Re: Ineffective Norcuron

["msmith_01" <msmith_01@msn.com>]

The only time in which I didn't have norcuron work was a male who sustained
a closed head injury.  The patient was goofy to the point of needing his
airway protected.  I wanted to nasal the guy the nurse thought that the
patients ICP would be pushed too high.  A RSI ensued, airway was confirmed
in the usual manner.  As we were moving to the aircraft the patient started
to wake from the short acting paralytic. I requested that the nurse push the
vec, her reply was, "I like to wait until the last possible minute."  The
patient becomes combative the nurse pushes a syringe full of a clear liquid.
Now the patient is really fighting, attempting to pull the tube... the work.
The nurse draws more saline and mixes the norcuron gives it and the patient
stops fighting the rest of the transport is uneventful.  As I clean the AC I
find two vials of Norcuron,  one empty, the other with the plastic cap gone
and a white powder in the vial..  I took it into the nurse showed her, her
reply was, "Oops I do that every now and then."

I asked, "I wonder how high his ICP got?"

Mike
----- Original Message -----
From: Harleydog <harleydog@sport.rr.com>
To: <flightmed@flightweb.com>
Sent: Sunday, November 18, 2001 7:51 PM
Subject: Re: Ineffective Norcuron


> 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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