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Sunday, June 1, 2008

Why paralyze when you could just extubate?

Sometimes I'm glad I'm not a doctor. They have a responsibility on their shoulders that I would never want to have. There are a lot of times I opine that this should be done or that, but it's the doctor who has to bolster the brunt of the responsibility for that person's life.

So when this 47-year-old male came in after overdosing for the second time, he was placed on a ventilator to support his breathing and to protect his airway. But this came a little too late, as he had already aspirated. So, when he started waking up the next day, and went ballistic, the doctor decided to paralyze (and sedate) him instead of taking him off the vent.

Do you see the problem my co-worker and I have with this. We had already sucked a ton of brown shit from this guys lungs, so there isn't a lot of it left. He was breathing fine on his own even with a load of sedatives in his system, and when they let those wear off, he went ballistic again. But, instead of yanking the tube and letting him fly on his own, the doctor decided to paralyze him again.

Yesterday my co-worker told me he went ballistic himself because, "there is no f#%%ing reason not to extubate that patient."

How inhumane is it to keep paralyzing someone because they are "TICKED" that they have a tube up every orifice.

To be fair, however, we have to look at the doctor's end of this. The patient did aspirate. He did OD before and ended up on a vent that time too, and he did develop ARDS that time. But still, there are no signs the patient is in ARDS now.

Due to the drug he overdosed on ( I can't remember what it was), there were some complications to watch out for, but the patient, according to the nurse, "is fine other than the fact he's paralyzed."

Are we missing something here? Are we right that this patient is inhumanely paralyzed, or is the doctor right? We may never know. And that is why doctors make the big bucks and we don't.

To be honest, it's easy taking care of a paralyzed vent patient. But is that what's in the best interest of the patient? It's not our decision to make.

1 comment:

keepbreathing said...

I can see both sides. On the one hand, he's probably fine and could probably be extubated and discharged. On the other hand, the doctor's liability and the potential harm to the patient are greater if he is extubated too soon and then develops ARDS on a medical floor, where who knows how long it will take for him to be noticed?

On a more dark-humor-or-is-it note, I can also see the benefit in punitive ventilation. Just kidding! Or am I?