Block

[chbare]

What was his monitor / 12-lead?

Fentanyl with the head injury?

Initial XII lead: Sinus Tachycardia without any other significant findings.

While fentanyl is associated with rigid chest wall syndrome (typically, high doses given quickly), it is not typically associated with keeping somebody in a state that mimics neuro-muscular blockade for 24+ hours.

Take care,

chbare.

[AnthonyM83]

Well if it's not a drug interaction (including home medications, eg anticonvulsants) and it's not caused by his injuries, then it has to do with drug itself (OD, wrong drug, faulty drug) or something metabolic (distribution, elimination, etc)

Several disorders/conditions can put one at risk for prolonged effect.

How are his electrolytes? pH levels?

Signs of conditions like neuromuscular disorders, hepatic or renal failure, porphyria?

Something that would decrease plasma cholinesterase activity.

Try to get medical history from family.

Don't try to counteract with neostigmine, though!

Edited July 3, 2009 by AnthonyM83

[p3medic]

or something metabolic (distribution, elimination, etc)[b]

[chbare]

Something that would decrease plasma cholinesterase activity.

You are right on the money. When you have prolonged paralysis following sux, you need to consider a couple of things:

1) Phase two type block. Typically, sux when given properly will cause what is called a phase one I block of the neuro-muscular junction. AKA depolarization block. However, a phase II block can occur if sux is given improperly, repeated doses for example.

2) Decreased plasma cholinesterase activity.

Take care,

chbare.