Re: Ineffective Norcuron

["David Ellis" <davidcfp@hotmail.com>]

Thanks to everyone for the answers so far.  Just to clear a couple of 
points:
     The patient was a 26 year old female wih a history of epilepsy, for 
which she took pheonbarb.  She had one IV started prior to our arrival, and 
we initiated a second.  Meds were pushed through both, with the same lack of 
effect.  We did suspect recreational drug use, but had no hard evidence to 
support this.
     All of our narcotics and RSI meds are kep with the flight crew at all 
times, and are locked up in the base when not out on a flight.  I doubt that 
exposure to environment caused a breakdown, but that is always something to 
consider.
     The crew on the shift prior to mine used norcuron from this same lot, 
with no problems, so I don't think it was a bad batch.  Again, certainly 
something to consider.
     Thanks again for the replys so far--anything furher is appreciated!
David


>From: "Harleydog" <harleydog@sport.rr.com>
>Reply-To: flightmed@flightweb.com
>To: <flightmed@flightweb.com>
>Subject: Re: Ineffective Norcuron
>Date: Sun, 18 Nov 2001 18:51:52 -0600
>
>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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