Re: Ineffective Norcuron

["Harleydog" <harleydog@sport.rr.com>]

I can think of a couple possibilities.  It sounds like Norcuron wasn't the
only medication that didn't take effect.

1.  Possibly the IV access was not really patent? - I'm sure we've all been
fooled before - I know I have.  I pushed paralytics through a central line
(Cordis) a couple of weeks ago with no effect.  I got good blood return when
I drew back in this case and "assumed" the line was patent.  It turns out
the Cordis was leaking around a transvenous pacer wire under a bulky
dressing.  We quickly fixed the problem with a peripheral line.  Did you
attempt to push any meds through your own IV access?
2.  Extremes in temperature could breakdown the Norcuron while in storage
before the expiration date.  We all know how easy it is to regulate
temperature inside an aircraft (lol).  Though the ineffectiveness of the
benzos leads me to believe it was an IV access problem...
3.  Check with anyone else using Norcuron from the same lot - particularly
anesthesia.  Maybe you have a bad batch of medication.

Let the list know what y'all find out.

Larry Dixey, RN, NREMT-P
Life Air Rescue
Shreveport, LA


----- Original Message -----
From: David Ellis <davidcfp@hotmail.com>
To: <flightmed@flightweb.com>
Sent: Sunday, November 18, 2001 4:21 PM
Subject: Ineffective Norcuron


> Has anyone had an instance in which Norcuron has failed to induce
paralysis
> in a patient?  Case in point:  young female seen in small ED for status
> seizures.  10mg ativan and 40mg valium given with no affect on seizure
> activity.  Pt was intubated and evenually stopped seizing prior to flight
> crew's arrival. Pt was found by flight crew to be very combative with ED
> staff pushing large amounts of valium and versed in an attempt to control
> the patient, who required four staff members to hold her down.  As this
> small ER did not stock any form of paralytic, the flight crew pushed 10mg
> Norcuron with no affect on the patient.  The IV lines were patent and the
> norcuron was in date and recently purchased.  Further versed was given and
> the patient restrained, at which time the patient momentarily lapsed into
> unconsciousness, but would still withdraw from pain.  Pt was taken to
> aircraft and shortly after take off became combative again.  An additional
> 10 mg dose of Norcuron was given, inducing paralysis for less than 10
> minutes.  Prior to transport and throughout the 75 minute flight, numerous
> forms of sedation were attempted, with no evident affect to the patient.
> The crew spent the majority of the flight physically restraining the
> patient.  If anyone has had a similar experience, or can shed some light
on
> the causes for this, I would greatly appreciate it!
> David
>
>
>
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