Let's talk about electroconvulsive therapy or
ECT. This is becoming a little bit
more common in common because the stigma behind it has been
removed and it's a great treatment for people that have
resistance to pharmacological intervention or cognitive
behavioral therapy, especially things like depression or
bipolar. So what is this?
Well, when the brain is not functioning properly, and I'm
just going to give you a brief synopsis before we get into the
specifics. When we talk about Ekgs and we
talk about the heart doing one of these dysrhythmia, it's out
of control. Medication doesn't work.
Nothing is working at this point, right?
We tried one medication, we tried another medication.
We tried this, we tried that. We tried ice water immersion and
you know, in ventricular tachycardias like SVT and we're
sitting here, we're doing one of these and we can't get it out
with medication, with other interventions.
What is our, what is our last resort to get this heart to
start wearing? What do we do?
We cardiovert them with their heart.
We cardiovert them. We shot them in depression and
bipolar. When pharmacological
intervention does not work, when CBT does not work.
What are we doing when the brain is going like this?
Now it's the brain that's doing this.
Well, you shocked them. Same concept.
Same concept, different organ. So when the brain isn't
functioning properly we do this ECT.
This electroconvulsive therapy which is controlled.
It is a medical procedure where we do pass an electric current
through the brain. We do it under general
anaesthesia, and what this does is it sends them into a
generalized seizure, which is also known as your tonic clonic
seizure. But we're doing this on purpose.
It's a reset. It's under a minute.
Whereas your tonic clonic, you have that, that tone that that
stiffness, that rigidity, and you have the jerky movements,
tonic clonic where they can bite their tongue, things of that
nature. And it lasts while we time it
because it depends on how long it lasts, right?
We don't know. So now we're able to reset these
neurotransmitters and reset our brain.
So things like severe depression, bipolar and certain
psychotic states where the brain is brain is doing one of these.
Whereas in cardiology, the heart's doing one of these.
And the heart, if none of these things work, we shock them.
If the brain is doing one of these, well, we shock them.
Anybody ever seen EEG? Actually, EEG done?
Doesn't it kind of look like an EKG with the waves, the
patterns, the different electrodes?
Yeah. Not that they're related, but
I'm just saying think about that.
So same idea to make it simple prior to this procedure, we're
going to make them NPO 6 to 8 hours.
If we're trying to cause a seizure, are we going to give
them anti seizure medication? No, we're going to hold it if
we're trying to cause a seizure. Are we going to give a treatment
for seizures like benzodiazepines?
No 'cause then I can induce A seizure.
They go under general anesthesia, which we'll talk
about with the muscle relaxant, and they'll be unconscious.
We put in my mouth guard in 'cause we are causing that
generalized seizure, which is also known as a tonic clonic
seizure. So what is general anesthesia?
It is a medically induced anesthetic process, but it's
reversible. They're going to be unconscious.
We give them analgesia, analgesia for pain, muscle
relaxants so they're able to not have that severe tonic clonic
reaction. But we're not giving them anti
seizure medications or benzos because those will stop us from
causing it. But we want them to be in a very
relaxed, unaware state so we can actually perform this to the
best of its ability. We don't want them to feel
anything or remember the procedure had said general
anesthesia. So what do we use things like
succinylcholine as we get to the words that end of this
procedure. I'm sorry.
As we get to the end of this lecture, you will see where
succinylcholine presents itself for a second time.
So know this drug, identify this drug, know that it's used for
general anesthesia and ECT. And then as we get further,
there's a genetic component that, for instance, in this
situation that if they're given succinylcholine, that they can
develop. We talk about the difference
between malignant hyperthermia and neuroleptic malignant
syndrome. And again, we're going to make
sure that they're safe and comfortable while allowing this
therapeutic shocking of the brain to occur.
After the procedure, they will be disoriented, so don't allow
them to drive. They may not remember what
happened. So that retrograde amnesia, they
may develop a headache. We did just shock them and again
give them oxygen before and after.
We want to all always make sure that we're getting that blood
flow and oxygen to the brain.