but elicited muscle contractions vs nerve contractions. I can't tell you how many times I've seen electrodes over the eye brows or both electrodes directly over the ulnar nerve. I also have read some recent articles that suggest that ventilator compliance may be a better measure..titrating the drip until no breath stacking is evident.
There definitely are a lot of issues at play with TOF, especially if everyone is not on the same page. All the more reason for better education and ensuring that everyone is doing things the proper way.
That said, it really depends on what you are using the paralytic for. I think TOF is just another tool like anything else we have. We shouldn't always rely on it but it can be useful just as other methods. I think, especially in the age of COVID, there is a lot of benefit in titrating to vent compliance without the need for TOF, but we have many other uses for paralytics too.
The biggest problem with them is ensuring that we have adequate paralysis with the very least amount needed for the shortest period of time needed. Its obviously not an exact science but there certainly are consequences to getting it wrong and I think a proper TOF really helps here.
What? is the APB innervated by the ulnar nerve or median? I learned in medical school its median.
How did you get so knowledgeable??
Its truly just about time. The more you do something the more you will learn. That said, I do also put in time and research into my videos to make sure I cover everything and hit all the points I want to, so remembers its always a never ending learning process for all of us.
16:41 great video, but I'm pretty sure succinyl-choline is a depolarizing blocker, but you used it as an example for a non-depolarizing, if I am not mistaken
Thank you! And yeah that is what I said, but I could see how that may be confusing as I started talking about non-depolarizing NMBs first.
It was still a very helpful video, and it's true that it could be interpreted differently, making it correct, but it was a bit confusing, yes, but keep making helpful content :D
Would it then be better to stimulate the facial nerve when monitoring patient's neuromuscular blockage, during operation where both arms need to be positioned out of reach? What are the potential side effects in this stimulation?
Sure, if the arms aren't going to be accessible, then yeah use the facial nerve. That said, if you had wires to run out from the arm, you'd probably be ok if all was working well to begin with. No issues that I'm aware of regarding one site over the other and its a very much acceptable site to use.
@@ICUAdvantage Thanks. Very few here have ever considered it, it's a bit extreme to some.
Can you do a video on BIS monitoring?
common what are you? amazing!!
Appreciate that. Thank you!
What if the patient is given a NMBA bolus or an infusion started before you’re able to assess supramaximal stimulation. How do you manage the TOF assessment over the hours or days that follow when you have no baseline to work from?
I would like to know this as well!
Great question. At that point, you would essentially do the same thing. It's just going to be harder to ensure that you've got it at the right level and might end up at a higher level. It's not the end of the world as going with a stronger output won't make them twitch anymore.
First to comment. I super love your videos 😊
Woohoo!! Glad to hear this!
4th yr nursing student in the Philippines
Eddie, if I'm giving high dose fentanyl and propofol, does that affect the twitching?
Nope!
Enter me directly inside the weekly gift card, Eddie. I'm ready.
Ahh, sorry I was behind on this one! Here's the link!
adv.icu/3d1AiqR
Thank you
You're welcome