The medical team is concerned that J.A.’s condition may have worsened; he may have had a neurologic event (e.g., stroke) in the night.

The medical team is concerned that J.A.’s condition may have worsened; he may have had a neurologic event (e.g., stroke) in the night. J.A. is clinically unstable to bring to computed tomography (CT). The team needs J.A. to be alert for purposes of conducting a neurologic examination. To undergo the examination, J.A. must have his neuromuscular blockade discontinued and sedation lightened. One and one-half hours after discontinuation of cisatracurium J.A. is still not moving (TOF 0/4). The medical team feels J.A.’s cisatracurium’s paralytic effect should have worn off by now and is concerned about his prognosis. The medical team ask the clinical pharmacist to review J.A.’s case and affirm that the neuromuscular blockade has worn off.

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Case Study: Mr. John Hemsley, 56 years old, presented to his general practitioner (GP) with a three-month history of constipation and abdominal discomfort.

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