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Let's talk about 
electroconvulsive therapy or 

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ECT. 
This is becoming a little bit 

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more common in common because 
the stigma behind it has been 

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removed and it's a great 
treatment for people that have 

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resistance to pharmacological 
intervention or cognitive 

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behavioral therapy, especially 
things like depression or 

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bipolar. 
So what is this? 

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Well, when the brain is not 
functioning properly, and I'm 

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just going to give you a brief 
synopsis before we get into the 

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specifics. 
When we talk about Ekgs and we 

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talk about the heart doing one 
of these dysrhythmia, it's out 

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of control. 
Medication doesn't work. 

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Nothing is working at this 
point, right? 

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We tried one medication, we 
tried another medication. 

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We tried this, we tried that. 
We tried ice water immersion and

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you know, in ventricular 
tachycardias like SVT and we're 

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sitting here, we're doing one of
these and we can't get it out 

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with medication, with other 
interventions. 

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What is our, what is our last 
resort to get this heart to 

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start wearing? 
What do we do? 

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We cardiovert them with their 
heart. 

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We cardiovert them. 
We shot them in depression and 

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bipolar. 
When pharmacological 

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intervention does not work, when
CBT does not work. 

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What are we doing when the brain
is going like this? 

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Now it's the brain that's doing 
this. 

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Well, you shocked them. 
Same concept. 

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Same concept, different organ. 
So when the brain isn't 

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functioning properly we do this 
ECT. 

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This electroconvulsive therapy 
which is controlled. 

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It is a medical procedure where 
we do pass an electric current 

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through the brain. 
We do it under general 

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anaesthesia, and what this does 
is it sends them into a 

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generalized seizure, which is 
also known as your tonic clonic 

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seizure. 
But we're doing this on purpose.

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It's a reset. 
It's under a minute. 

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Whereas your tonic clonic, you 
have that, that tone that that 

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stiffness, that rigidity, and 
you have the jerky movements, 

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tonic clonic where they can bite
their tongue, things of that 

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nature. 
And it lasts while we time it 

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because it depends on how long 
it lasts, right? 

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We don't know. 
So now we're able to reset these

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neurotransmitters and reset our 
brain. 

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So things like severe 
depression, bipolar and certain 

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psychotic states where the brain
is brain is doing one of these. 

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Whereas in cardiology, the 
heart's doing one of these. 

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And the heart, if none of these 
things work, we shock them. 

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If the brain is doing one of 
these, well, we shock them. 

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Anybody ever seen EEG? 
Actually, EEG done? 

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Doesn't it kind of look like an 
EKG with the waves, the 

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patterns, the different 
electrodes? 

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Yeah. 
Not that they're related, but 

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I'm just saying think about 
that. 

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So same idea to make it simple 
prior to this procedure, we're 

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going to make them NPO 6 to 8 
hours. 

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If we're trying to cause a 
seizure, are we going to give 

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them anti seizure medication? 
No, we're going to hold it if 

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we're trying to cause a seizure.
Are we going to give a treatment

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for seizures like 
benzodiazepines? 

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No 'cause then I can induce A 
seizure. 

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They go under general 
anesthesia, which we'll talk 

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about with the muscle relaxant, 
and they'll be unconscious. 

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We put in my mouth guard in 
'cause we are causing that 

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generalized seizure, which is 
also known as a tonic clonic 

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seizure. 
So what is general anesthesia? 

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It is a medically induced 
anesthetic process, but it's 

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reversible. 
They're going to be unconscious.

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We give them analgesia, 
analgesia for pain, muscle 

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relaxants so they're able to not
have that severe tonic clonic 

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reaction. 
But we're not giving them anti 

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seizure medications or benzos 
because those will stop us from 

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causing it. 
But we want them to be in a very

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relaxed, unaware state so we can
actually perform this to the 

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best of its ability. 
We don't want them to feel 

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anything or remember the 
procedure had said general 

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anesthesia. 
So what do we use things like 

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succinylcholine as we get to the
words that end of this 

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procedure. 
I'm sorry. 

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As we get to the end of this 
lecture, you will see where 

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succinylcholine presents itself 
for a second time. 

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So know this drug, identify this
drug, know that it's used for 

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general anesthesia and ECT. 
And then as we get further, 

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there's a genetic component 
that, for instance, in this 

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situation that if they're given 
succinylcholine, that they can 

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develop. 
We talk about the difference 

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between malignant hyperthermia 
and neuroleptic malignant 

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syndrome. 
And again, we're going to make 

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sure that they're safe and 
comfortable while allowing this 

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therapeutic shocking of the 
brain to occur. 

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After the procedure, they will 
be disoriented, so don't allow 

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them to drive. 
They may not remember what 

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happened. 
So that retrograde amnesia, they

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may develop a headache. 
We did just shock them and again

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give them oxygen before and 
after. 

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We want to all always make sure 
that we're getting that blood 

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flow and oxygen to the brain.