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Continuous Neuromuscular Blockade

Continuous Neuromuscular Blockade. Peripheral Nerve Stimulator Use and Indication. When do we use NMBA?. Compromised patients with increased oxygen consumption related to pulmonary/cardiac disease Facilitating synchrony between mechanical ventilation and patient

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Continuous Neuromuscular Blockade

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  1. Continuous Neuromuscular Blockade Peripheral Nerve Stimulator Use and Indication

  2. When do we use NMBA? • Compromised patients with increased oxygen consumption related to pulmonary/cardiac disease • Facilitating synchrony between mechanical ventilation and patient • Maintaining endotracheal intubation • Optimizing conditions for imaging or diagnostic studies • Immobility of pt. during invasive procedure or transport • Increased ICP • Uncontrolled seizure activity • States of high metabolic expenditure • Emergent control of agitated or combative patient

  3. Which nerves can I use? (Where will twitches occur?) R or L ulnar/medial nerve (thumb) R or L posterior tibial nerve (great toe) R or L facial nerve (eyebrow) Train of Four = 4 equal twitches Test before paralytic initiated!!!!!! Supramaximal Stimulus (SMS) is the level at which additional stimulation current does not increase the twitch response Peripheral Nerve Stimulator

  4. NMBA • A minimal mechanical rate of 8 is required to ensure full ventilator support • Place a sign at HOB indicating “Pt. is on Neuromuscular Blockade” • Pt MUST always receive simultaneous sedation (benzo, barbituates, or propofol) and adequate analgesia (opiates) THIS IS A MUST!!!!!! • If the physician won’t order sedation you will not use paralytics

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