Studying for my CRNA school interview on Tuesday and I'm watching a ton of your videos to prepare. Thanks for being awesome! Keep making more ICU medication videos
This is incredibly helpful! You explained this really well and very much nursing focused. I can't find any other channel as good as yours. I am currently in critical care nursing program. Would love it if you could do a video on other paralytics (e.g. sux) as well, if you haven't. Thank you for what you do!
So great to hear this Bonnie! I'm really happy you have found the channel and are finding the videos helpful. I don't have any other paralytics yet as a part of this single med focused "CC Meds" series. I do have a playlist in the "ICU Drips" series, with a 4 (?) part discussion of paralytic infusions. I will be working to cover many more meds individually focused like this over time though. 😊
@@ICUAdvantage thank you I will for sure check those iv drips series out! My colleague did a presentation on CRRT using your videos. Super impressive. Keep up the amazing work and thanks again!
LOL well I'd argue that I'm no different than anyone else who has been doing this for years. I do ensure that I do some research and planning before each video so I can try and hit all the points appropriately 😊
Great content as always. I'd be interested to hear your real life experiences with these medications, especially in emergency situations. Could be vid's by themselves or tagged onto the end of other ones.
Had my first patient on a Roc drip with pressors/sedation/vented (I’m new to the ICU) and did a neuro exam at the start of shift with no pupillary reflexes and fixed at 4mm bilaterally. I asked my preceptor if that was typical for paralytics and he dismissed it as it wasn’t a big deal. It made me nervous the rest of the day as I had 0 twitches with TOF on his ulnar and facial nerves even between titrating Roc down every few hours. Lo and behold, he coded twice on my shift and I’m wondering if he was already brain dead when I received him.
You rightfully should be concerned if you are getting no twitches. Also, what did they come in with? Was a brain injury or anoxic injury a possibility for that patient? I hope you can see some other paralytic drips and see that pupillary light reflex is still present. Same goes for paralytics given post intubation. Check it and see. Ensure you have a good light.
Hi Eddie, thanks so much for this video. Can u please do a whole video on TOF. I had a pt in a prone position and Rocuronium Drip started on the pt and whilst get report I said I’m not taking the pt without a TOF and it was a big issue
You're very welcome Agnes. In that situation, why was it a big issue? Its really important to have that done, before hand and then checked regularly to ensure 1) that we are paralyzing too much and 2) that we are paralyzing enough. Not sure why it wouldn't have been being done nor why it was such an issue to have it.
As a student this really enhance my knowledge for a code Thank you Can you be my RN preceptor to finish my last 129 clinical hours if your in the state if California?
In our institution , doctors prefer not to dilute Rocuronium or Atracurium when given as continuous infusion, so it will be more effective according to them. What do you think? Does that matter?
and how then its given? I mean just full perfussor with Rocuronium? and secondly,for how long has been given continuous infusion at your place? in my clinic its just always as bolus every 1-2 hours, depends from miorelaxant.
I personally have never heard this. We have always used diluted paralytics without any issue. It seems to work just fine and the doses are as expected. Sometimes we just do repeated push doses, but if that is going to go on, then we move to the drip.
Hi Eddie, I binged watch your videos and I find it very useful especially for a nurse outside the US who seeks a job there. Question, is there any way to check the effectiveness of Roc aside from TOF? Here in our hospital in the Mid East, we are not using that. I feel concerned that I am not helping my patient due to this. 🙁
Hi Cess! Glad to hear these are helpful for you! Sorry for the slow response. To you question, I am not aware of another way to truly check effectiveness. We can kind of assess things like reduction of spontaneous breathing, loss of cough, no observable movements, etc, but I don't know if these would let us know if we've gone too far with blockage.
Does Roc or nimbex have an effect on the muscles of the gut and/or bladder? A general concern for patients on a continuous drip over a long period of time:
Great question. So NMBAs should have minimal if any effect on smooth muscle. There doesn't seem to quite be a consensus, but it seems as probably not much impact. That said, the immobility can lead to slowed gastric motility.
Yes, definitely interested in more on the train of 4. We don't seem to use that where I am.
Yes, definitely will be a future video!
Studying for my CRNA school interview on Tuesday and I'm watching a ton of your videos to prepare. Thanks for being awesome! Keep making more ICU medication videos
Right on man and congrats and best of luck on the interview tomorrow. You got this! Glad you've found the videos helpful!
Thanks for your very informative videos. The research you do for your videos are appreciated.
Absolutely my pleasure!
Roc has been a big one during the pandemic with all these covid ARDS thanks ,:)
Yes and even running in short supply!
This is incredibly helpful! You explained this really well and very much nursing focused. I can't find any other channel as good as yours. I am currently in critical care nursing program. Would love it if you could do a video on other paralytics (e.g. sux) as well, if you haven't. Thank you for what you do!
So great to hear this Bonnie! I'm really happy you have found the channel and are finding the videos helpful. I don't have any other paralytics yet as a part of this single med focused "CC Meds" series. I do have a playlist in the "ICU Drips" series, with a 4 (?) part discussion of paralytic infusions. I will be working to cover many more meds individually focused like this over time though. 😊
@@ICUAdvantage thank you I will for sure check those iv drips series out! My colleague did a presentation on CRRT using your videos. Super impressive. Keep up the amazing work and thanks again!
cant wait for the TOF this good stuff always!
Yes, def on the todo list!
And lol Morgan! Unfortunately not my area of expertise! haha That term is taking me way back!
Perfect! Thank you very much. Greatings from Germany
THANK YOU!!!!!!!!!!!!!!!!!!!!!!!!!!!!! How are you so damn smart and explain things very clearly and just EVERYTHING
LOL well I'd argue that I'm no different than anyone else who has been doing this for years. I do ensure that I do some research and planning before each video so I can try and hit all the points appropriately 😊
The video is so clear and helpful! Thank you so much xx
Great to hear this! You are very welcome.
Great content as always. I'd be interested to hear your real life experiences with these medications, especially in emergency situations. Could be vid's by themselves or tagged onto the end of other ones.
Interesting idea...
Had my first patient on a Roc drip with pressors/sedation/vented (I’m new to the ICU) and did a neuro exam at the start of shift with no pupillary reflexes and fixed at 4mm bilaterally. I asked my preceptor if that was typical for paralytics and he dismissed it as it wasn’t a big deal. It made me nervous the rest of the day as I had 0 twitches with TOF on his ulnar and facial nerves even between titrating Roc down every few hours. Lo and behold, he coded twice on my shift and I’m wondering if he was already brain dead when I received him.
You rightfully should be concerned if you are getting no twitches. Also, what did they come in with? Was a brain injury or anoxic injury a possibility for that patient?
I hope you can see some other paralytic drips and see that pupillary light reflex is still present. Same goes for paralytics given post intubation. Check it and see. Ensure you have a good light.
A roc drip. Honestly I have never heard of such a thing and I've been in the cvicu for the last 3 years. Interesting thought
Roc drip? Holy shit
Thanks for this video!! I’m so glad you liked added this because I wanted to know more about Roc since we use it a lot in MICU🙏🏾
Awesome! Glad to hear this was a good one for you!
Thanks for the video! Looking forward to the Tof one.
Wow, a lot of people asking for this. May need to move it up the list :)
Love your teaching as always. Thank you 😊.
You are too kind! Thank you!
Great lesson on Roc.
This is great. Thank you so much looking forward to more videos!
Thank you Debora!! I will keep them coming ;)
Superb! Thanks.
Awesome, thank you!
Thanks for the great video!
You are very welcome Michelle!
You’re the best! Love all of the content you put up.
Awesome! Glad you are liking it!
You’re super great at explaining 🤩
Thank you! 😃 I really appreciate that.
Thanks!
Thank you so much Mark!
Thanks Eddie
You're welcome Justin!
Thanks for your educative classes requesting if you could do targeted tempeture management in ICU.thank you for your updates highly appreciate.
Yes TTM is on the todo list!
Thank u very much boss
My pleasure! :)
Quite informative vedio 👍👍
Thank you. Glad you liked it!
Hi, can you teach on IABP, the concept and waveform?
Yes! It's on the todo list!
Make a video about hypertensive emergencies in the ICU
Its on the todo list!
Can you post a video about, thorough and efficient, end of shift nurse progress notes for icu
Hmmm.... I'll see if I can include that on the todo list, but honestly I haven't worked anywhere doing progress notes is many years.
Do paralytics have an effect on pupil reactions?
Hi Eddie, thanks so much for this video. Can u please do a whole video on TOF. I had a pt in a prone position and Rocuronium Drip started on the pt and whilst get report I said I’m not taking the pt without a TOF and it was a big issue
You're very welcome Agnes. In that situation, why was it a big issue? Its really important to have that done, before hand and then checked regularly to ensure 1) that we are paralyzing too much and 2) that we are paralyzing enough. Not sure why it wouldn't have been being done nor why it was such an issue to have it.
Eddie, the pt was on the Rocuronium drip without a TOF?
As a student this really enhance my knowledge for a code
Thank you
Can you be my RN preceptor to finish my last 129 clinical hours if your in the state if California?
Happy to hear it was helpful! Unfortunately I am not in Cali!
🔥
TY!
In our institution , doctors prefer not to dilute Rocuronium or Atracurium when given as continuous infusion, so it will be more effective according to them.
What do you think? Does that matter?
and how then its given? I mean just full perfussor with Rocuronium? and secondly,for how long has been given continuous infusion at your place? in my clinic its just always as bolus every 1-2 hours, depends from miorelaxant.
@@ВкуснаяВишня-ц7ч yes, just Rocuronium in the perfussor . The infusion continues for several days depending on the case .
I personally have never heard this. We have always used diluted paralytics without any issue. It seems to work just fine and the doses are as expected. Sometimes we just do repeated push doses, but if that is going to go on, then we move to the drip.
Hi Eddie, I binged watch your videos and I find it very useful especially for a nurse outside the US who seeks a job there. Question, is there any way to check the effectiveness of Roc aside from TOF? Here in our hospital in the Mid East, we are not using that. I feel concerned that I am not helping my patient due to this. 🙁
Hi Cess! Glad to hear these are helpful for you! Sorry for the slow response. To you question, I am not aware of another way to truly check effectiveness. We can kind of assess things like reduction of spontaneous breathing, loss of cough, no observable movements, etc, but I don't know if these would let us know if we've gone too far with blockage.
*succ had entered the chat*
Why is it that pupillary reaction is not affected by the roc?
Different neurotransmitter/receptor activation than skeletal muscle. Same for cardiac muscle.
Does Roc or nimbex have an effect on the muscles of the gut and/or bladder? A general concern for patients on a continuous drip over a long period of time:
Great question. So NMBAs should have minimal if any effect on smooth muscle. There doesn't seem to quite be a consensus, but it seems as probably not much impact. That said, the immobility can lead to slowed gastric motility.
I can't find the notes for this topic. Any help?
Good catch. That one got missed. It is there now though! :)
And thanks so much for your support Vosk!
CCRN