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Factual reason behind using 1:10000 over 1:1000 Epi in Cardiac Arrest

Discussion in 'ALS Discussion' started by Ecgg, May 23, 2011.

  1. Ecgg

    Ecgg New Member

    Hello!

    I was looking for studies or any supported scientific data/studies that shows why 1:10000 solution IV/IO is preferred in Arrest setting over 1:1000?

    I herd multiple accounts stating various things without any material to support it. Here is some of the things that I herd:

    1-1:10000 has the Saline in it to help propel the medication further into the central circulation. Thus don't have to follow up with Syringe NS boluses.
    2-1:1000 Epi given IV can cause phlebitis, necrosis and all kinds of havoc if given IV. Thus avoid giving 1:1 1mg per 1ml epi IV.
    3- To avoid medication errors. Prefilled syringes offer idiot proofing.

    Science/Data backing would be appreciated why 1:10000 is the preferred solution in arrest setting.
  2. usalsfyre

    usalsfyre You have my stapler

    Considering epi has never proven to be helpful in ensuring survival to discharge in the setting of arrest AND 1mg of epi is 1mg of epi is 1mg of epi no matter how much solution it's dissolved in AND even 1:10000 should be followed with a flush to ensure all of the medication makes it into circulation, I highly doubt there's any data like what you seek out there. I'm certainly not aware of any.

    The only reasons I can think of for 1:10000 are a.) ease of use and b.) so it's easier to dilute down for use as a bolus dose pressor.

    What are you seeking this info for?
  3. medicsb

    medicsb Member

    Location:
    PA/NJ/DE area
    EMS Training:
    EMT-Paramedic
    www.pubmed.com - search til you're blue in the face here.

    What usalsfyre said.

    However, diluted vs. undiluted amiodarone for cardiac arrest was studied in Europe somewhere, so you never know.
  4. mycrofft

    mycrofft Still crazy but elsewhere

    Location:
    Central California
    Whether or not it works...

    The potential excitement and crowded conditions of codes makes for heightened chances for misdoseage. Better to have a lower concentration ready to go instead of titrating from more-concentrated solutions, leaving half-used syringes lying around, etc.

    Also, in re. "excitement" above, not all codes take place in calm well-lit and constantly rehearsed places like hospitals or with experienced MD's etc around.

    They probably did a study long ago, maybe on dogs, and it crept into practice because it seemed to work.
  5. usalsfyre

    usalsfyre You have my stapler

    Anyone remember 30mgs in 30ml vials?
  6. Aidey

    Aidey Forum Deputy Chiefette Community Leader

    Location:
    USA
    Oddly enough, yes. Never could figure out the point of that aside from an epi drip (which was so far out of my protocols at the time I doubt any of my co-workers knew it was possible).
  7. 18G

    18G Paramedic

    I'm not aware of any evidence for either but just thinking of the effect 1:000 epi has on a conscious person when given IV it makes sense as to why that concentration is not given in an arrest.

    My guess would be the 1:000 in an arrest would be too potent and cause too much vasoconstriction to the point its harmful and may impede the improved cerebral and coronary perfusion pressures were shooting for.

    I'm not saying this to be true cause I've never seen any evidence but it does make sense and is my educated guess for what it's worth :)
  8. usalsfyre

    usalsfyre You have my stapler

    How does 1 mg of epi cause more vasoconstriction than 1 mg of epi?
  9. 18G

    18G Paramedic

    The rate of absorption and potency makes the difference.

    How does 1mg of epi in 250mL cause a different effect than 1mg of 1:1000 epi as 1mL?

    It's all 1mg right? But a big difference in effect.

    Try giving 1:1000 epi IVP to a conscious patient as compared to 1:10000 epi IVP of the same dose and tell me if the patient responds any differently. I think you would tell the difference really quick!
    Last edited by a moderator: May 23, 2011
  10. usalsfyre

    usalsfyre You have my stapler

    1 mg of epi causes the affect no matter what it's diluted in, assuming the same rate of administration. Now obviously there's practical limits to that, I can't administer a 500ml bolus as fast as I can give 1ml. But I can push 1mg in 10mls just as fast as I can push 1mg in 1ml. The rate of absorption will be the same, your talking about a minor difference in volume.
    Last edited by a moderator: May 23, 2011
  11. usalsfyre

    usalsfyre You have my stapler

    I've done it and never noticed a difference between the two, they all get jittery as hell.
  12. 18G

    18G Paramedic

    It still comes down to potency.

    Heat is heat right. What if I touch you with something that is 70F versus something that is 250F for the same length of time? It's the same element touching you but with drastically different results.

    Epi is a high-profile medication solely due to the different potencies. If they were both the same and resulted in the same effects than why is there two different potencies???

    Many patients have been harmed significantly when given 1:1000 IVP versus the lesser concentrated 1:10,000.

    I have never, ever heard of patients being administered 1:1000 epi IVP. In fact I have always read and personally been strongly warned about ever giving 1:1000 epi IVP.
    Last edited by a moderator: May 23, 2011
  13. usalsfyre

    usalsfyre You have my stapler

    Your confusing volume and dose. 1mg of epinephrine is no way shape or form more potent than 1mg of epinephrine. However, 1 miliLITER of 1:1000 epinephrine solution is drastically more potent than 1 ml of 1:10000 epinephrine solution.
  14. usalsfyre

    usalsfyre You have my stapler

    See my above note about 30mg in 30ml vials. One service I worked for did not carry any prefills.
  15. 18G

    18G Paramedic

    I've seen services that carry vials of "high-dose" 1:1000 epi when it had to be given down an ET tube so your not putting all that fluid into the lungs with the pre-filled 1:10,000 syringes. But I have never heard of 1:1000 epi EVER being given IVP.

    Maybe I'm not hearing you correctly, but several high-profile and lethal cases have resulted from 1:1000 epi being given IVP instead of 1:10,000. And hospitals and EMS services are always cautioned about having the epi concentrations marked appropriately so there is no chance for the wrong concentration to be administered.
  16. usalsfyre

    usalsfyre You have my stapler

    We were supposed to mix it with 9mls of saline to make....Epi 1:10000. Most of us just gave 1ml out of a syringe into a running IV line. In fact during the last prefill shortage our hospital pharmacy supplied us with bags containing a 10ml syringe, filter needle, a 1mg amp of 1:1000 epi and a strip vial of saline and told us to mix the drug.

    Again, your mixing up concentration and dose. If I determine I need to give 3mls of 1:10000 solution, but pull the wrong med and give 3mls of 1:1000 solution, yes I have MASSIVELY overdosed the patient (3mgs vs 300mcgs). But if I give 0.3mls of 1:1000 solution or 3mls of 1:10000 solution, I have given 300mcgs either way. The dose is EXACTLY the same, the volume needed to do so is less.

    Another wonderful pile of Joint Commission crap.

    Epi is no different from any other drug. For instance I have carried Midazolam in 10mg in 1ml (1:100 solution) and 5 mgs in 5mls (1:1000) solution. If I give 0.5mls of the 10 in 1 and 5mls of the 5 in 5 have I not given the EXACT SAME DOSE?

    The reason for 1:1000 on EMS units is subcutaneous and intramuscular injection.
  17. the_negro_puppy

    the_negro_puppy New Member

    Indeed we carry mainly 1mg/1ml adrenaline

    we have also started carrying 1mg/10ml for paediatric arrests
    Another wonderful pile of Joint Commission crap.
  18. mycrofft

    mycrofft Still crazy but elsewhere

    Location:
    Central California
    Thermodynamics and pharmacology are not comparable

    press on;)
  19. Ecgg

    Ecgg New Member

    After reading what I could find on the Internet it has to do with ease of use in emergency setting, and safety measures not to draw up excess amounts. Also with 1:10000 you can push the drug further into circulation because it has the added saline in the bristojet. (None of this is science based)

    I am seeking the science/research supported info so I have an educated/case supported basis to speak from. Don't want to continue with the old paradigm blind leading the blind.
  20. Ecgg

    Ecgg New Member

    Those are still carried in all ambulance units I work at.

    [​IMG]

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