#Tweetorial 🚨
Team asked about Train of Four #TOF testing during #ICUrounds this weekend. So here’s a quick review!
HOW: Stimulator delivers 4 consecutive electrical impulses (typically at 2 Hz).
📸 : Commonly used stimulator. No COI
Team asked about Train of Four #TOF testing during #ICUrounds this weekend. So here’s a quick review!
HOW: Stimulator delivers 4 consecutive electrical impulses (typically at 2 Hz).
📸 : Commonly used stimulator. No COI
WHERE: Using the two electrodes (ARROWS in 📸), these 4 electrical impulses are delivered to a peripheral nerve, typically the ulnar nerve.
WHAT are we looking for? Contractions of the associated muscle: The “thumb muscle” aka adductor pollicis.
📸: H/T to medicoapps
WHAT are we looking for? Contractions of the associated muscle: The “thumb muscle” aka adductor pollicis.
📸: H/T to medicoapps
So, what is TOF testing used for?
To assess the level of “paralysis” caused by neuromuscular blocking agents (NMBA) eg. Cisatracurium being used for paralysis in a mechanically ventilated patient with severe ARDS
It’s most commonly used in the OR or the ICU
To assess the level of “paralysis” caused by neuromuscular blocking agents (NMBA) eg. Cisatracurium being used for paralysis in a mechanically ventilated patient with severe ARDS
It’s most commonly used in the OR or the ICU
The response is graded from 0-4 out of 4 depending on how many “twitches” are generated by the 4 electrical impulses.
0: Complete blockade (eg. For surgeries requiring complete paralysis)
4: No blockade (see video of one of our team members, with permission)
0: Complete blockade (eg. For surgeries requiring complete paralysis)
4: No blockade (see video of one of our team members, with permission)
To summarize, #TOF testing is used to assess degree of neuromuscular blockade.
Prior to starting paralysis, confirm that 4 twitches occur + note the strength of impulse required.
Post paralysis, deliver impulses at same strength to assess degree of paralysis!
End #Tweetorial
Prior to starting paralysis, confirm that 4 twitches occur + note the strength of impulse required.
Post paralysis, deliver impulses at same strength to assess degree of paralysis!
End #Tweetorial
Loading suggestions...