Paralysis with NMBs (Nursing)

00:00 Hi. Welcome to our pharmacology video series. Now, in this one we're going to take a look at neuromuscular blockers, specifically the competitive neuromuscular blockers. So, let's start with the question. What do you think it would feel like to have been given a neuromuscular blocker without a sedative? Well, let me tell you. I want you to keep in mind what these powerful drugs can do because they paralyze the skeletal muscle. So, what would it feel like? Well, it would be like a nightmare because you could sense everything, but you couldn't move anything. So, you would hear what was going on. You could see, if you could move your eyelids, which you can't. But you can definitely hear, you can feel, you have all these other sensations, you just can't control voluntary movement. So, why would we do this to someone outside of some sick kind of movie? You mean paralyze them while they're fully conscious. Well, the answer is we don't. Sedatives are always given with neuromuscular blockers and pain control as needed. But I want you to get the concept that these drugs are intense. Okay, they're great for the use that we have them for, but it's your responsibility as a nurse to recognize these drugs and know that anyone on this type of medication is going to need particularly special monitoring and ventilator support. So, the sedation is required. It's always used with neuromuscular blockers because we want to help decrease that anxiety that you or I would have if we were on a neuromuscular blocker. Remember, totally paralyzed but yet still completely awake unless you give them the sedation, which is why we always do. So, we do this to someone. We paralyze them with neuromuscular blockers. We use the sedatives because there are really helpful times for patients to be motionless and completely powered down as much as possible. So, neuromuscular blockers do have their place. Let's talk about some of those. First one is surgery. Now, that should make sense. If we're cutting on someone's body, it's really a good idea if they're perfectly still. What about endotracheal intubation? Well, sometimes that can be problematic, so it's another good time for a patient to be perfectly still in an emergency. Now, we have someone on a neuromuscular blocker.

02:28 We also have to have them on some type of ventilator support like a mechanical ventilator.

02:33 Sometimes, the patient is so critically ill, we talked about powering them down. That's why a physician might order a neuromuscular blocker because we want all the energy to go on healing and trying to resolve whatever has caused that patient to be this critically ill. So, surgery, endotracheal intubation, that is when you're putting a breathing tube in down into the trachea, and mechanical ventilation to someone who's extremely ill. Now, there are some other procedures, but that gives you a good kind of overall of why we use neuromuscular blockers. So, let's go back to that paralysis with intubation. So, again, you've got somebody in the ventilator. They're critically ill. What are the benefits to healing? And we talked about how you want them powered down, not extending any energy outside what is absolutely necessary, but this will also eliminate the gag reflex. So, if someone's being intubated, in a crisis, we're having a difficult time intubating them, we can use this to limit that gag reflex.

03:35 I mean eliminate that gag reflex. Being on the ventilator is not as easy as it looks, okay. It's pretty uncomfortable for the patients. Now, some patients that are on chronic ventilators have adjusted to it, but for most people, it's not a very comfortable procedure, so they can fight it, particularly if they're not completely there in neuro status. So, that's another reason why someone might fight against the ventilator and a neuromuscular blocker might be needed.

04:05 You know, patients tell us if you've ever talked to someone who's been on a ventilator, it could make them feel like they're not getting enough air. Even though it's healthcare providers, we can quantify it. We can look at the numbers. We can look at their tidal volume.

04:18 We can look at their arterial gases. We can look at all kinds of things, and it looks okay to us, but it doesn't feel that way to patients. So, a lot of times that's another reason why patients can fight that ventilator because they're feeling air hungry. And lastly, just to kind of wrap that up, what sums up these 3 statements is we don't want patients wasting energy, that they need to heal on fighting the ventilator. So, that's why we use neuromuscular blockers with intubated patients while we're doing the procedure, at times when it's needed and it's emergent, and then while we have patients on mechanical ventilation to help critical ill patients recover faster. I keep saying mechanical ventilation, but we've got a big old exclamation point right on this slide. Anyone on a neuromuscular blocker is going to have to be on mechanical ventilation because the muscles of respiration are also paralyzed, specifically the diaphragm.

05:20 That is skeletal muscle, and so that's also going to make it impossible for the patients to breathe.