# What unusual medications have you given/seen given during a code?



## ParamedicStudent (Nov 30, 2016)

Now I'm not talking about the usual Epi and Amio/Lido drugs, and I know that different situations call for different things, and different places (ER for example) have different protocols.

During my hospital clinical, I've pushed Atropine and Sodium Bicarb (that thing was difficult to push) during a code, and I thought that was unusual due to us learning the standard ACLS. I remember Atropine being in a peds arrest protocol, but not for adult. And I remember back in the day they had a song like "everybody shock mama shock papa shock etc etc"


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## NomadicMedic (Nov 30, 2016)

In aVF arrest backninbtbr day:

Shock, Shock, Shock, Everybody Shock, Little Shock, Big Shock, Momma Shock, Poppa Shock

Shock= Defibrillate
Everybody= Epinephine
Little= Lidocaine
Big= Bretylium
Momma= Mag 
Poppa= Procainamide


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## TransportJockey (Nov 30, 2016)

One place I worked a couple years back had aminophylline in algorithm for asystolic arrest

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## rescue1 (Nov 30, 2016)

ParamedicStudent said:


> Now I'm not talking about the usual Epi and Amio/Lido drugs, and I know that different situations call for different things, and different places (ER for example) have different protocols.
> 
> During my hospital clinical, I've pushed Atropine and Sodium Bicarb (that thing was difficult to push) during a code, and I thought that was unusual due to us learning the standard ACLS. I remember Atropine being in a peds arrest protocol, but not for adult. And I remember back in the day they had a song like "everybody shock mama shock papa shock etc etc"



Atropine and bicarb used to be part of standard ACLS back in the day, so maybe the physician was using an older algorithm.

I still see glucose given every so often, despite it being taken out of the protocols and ACLS guidelines.


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## Handsome Robb (Nov 30, 2016)

We give inline albuterol intra-arrest sometimes.

Well I do at least. 


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## VentMonkey (Nov 30, 2016)

Handsome Robb said:


> We give inline albuterol intra-arrest sometimes.
> 
> Well I do at least.


Across the board, or hyper-K+/ ESRD's only?


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## akflightmedic (Nov 30, 2016)

1:1000 Escalating Epi down the tube   

Ahhhh those were the days of ignorance.


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## Handsome Robb (Nov 30, 2016)

VentMonkey said:


> Across the board, or hyper-K+/ ESRD's only?



HyperK/ESRD or if capno shows an obstructed waveform. 


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## VentMonkey (Nov 30, 2016)

akflightmedic said:


> 1:1000 Escalating Epi down the tube
> 
> Ahhhh those were the days of ignorance.


Weren't they, though?...weren't they?...


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## WolfmanHarris (Nov 30, 2016)

We carry calcium gluconate for hyperkalemia arrests/pre-arrests, though I couldn't tell you if it's ever been used. I think the odd time we'll still get a Doc over the patch line order bicarb in a prolonged arrest (we have a strange requirement to patch after 3 rounds of epi. Not necessarily for a pronouncement, just because.)


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## VFlutter (Nov 30, 2016)

Methylene Blue


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## VentMonkey (Nov 30, 2016)

Chase said:


> Methylene Blue


@Chase, I think you win this thread; curious, how much is that particular antidote going for these days? I can't imagine it's very cheap.


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## medicsb (Nov 30, 2016)

Of course I'm on the ED side, but I haven't used anything too outlandish.  But some colleagues of mine have pushed TPA for presumed massive PE and esmolol has been given a number of times for refractory VF/VT.  We started stocking intralipid at the recommendation of our toxicologist, but I don't think it has been given yet.


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## VFlutter (Nov 30, 2016)

VentMonkey said:


> @Chase, I think you win this thread; curious, how much is that particular antidote going for these days? I can't imagine it's very cheap.



I am not sure how much it costs. It actually was used for post-CPB vasoplegia during that code. I personally have never seen it used for cyanide/methemoglobinemia, although I have not seen many of those patients. It is still used in cardiac surgery on rare occasions.


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## medicsb (Nov 30, 2016)

Methylene blue may also be used for calcium channel blocker overdose.  It can also be used in septic shock.


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## ERDoc (Dec 1, 2016)

medicsb said:


> Of course I'm on the ED side, but I haven't used anything too outlandish.  But some colleagues of mine have pushed TPA for presumed massive PE and esmolol has been given a number of times for refractory VF/VT.  We started stocking intralipid at the recommendation of our toxicologist, but I don't think it has been given yet.



I've done the tpa thing once.  Early 30's collapsed in front of family.  ROSC showed a narrow complex tachy in the 140s.  Turned out not to be a PE but some dietary supplements he got online from Mexico that contained fentanyl and roc.

Are they still teaching to push meds down the tube anywhere?


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## VentMonkey (Dec 1, 2016)

medicsb said:


> Methylene blue may also be used for calcium channel blocker overdose.  It can also be used in septic shock.


Apparently, it's got quite the versatility...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3087269/#!po=1.13636


medicsb said:


> We started stocking intralipid at the recommendation of our toxicologist, but I don't think it has been given yet.


I'd be interested to know if, or when you or your colleagues utilize this.


medicsb said:


> some colleagues of mine have pushed TPA for presumed massive PE and esmolol has been given a number of times for refractory VF/VT.





ERDoc said:


> I've done the tpa thing once.


Out of curiosity, at that point in such a code when it's thought to be (ruling out) a possible massive PE, what's the risk/ reward ratio, and their likelihood of survivability at that point?


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## Tigger (Dec 1, 2016)

ERDoc said:


> Are they still teaching to push meds down the tube anywhere?


It was mentioned in my program, but I'm not sure why you would with all the other options.

NAVEL...


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## StCEMT (Dec 1, 2016)

Tigger said:


> It was mentioned in my program, but I'm not sure why you would with all the other options.
> 
> NAVEL...


I remember learning about NAVEL, but I don't think I know what half of it is off the top of my head anymore. Not that I ever see myself actually using it when I have multiple other options.


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## VentMonkey (Dec 1, 2016)

StCEMT said:


> I remember learning about NAVEL, but I don't think I know what half of it is off the top of my head anymore. Not that I ever see myself actually using it when I have multiple other options.


*N*arcan, *A*tropine, *V*alium, *E*pinephrine, *L*idocaine.

I was thinking of that acronym earlier when I came across this thread and remembered ACLS still using something similar, either "LEAN", or "LANE".


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## StCEMT (Dec 1, 2016)

VentMonkey said:


> *N*arcan, *A*tropine, *V*alium, *E*pinephrine, *L*idocaine.
> 
> I was thinking of that acronym earlier when I came across this thread and remembered ACLS still using something similar, either "LEAN", or "LANE".


Huh....I was thinking Vasopressin was V, but it seemed like a weird one considering E.


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## VentMonkey (Dec 1, 2016)

StCEMT said:


> Huh....I was thinking Vasopressin was V, but it seemed like a weird one considering E.


When I first came to this county, ET medication administration was still very much a "thing", as was stacked shocks. Literally, it was written in our protocols as such.

ACLS had already switched to the current algorithm prior, but our paramedic protocols had yet to reflect it, so when I took my county protocol I asked our then EMS department coordinator which to abide by, and I was told either, or. 

Thankfully, even the older paramedics _eventually _embraced IO over ETI med wash (it really was crap). Then even finally saw the importance of 12-lead ECG's once those were rolled out as well. I have been here just shy of 8 years now.


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## StCEMT (Dec 1, 2016)

VentMonkey said:


> When I first came to this county, ET medication administration was still very much a "thing", as was stacked shocks. Literally, it was written in our protocols as such.
> 
> ACLS had already switched to the current algorithm prior, but our paramedic protocols had yet to reflect it, so when I took my county protocol I asked our then EMS department coordinator which to abide by, and I was told either, or.
> 
> Thankfully, even the older paramedics _eventually _embraced IO over ETI med wash (it really was crap). Then even finally saw the importance of 12-lead ECG's once those were rolled out as well. I have been here just shy of 8 years now.


We have nothing for ET meds, but DSD is a thing for my protocols in VF/VT. Our cardiac arrest protocols were just recently updated for CCR, but I am pretty sure they left DSD in their down the line, I need to get a new copy and check tomorrow.


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## EpiEMS (Dec 1, 2016)

VentMonkey said:


> I was told either, or.



Either follow protocol or follow current ACLS guidelines?


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## VentMonkey (Dec 1, 2016)

EpiEMS said:


> Either follow protocol or follow current ACLS guidelines?


Yes, this was years ago though. They eventually changed it. 

It's funny, I haven't been a paramedic an incredibly long time but going down memory lane from the time I started altogether sure hasn't made me feel any younger. 

The protocols when I started here alone were quite archaic, as were a lot of paramedics, but it's changed pretty much for the better.


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## EpiEMS (Dec 1, 2016)

VentMonkey said:


> Yes, this was years ago though. They eventually changed it.
> 
> It's funny, I haven't been a paramedic an incredibly long time but going down memory lane from the time I started altogether sure hasn't made me feel any younger.
> 
> The protocols when I started here alone were quite archaic, as were a lot of paramedics, but it's changed pretty much for the better.



That's good to hear - I would hope that "Shock, Shock, Shock, Everybody Shock, Little Shock, Big Shock, Momma Shock, Poppa Shock" isn't in anybody's protocols any more. 

How would you document that you didn't - strictly speaking - follow protocol, but were following standard of care / staying within your scope, etc.?


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## VentMonkey (Dec 1, 2016)

EpiEMS said:


> How would you document that you didn't - strictly speaking - follow protocol, but were following standard of care / staying within your scope, etc.?


I would put in my narrative something to the effect of "per ACLS guidelines" in regards to my sequence of procedures performed.

The ET medications took a while, and I remember a former supervisor who swore by it. I've done it a few times as it was a last ditch measure (think heroin-induced arrests), and it was a hot mess of liquid meds going nowhere fast.

When I started in SoCal as a tech, I want to say that was still their first round "get it in them" route.


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## EpiEMS (Dec 1, 2016)

VentMonkey said:


> I would put in my narrative something to the effect of "per ACLS guidelines" in regards to my sequence of procedures performed.



That makes sense, and it's certainly reasonable, given that ACLS is totally standard of care. If only CCR becomes the new CPR...then I'll see if I can get away with not ventilating!



VentMonkey said:


> The ET medications took a while, and I remember a former supervisor who swore by it. I've done it a few times as it was a last ditch measure (think heroin-induced arrests), and it was a hot mess of liquid meds going nowhere fast.
> 
> When I started in SoCal as a tech, I want to say that was still their first round "get it in them" route.



Wow. ET meds rather than IO, I feel like it's the 80s! Did you have IO at the time? I would imagine so if it hasn't been that long!


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## ERDoc (Dec 1, 2016)

VentMonkey said:


> Out of curiosity, at that point in such a code when it's thought to be (ruling out) a possible massive PE, what's the risk/ reward ratio, and their likelihood of survivability at that point?



There isn't a great amount of evidence either way.  I was assisting in the code and wasn't the one to make the decision but the thought process was, "well, here's a young, healthy guy with no history of substance abuse who had a sudden collapse and now has a notable tachycardia (which there are a large number of explanations for).  If I recall correctly, he complained of some pain in the chest just before he collapsed, so PE was high on the differential.  Once he was stabilized a CT was done which showed no PE.  He ended up with almost 100% neurological recovery.  Here is an article from EMdocs:

http://www.emdocs.net/pushing-tpa-i...vidence-when-can-we-make-the-most-difference/


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## ERDoc (Dec 1, 2016)

Tigger said:


> It was mentioned in my program, but I'm not sure why you would with all the other options.
> 
> NAVEL...



There really is no reason but I know some things die hard so I was just curious.  It was never mentioned in medical school and I'm not sure if some docs coming out of school know about it.


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## VentMonkey (Dec 1, 2016)

EpiEMS said:


> Wow. ET meds rather than IO, I feel like it's the 80s! Did you have IO at the time? I would imagine so if it hasn't been that long!


It doesn't seem that long ago (to me), but ETI was the first thing in an arrest at the time, so many would intubate, and if it was in before their/ their partners IV, the first round of ACLS meds would be given this route.

I'm sure there are providers on here who recall this being common practice as well.


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## Carlos Danger (Dec 1, 2016)

VentMonkey said:


> It doesn't seem that long ago (to me), but ETI was the first thing in an arrest at the time, so many would intubate, and if it was in before their/ their partners IV, the first round of ACLS meds would be given this route.
> 
> I'm sure there are providers on here who recall this being common practice as well.


Exactly how we did it when I started. I think that was standard ACLS at the time (mid-90's).


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## VentMonkey (Dec 1, 2016)

Remi said:


> Exactly how we did it when I started. I think that was standard ACLS at the time (mid-90's).


Thanks, I now feel slightly less older.


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## NomadicMedic (Dec 1, 2016)

When I started way back when, all the code meds went down the tube. Granted, I wasn't a medic back in the Bretyllium days, but I remember it. (And shocked lots of asystole or as we interpreted it, "fine vf", with my LifePak 5)

Have you seen the Chicago fire department cardiac arrest video from the 90s? It's an awesome, hot mess of meds down the tube, putting the layrngoscope down on the slushy floor, one handed CPR, laconic defib shocks and mustaches. Watch it. It'll take you right back.


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## medicsb (Dec 1, 2016)

Man, that was painful to watch.


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## phideux (Dec 2, 2016)

Let's pre-oxygenate by suctioning him for a minute or 3.


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## Bullets (Dec 2, 2016)

Probably the things thats getting the most controversial response around here is hands on defibrillation. Our ER staff is pretty evenly split about it and it usually causes a huge fight because everyone else has been trained to not touch anyone because their sister's brother's uncle's girlfriend was a nurse in a different hospital and saw someone get blown into the next county because they were touching a patients foot


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## Carlos Danger (Dec 2, 2016)

Bullets said:


> Probably the things thats getting the most controversial response around here is hands on defibrillation. Our ER staff is pretty evenly split about it and it usually causes a huge fight because *everyone else has been trained to not touch anyone because their sister's brother's uncle's girlfriend was a nurse in a different hospital and saw someone get blown into the next county because they were touching a patients foot*



Not sure you can really blame folks for their skepticism. It's less an issue of hearsay and much more an issue of having always been trained specifically to "clear" before a shock is delivered. 

We are all trained to put our own safety first. "Scene safety" and all that. It might not be technically correct in this case, but it is perfectly rational.


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## Carlos Danger (Dec 2, 2016)

Not sure how "unusual" these are, but the case I remember giving the most stuff to included FFP, cryoprecip, PRBC's, and aminocaproic acid. And an epi drip, among other things. 

Didn't work, BTW.


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## EpiEMS (Dec 2, 2016)

Remi said:


> Not sure how "unusual" these are, but the case I remember giving the most stuff to included FFP, cryoprecip, PRBC's, and aminocaproic acid. And an epi drip, among other things.
> 
> Didn't work, BTW.



Wow, that's some serious interventions. Traumatic arrest?


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## medichopeful (Dec 2, 2016)

Remi said:


> Not sure how "unusual" these are, but the case I remember giving the most stuff to included FFP, cryoprecip, PRBC's, and aminocaproic acid. And an epi drip, among other things.
> 
> Didn't work, BTW.



The case I remember where we gave the most stuff was just the other day.  Epi drip along with epi boluses, bicarb drip and bicarb boluses, FFP, platelets, PRBC, fluids, and calcium chloride.   Morphine drip after the patient went comfort, along with ketamine bolus for palliative care.  Outcome was the same as if we hadn't done any of that, but good learning experience.


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## Carlos Danger (Dec 2, 2016)

EpiEMS said:


> Wow, that's some serious interventions. Traumatic arrest?



Massive DIC in a 24 year old mom about 24 hours after she gave birth.

She kept pulses as long as the epi drip was on and both Level Ones were infusing blood. But whenever we turned off the Level Ones to switch to pressure bags to load her into the helicopter, she'd arrest. The hospital was running out of type-specific blood, so we finally realized it was futile and they called her husband in to say goodbye to her before we turned everything off for the last time. 

Saddest thing I've ever seen. And I've seen some really bad situations in the SICU and TICU.


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## EpiEMS (Dec 2, 2016)

Remi said:


> Massive DIC in a 24 year old mom about 24 hours after she gave birth.
> 
> She kept pulses as long as the epi drip was on and both Level Ones were infusing blood. But whenever we turned off the Level Ones to switch to pressure bags to load her into the helicopter, she'd arrest. The hospital was running out of type-specific blood, so we finally realized it was futile and they called her husband in to say goodbye to her before we turned everything off for the last time.
> 
> Saddest thing I've ever seen. And I've seen some really bad situations in the SICU and TICU.



Darn, that's really sad. Was she being transported to a higher level facility for some sort of definitive treatment?


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## Bullets (Dec 2, 2016)

Remi said:


> Not sure you can really blame folks for their skepticism. It's less an issue of hearsay and much more an issue of having always been trained specifically to "clear" before a shock is delivered.
> 
> We are all trained to put our own safety first. "Scene safety" and all that. It might not be technically correct in this case, but it is perfectly rational.


I get that this is what everyone has been trained to do, im clear you're clear everyone's clear, ect. But when i have challenged people as to WHY thats the training most come up with some apocryphal story, ect. Of course, you cant bring science to the discussion


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## EpiEMS (Dec 2, 2016)

Bullets said:


> Of course, you cant bring science to the discussion



I've tried to - I always get shot down. I know that nitrile gloves are likely not enough to protect us, but I'm generally convinced that I wouldn't feel the shock nor would it likely adversely (see: one, two - not strictly about HOD, but is relevant, and three - this is very anecdotal ) impact me (especially with certain precautions).


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## Carlos Danger (Dec 2, 2016)

EpiEMS said:


> Darn, that's really sad. Was she being transported to a higher level facility for some sort of definitive treatment?



Yeah, she had been to the OR twice, IIRC, since delivery. Then she went into DIC and they called us to take her to the mother ship, but it was too late.


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## VFlutter (Dec 2, 2016)

Remi said:


> Massive DIC in a 24 year old mom about 24 hours after she gave birth.
> 
> She kept pulses as long as the epi drip was on and both Level Ones were infusing blood. But whenever we turned off the Level Ones to switch to pressure bags to load her into the helicopter, she'd arrest. The hospital was running out of type-specific blood, so we finally realized it was futile and they called her husband in to say goodbye to her before we turned everything off for the last time.
> 
> Saddest thing I've ever seen. And I've seen some really bad situations in the SICU and TICU.



Very similar to a couple patients I have seen, going back to the AFE discussion. I am sure they would have died without ECMO.


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## CANMAN (Dec 6, 2016)

Remi said:


> Massive DIC in a 24 year old mom about 24 hours after she gave birth.
> 
> She kept pulses as long as the epi drip was on and both Level Ones were infusing blood. But whenever we turned off the Level Ones to switch to pressure bags to load her into the helicopter, she'd arrest. The hospital was running out of type-specific blood, so we finally realized it was futile and they called her husband in to say goodbye to her before we turned everything off for the last time.
> 
> Saddest thing I've ever seen. And I've seen some really bad situations in the SICU and TICU.



I agree, these are the absolutle worst. I have participated in similar a transport, and it was one of very few calls that has ever rattled me. Thats after years of doing pediatrics. My worst fear of when my wife and I have kids.


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## E tank (Dec 16, 2016)

akflightmedic said:


> 1:1000 Escalating Epi down the tube
> 
> Ahhhh those were the days of ignorance.



that's what our kids are going to say about us! ; )


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## firecoins (Dec 18, 2016)

Not sure of any unusual meds, just older protocols.


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## Flight-LP (Dec 22, 2016)

TransportJockey said:


> One place I worked a couple years back had aminophylline in algorithm for asystolic arrest
> 
> Sent from my SM-N920P using Tapatalk


And that was the first drug I yanked from the formulary when I arrived. Absolutely pointless.


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## StCEMT (Dec 22, 2016)

Remi said:


> Massive DIC in a 24 year old mom about 24 hours after she gave birth.
> 
> She kept pulses as long as the epi drip was on and both Level Ones were infusing blood. But whenever we turned off the Level Ones to switch to pressure bags to load her into the helicopter, she'd arrest. The hospital was running out of type-specific blood, so we finally realized it was futile and they called her husband in to say goodbye to her before we turned everything off for the last time.
> 
> Saddest thing I've ever seen. And I've seen some really bad situations in the SICU and TICU.


So having kids sounds a lot scarier now....damn that's rough though...


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## E tank (Dec 22, 2016)

DEmedic said:


> Have you seen the Chicago fire department cardiac arrest video from the 90s? It's an awesome, hot mess of meds down the tube, putting the layrngoscope down on the slushy floor, one handed CPR, laconic defib shocks and mustaches. Watch it. It'll take you right back.



Ooofta...guy never had a chance....but that distended belly from the Robert Shaw demand valve brought back some pretty warm and fuzzy memories..


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## E tank (Dec 22, 2016)

Chase said:


> I am sure they would have died without ECMO.



ECMO=game changer


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## VFlutter (Dec 22, 2016)

E tank said:


> ECMO=game changer



I really hope adult retrieval / salvage ECMO becomes more common like it is in Peds.


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## CANMAN (Dec 25, 2016)

Chase said:


> I really hope adult retrieval / salvage ECMO becomes more common like it is in Peds.



I think ECMO and transport is a mixed bag with alot of variables. We have been doing ECMO with the Cardiohelp for a good while now, and logistically it can be a huge pain in the ***, especially when you toss in a Balloon pump into the mix. Alot of the MD's who are cannulating in the community hospital setting then requesting transport to tertiary facility don't account for the time to move these people. Often times (not always) it is much faster to max patient on pressor support and rapidly move the patient to said ECMO facility, rapid deploy, then wean off the pressor support than to deploy and then move the patient.


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## Carlos Danger (Dec 25, 2016)

CANMAN said:


> I think ECMO and transport is a mixed bag with alot of variables. We have been doing ECMO with the Cardiohelp for a good while now, and logistically it can be a huge pain in the ***, especially when you toss in a Balloon pump into the mix. Alot of the MD's who are cannulating in the community hospital setting then requesting transport to tertiary facility don't account for the time to move these people.* Often times (not always) it is much faster to max patient on pressor support and rapidly move the patient to said ECMO facility, rapid deploy, then wean off the pressor support than to deploy and then move the patient.*



Yeah but then the referring doc doesn't get to be all cutting edge and aggressive and heroic and stuff.


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## CANMAN (Dec 25, 2016)

Remi said:


> Yeah but then the referring doc doesn't get to be all cutting edge and aggressive and heroic and stuff.



This is true!


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## NPO (Jan 2, 2017)

EpiEMS said:


> How would you document that you didn't - strictly speaking - follow protocol, but were following standard of care / staying within your scope, etc.?



I work in the same system as @VentMonkey and I asked our medical director that very same question one day in the ED. 

His response? 

"Generally, if you can justify what you're doing...Do it. I won't care."



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## 18G (Feb 23, 2017)

Calcium chloride. I have seen an intensivist and EM doc give empiric calcium in refractory arrest patients. I think there is a good use case for empiric calcium in cardiac arrest which covers hyperkalemia and CCB toxicity; calcium can also increase contractility. Calcium is also pretty benign.


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## STXmedic (Feb 23, 2017)

CaCl is uncommon?


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## TransportJockey (Feb 23, 2017)

Maybe he's used to seeing gluconate and no chloride?

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## VentMonkey (Feb 23, 2017)

I would venture to guess any electrolyte given in excess is hardly benign.


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## Carlos Danger (Feb 23, 2017)

A gram of CaCl _is_ pretty safe. I've used it in the OR with great success for hypotension that is refractory to pretty much everything else. I don't know about using it during arrest, though. It used to be standard ACLS but I haven't seen it used during CPR in a long time. 

My thinking is that just like so many other things that have been daily practice in anesthesia for decades ("push dose" pressors, ketamine, intubating on long-acting NMB's, etc.) but were just recently "discovered" by ED and ICU folks, giving some calcium post-arrest or for otherwise refractory hypotension might someday be a pretty routine thing.


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## TransportJockey (Feb 23, 2017)

We tend to use calcium in dialysis arrests, but that's the extent of it for daily uses except some very unusual calls or CCB overdoses 

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## E tank (Feb 23, 2017)

An empiric whack of calcium is de rigueur for coming off of the bypass pump. Almost a rabbits foot. Definitely improves contractility after a bunch of banked blood products (citrate preservative binding of free calcium). Good for dilutional hypocalcemia too. All that being said, the effect is transient and IME, it doesn't do  what a slug of epi wouldn't MOST times. Your results may vary.


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## EpiEMS (Feb 23, 2017)

Remi said:


> I don't know about using it during arrest, though. It used to be standard ACLS but I haven't seen it used during CPR in a long time.



ACLS says "Studies of calcium during cardiac arrest have found variable results on ROSC, and no trial has found a beneficial effect on survival either in or out of hospital. Routine administration of calcium for treatment of in-hospital and out-of-hospital cardiac arrest is not recommended. (Class III, LOE B)"

The most recent study they cite is from 1998, though...so, you know, science progresses?


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## E tank (Feb 23, 2017)

EpiEMS said:


> ACLS says "Studies of calcium during cardiac arrest have found variable results on ROSC, and no trial has found a beneficial effect on survival either in or out of hospital. Routine administration of calcium for treatment of in-hospital and out-of-hospital cardiac arrest is not recommended. (Class III, LOE B)"
> The most recent study they cite is from 1998, though...so, you know, science progresses?



I don't think it works well in an ischemic heart. If the reason for the fall in contractility is something other than ischemia, you'll see some response with calcium, in my experience.


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## GMCmedic (Feb 26, 2017)

We give Calcium Chloride in dialysis arrests. Other than that, and dual sequential defibrillation, our arrest protocol is pretty standard. 

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## Handsome Robb (Feb 26, 2017)

We're adding esmolol for refractory VF with a consult with our Medical Director. Depending on the results it may become a standing order or may get scrapped. 


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## RocKetamine (Feb 26, 2017)

Benadryl (not joking) for a suspected anaphylaxis induced cardiac arrest.  

And no, it didn't help.


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## Eden (Mar 11, 2017)

Salbutamol ett for hyperk/ obstructive etco2.. quite routine here


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