00:00
Hi, welcome to our respiratory video series. Now on this
one, we're going to look at what
happens when a diaphragm goes bad. So let's talk about what
can paralyze or damage the
diaphragm. Now, they can be drugs like neuromuscular blocker
drugs. Those paralyze the
larynx, the diaphragm, and we use them in surgery in
critical care areas. Now, the goal is not to
necessarily paralyze the diaphragm but is to kind of power
down the patient. It paralyzes all
the skeletal muscles. Since the diaphragm is a skeletal
muscle, that's why these neuromuscular
blockers paralyze the diaphragm. Now if it's not a drug, it
could also be an injury from trauma
to the diaphragm or to the phrenic nerve. That's the one
that controls the diaphragm,
communicates from the brain down to the muscle. So let's
take just a quick look at
neuromuscular blockers. Now these are drugs, they interrupt
the transmission of nerve
impulses and the skeletal neuromuscular junction. Remember,
skeletal tells us what type of
muscle it is. Neuromuscular means the nerve system, the
muscular. So that's the space in
between where the nerves tell the muscles what to do. Now,
neuromuscular blockers just block
that transmission in between the nerves and the muscles. So,
it really stops acetylcholine
from triggering the muscle contraction and that's what
causes a paralysis that's why it's
helpful in anesthesia, we use it as an anesthesia adjuvant.
That means an adjuvant just means
something that we use alongside. So if you're having
surgery, it's really kind of convenient
that the patient not be moving around, that's why a
neuromuscular blocker is helpful. We can
use it as a relaxant during electroshock therapy. Now, I
didn't even realize we still did
electroshock therapy and it's not done very often but it is
done in cases of severe depression.
01:58
When other types of treatment and drugs where ineffective,
this is one option if it's
recognized as I want to try for a patient but we can use it
during electroshock for the same
purpose. It will help paralyze the patient so they're not
moving during the therapy. Now we
also use it in critically ill patients, we need to kind of
power them down. We want all their
energy to be focused on getting better. We've got them on
the mechanical ventilator and if
you're on a neuromuscular blocker, you can't breathe by
yourself so you'll have to have some
type of ventilator support which is usually a mechanical
ventilator. Now, I'll introduce you
to a couple of the drugs just so you recognize the name.
Succinylcholine is the long name, you'll
often heard it refer to as sucs. Now you can use it in
surgical procedures and they want a rapid
onset and a brief duration of muscle relaxation, maybe say
we're trying to intubate the
patient. That would be one use of succinylcholine. So we can
use it in endoscopies, in ECT.
03:00
This is an example of a neuromuscular blocker, goes in quick
rapid onset, doesn't last for a very
long time so if we just want it for a quick procedure that's
an option. Now, rocuronium. Now we
use this for inpatient and outpatient so we can use it as an
adjunct to general anesthesia
because you want to facilitate both the rapid sequence of
intubating a patient. We also use
this for skeletal muscle relaxation during surgery or on
mechanical ventilation. So if someone
might be on a drip of this medication or a constant
administration of rocuronium to keep them
paralyzed over a period of time in a critical care unit.
Sucs, quick, in and out, get the procedure
done. Rocuronium might be something that they use for a
longer period of time. Now at the
bottom, we've listed some other examples for you.
Rocuronium, you'll see the other names
right there. So that kind of gives you a feel, a lot of them
end in "onium", that will be a clue
to you when you see those drug names. I know it's
succinylcholine is a little different, but you
can remember that one because of the ending "choline" and
you know that impacts
acetylcholine in the neuromuscular junction. So those are a
couple quick tips to help you
remember these drug names.