Ect-_an_Introduction_to_Nursing_Students

ECT An Introduction to Nursing Students □ ECT remains an important, effective & safe treatment for a variety of Neuropsychiatry disorders. History: ❖ 1500 – Paracelsus induced seizures by camphor (By mouth to treat psychiatric illness) ❖ 1934 – Meduna used injections of camphor to induce seizure in treating catatonic symptoms. ❖ 1938 – Cerletti and Bini used electrical shock to induce seizure for the treatment of psychosis. Direct ECT: Electrical shock given to a conscious patient. Modified ECT: ECT with Anesthesia and muscle relaxant. Mechanism of Action : Specific mechanism is unknown. 1. Neurophysiology: Metabolism of glucose & oxygen and permeability of BBB increases. 2. Neurochemical: Changes in neurotransmitters like Nor epinephrine, serotonin, Dopamine, GABA, opioids etc. 3. Neuroplasticity: In animals synaptic plasticity is observed. Frequency of ECT’s : ✓ Generally – 3 times a week on nonconsecutive days. ✓ Daily: Used in most urgent situations like SUICIDE, Severe mania. ✓ Once a week: For continuation ECT Number of Sessions ✓ Should be individualized as requirement ✓ Average 6 – 12 sessions Indications : o Major:- SUICIDE patient o Major Depressive disorder. o Mania – severe & Rapid cyclers o schizophrenia. o Others:- OCD – catatonia – Delirium Narcoleptic malignant syndrome ▪ Intractable seizures. o Contraindication: Raised intracranial pressure. Pretreatment evaluation: Psychiatric Assessment: • Establish the indication for ECT • Explore post treatment with ECT • Behavioral Assessment • Cognitive evaluation for orientation, memory. Consent : ❖ Written informed consent must be obtained. ❖ Discuss the benefits & risks. ❖ Consent may be withdrawn during the course of ECT. ❖ If patient cannot give consent, then family members consent can be taken. ECT Procedure : Pre – ECT Checks ➢ Patient’s Identity. ➢ Fasting since 8 Hours. ➢ Bowel & Bladder Emptied. ➢ Not wearing tight cloths. Administration of Anesthetic : ✓ Establish I.V. access ✓ Attach monitoring ( HR, BP, EEG ) ✓ Ventilate with pure oxygen via face musk. ✓ Give short acting Anesthetic (Thiopentone) with atropine followed by muscle relaxant ( Succynyl Scoline ) ✓ Insert bite – block between teeth. Recovery : ❖ Ensure adequate airway. ❖ Monitor vitals until stable. ❖ Continuous observation. ❖ Specific problems / complications ❖ Sub shocks / inadequate seizures. ❖ Prolonged seizures: > 90 secs for cuff, > 120 secs for EEG ❖ Give I.V. Diazepam – 10 mg (or) Thiopentone 100 – 200 mg. ❖ Status Epilepticus. ❖ Delirium ❖ Prolonged apnea Adverse Effects : → CVS: Bradycardia → R.S.: Prolonged apnea → CNS: Prolonged seizures → Teeth: Broken / dislodged → Musculoskeletal: # long bones / spine. → Neuro-cognitive: Ante grade & Retrograde amnesia → Others: Headache, Nausea. [pic] [pic]