chbare Posted July 2, 2009 Author Share Posted July 2, 2009 Nailed it, classic posterior dislocation. So, patient has a closed reduction in the ER and a CT of the head. He is admitted to the ICU for a cerebral contusion. Unfortunately, I cannot let you off that easy. You return the next day and the patient's doctor asks in an aggressive tone, "What the *@%& did you give the patient?" The patient was admitted in an unresponsive state and remained unresponsive throughout the next 24 hours. His blood sugar was maintained and repeat CT scans did not indicate any worsening of the patients head injury. He remains unresponsive and the patient's doctor states no paralytic medications have been given. Take it from here. Take care, chbare. Link to comment Share on other sites More sharing options...
AnthonyM83 Posted July 2, 2009 Share Posted July 2, 2009 "Do you have a copy of my run patient care report? I'll look it over with you, just so I can be exact and give you doses." But really, I'd ask him why he thinks it was something we gave. He got O2, D50, Fentanyl/Succ/Etomidate/Propofol (since scenario said we went ahead with RSI). Don't think any of those medications should be causing unresponsiveness 24 hours later. There may be concerns about use with head trauma with some of them, but they were either necessary or literature supports shows acceptable outcomes despite concerns. Any kidney injuries that could affect drug excretion? Maybe get an MRI? Not all head trauma patients recover? Link to comment Share on other sites More sharing options...
p3medic Posted July 2, 2009 Share Posted July 2, 2009 "Do you have a copy of my run patient care report? I'll look it over with you, just so I can be exact and give you doses." But really, I'd ask him why he thinks it was something we gave. He got O2, D50, Fentanyl/Succ/Etomidate/Propofol (since scenario said we went ahead with RSI). Don't think any of those medications should be causing unresponsiveness 24 hours later. There may be concerns about use with head trauma with some of them, but they were either necessary or literature supports shows acceptable outcomes despite concerns. Any kidney injuries that could affect drug excretion? Maybe get an MRI? Not all head trauma patients recover? Look at your drugs again, ask yourself which one might cause this presentation..... Link to comment Share on other sites More sharing options...
chbare Posted July 2, 2009 Author Share Posted July 2, 2009 It is not related to his injury. While he may appear unresponsive, he may in fact be awake, but unable to move or communicate. Take care, chbare. Link to comment Share on other sites More sharing options...
AnthonyM83 Posted July 2, 2009 Share Posted July 2, 2009 Hmmm. You're describing a paralytic, but I have max duration of sux listed at 10 minutes. (Fentanyl at 2 hours, etomidate at 5 min, propofol at 10 min) Is this a drug interaction with something else he was taking....or do I just have incomplete/incorrect info on the drugs I gave him? Link to comment Share on other sites More sharing options...
p3medic Posted July 2, 2009 Share Posted July 2, 2009 Hmmm. You're describing a paralytic, but I have max duration of sux listed at 10 minutes. (Fentanyl at 2 hours, etomidate at 5 min, propofol at 10 min) Is this a drug interaction with something else he was taking....or do I just have incomplete/incorrect info on the drugs I gave him? Is there anything that you can think of that might increase the duration of action of one of these drugs? Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted July 2, 2009 Share Posted July 2, 2009 Is he on Metformin? I believe that Metformin will extend paralytics. Link to comment Share on other sites More sharing options...
HellsBells Posted July 2, 2009 Share Posted July 2, 2009 Well, its possible that the succ could have increased his potassium level if he was hyperkalemic prior to the accident, I suppose that its possible he could have had some preexisting kidney damage related to his diabetes. Link to comment Share on other sites More sharing options...
chbare Posted July 2, 2009 Author Share Posted July 2, 2009 Not on metformin. No potassium imbalance noted. No underlying renal problems. This is not an interaction between two drugs. You guys are on the right track. You should essentially think about two concepts occurring in this case. These two concepts relate to one of the medications given during the RSI. Take care, chbare. Link to comment Share on other sites More sharing options...
AnthonyM83 Posted July 3, 2009 Share Posted July 3, 2009 (edited) What was his monitor / 12-lead? Fentanyl with the head injury? Edit: This is the only one I haven't seen given with head injury, rather only told it can be given, despite head injury being listed as a contraindication in many sources. Edited July 3, 2009 by AnthonyM83 Link to comment Share on other sites More sharing options...
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