"Help, I just injected myself with succinylcholine"

"Help, I just injected myself with succinylcholine"

One day while on my Family Medicine rotation I was eating lunch in the break room I was sitting and talking with the drug reps and some of the doctors. One of the doctors there was Dr Patterson, a family practice doc from the other side of the office. I didn't work with Dr. Patterson, but I knew who she was. Somehow we wound up talking about medical professionals that get addicted to and abuse drugs. She busted out with a story that was so unbelievable that I had to write about it and share. As is usually required in my medical stories, you need a little bit of background info.

When patients undergo general anesthesia for major surgery the anesthesiologist has to choose the right combinations of drugs in order to successfully knock the patient out enough to be able to do the surgery. Usually they have to use a combination of a couple of different drugs in order to do this right. You have to use sedatives to knock the patient out so they don't remember the surgery and and don't wake up in the middle of it. You have to use narcotics or other pain meds in order to make them not feel the pain of the surgery, and you have to use paralytics to prevent them from moving and relax their muscles so you can do all the surgery things you need to do. Depending on what surgery you are doing, how long it is going to take, the patients physical and chemical attributes etc etc, the anesthesiologist has to modify drugs and dosages and stuff. Every once in a while you hear a story about a patient that had a bad experience with their anesthesia A popular nightmarish type story of this is the patient who wakes up during the surgery and can feel the pain of the surgery, but is still paralyzed and can't say or do anything but endure the agony of the remainder of the surgery while quietly going insane.

Morphine and Fentanyl are popular narcotics used for pain both during and after surgery, which also happen to be very popular drugs for hard core medical drug abusers to get addicted to. Succinylcholine is a paralytic used to very rapidly knock someone down for intubation or things like that. It causes you to very quickly loose all control of your muscles. This includes all skeletal muscles, but also affects your respiratory muscles. Luckily your heart is not affected. It's basically the same as Curare, the stuff that people dip poison blow darts in to hunt monkeys and stuff in the amazon. The monkey dies of asphyxiation from not being able to breathe. The same thing happens with Succinylcholine. It has been used in murders occasionally and probably has been on CSI, but it's not all that great as a murder weapon because it is relatively short acting. You have to give a really big dose to keep a human paralyzed long enough from them to asphyxiate and die. Any kind of artificial respiration would prevent this, so anyone with CPR training who can do rescue breathing, or someone with a bag-valve mask would be able to save them.

Now the story:

Dr. Patterson said that back in the day when she was a resident on her surgery rotation she had a really crazy thing happen. During a surgery, while everyone was paying attention to the surgery and doing their thing, the Anesthesiologist suddenly announced, "Help, I just injected myself with succinylcholine", and while everyone was stunned trying to process what he said and what it meant, proceeded to fall to the floor completely paralyzed and apneic (not breathing). Because he had said something, the operating room staff was able to get to him and give him rescue breaths until the drug wore off and he woke up saving his life. Without his announcement, he would have just fallen over unconscious and everyone would have been left wondering what happened and possibly not getting to him in time or misinterpreting his unconsciousness as something else and risk getting chest compressions or something worse. But the immediate question that leaps into your mind when hearing this story is, how do you accidentally inject yourself with succinylcholine? because there is no way that he would have done it on purpose. Well it turns out that the anesthesiologist was addicted to morphine and for a long time had been stealing and injecting himself with the morphine that was supposed to have been going to the patient during the surgery. This time he had accidentally injected himself with the succinycholine rather than the morphine and paralyzed himself. Dr. Patterson said once the dust settled and everyone figured out what had happened and that he had been stealing the patient's meds he was eventually fired, but hopefully went into rehab someplace before getting hired someplace else as was most likely going to happen. Susan theorized that the anesthesiologist probably ought to have just kept his mouth shut and let them resuscitate him and later claim to have had a "syncopal" episode and played it off as a freak blackout and kept his dirty little secret. But we both agreed that given the shock and panic of the situation he probably didn't have a lot of time to decide what to do before going limp and decided against risking his life to the resuscitation skills of a surprised surgical staff. But how is that for a whopper of a story? I wouldn't have believed it to be true, but Dr. Patterson assured me that it was 100% true since she was there when it happened. Wow.

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