Neuromuscular Blocker Reversal - Paralytics (Part 4) - ICU Drips
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- Опубликовано: 17 дек 2019
- In this this final lesson we take a look at the intricacies of the group of medications that we have available when it comes to neuromuscular blocker reversal.
We start off with a quick overview of the autonomic nervous system, focusing on the parasympathetic nervous system and the use of acetylcholine as a messenger to activate the muscarinic receptors. The reason this is important is in order to reverse our paralytics, we need to provide high amounts of acetylcholine. The way that we do this is by blocking an enzyme called acetylcholinesterase that normally breaks down Ach.
Unfortunately though, these medications block this enzyme throughout our patients bodies and lead to an abundance of Ach everywhere which can lead to massive activation of their parasympathetic nervous system and comes with some very serious side effects, including bradycardia and asystole.
In order to prevent this from happening, we have to use an anti-muscarinic (anticholinergic) drug to block the muscarinic receptors from being activated by Ach. These medications must be given at the same time that our acetylcholinesterase inhibitors are given. We have a few medications that can do the job, but Glycopyrrolate is our first line drug, backed up by atropine when that medication fails to perform.
We conclude the lesson talking about a newcomer to the world of paralytic reversal with a medication called Sugammadex that directly binds our aminosteroids and prevents them from activating Ach receptors.
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#ICUDrips #Paralytics #ICUAdvantage
Nice down and dirty review. Started watching your videos in 2020 when I was a new grad in ICU, they were so complex. Now, Im in CRNA school in PA and still using your content. Thank you.
Thanks Eddie - your four videos on NMJ blockade are pitched at just the right level for what I was looking for. :)
Enjoyed this series about paralytics. Great stuff.
Glad to hear it!
Thanks much for this. This is exactly what I was looking for with paralytics.
Sweet. Glad this was what you needed.
Thank you guys so much for watching! 🙏 Please leave us a like 👍if you enjoyed the video. We truly do appreciate it! Also we love 💗hearing your comments so feel free to tell us what you think of the video. 😍
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Heart Failure: ruclips.net/p/PL2oVjKTYocdNdFoS31yGhylKwib9lRf73
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Thank you so much for your content! I do have one question, though and it might be a really dumb and obvious one.. near the end of this video, you reference acetylcholine on muscarinic receptors and reversing that but I was truly, until now, under the impression that nmb agents are primarily acting on nicotinic (Nm) receptors as that's where all the skeletal muscle involvement is activated or inhibited. Have I been getting this backwards, or am I just not understanding the full meaning of the material? Thank you so much for your time and amazingly high-quality content!
I really enjoy your content; it has been extremely helpful for me in the ICU internship! I would love to see you create a lesson on Malignant Hyperthermia! :)
So great to hear Amy! Glad you've enjoyed them and found them helpful for you.
That is a great suggestion and I'm surprised I didn't have that one on the todo list already. Adding it now! :)
Please make Pacu ones
What's the problem with atropine crossing the BBB? Thank you! Great revision for me!
Like like likeeee 👍🏼 great lecture 💯
Awesome! Thank you!
Would it be incorrect for me to assume that these reversal agents do not have a complete affect on succinylcholine especially regarding fasciculation side effects?
Do we use Sugamadex with anything else like glycopyrollate? or does the act/ achesterase go back to normal and not cause Brady?
So Sugamadex does not impact ACH at all. It binds with the aminosteriod paralytics, preventing them from binding with the receptors, and thus can no longer block the ACH thats there. This is the beauty of this med is it doesn't have these other effects that we have to counter act and instead targets the paralytic itself.
👍👍👍👏👏👏🙏🙏🙏
Thank you!
1.5 minutes wastage in initial video
Appreciate the feedback