Can you push ALS drugs based off an AED's decision to shock?

[VentMedic]

But, if the person is pulseless...dead....and you are on a TransAtlantic flight, how long to you think CPR will be effective? Until the next stop?

 

[KEVD18]

heres how it basically break out: if you code on an airplane, theres a really really really good chance you're going to remain dead. the drugs and the aeds and the rest of the crap are just there to make two groups of people feel better. the passengers, so they can think "if i have a problem, jet blue has mechanisms in place to help me. i feel all warm and fuzzy"; and the airlines so they can say "well, we did everything we could. the drugs and toys were there. if the passangers want to pay the fare increases, we can staf an er attending on every flight, but other than that this is all we can do".

 

[marineman]

I can tell you I definitely wouldn't be the one risking my behind to do it but just wondering if you might be able to get away with thinking on the most basic terms. With either V-tach or V-fib our first line drug is Epi. So if the AED came back and said it was a shockable rhythm could you technically go ahead and push the drug blind. Also if a patient is PNB with a non-shockable rhythm both Atropine and Epi are indicated so if the AED came back and said no shock advised could you give the drugs?

Again before everyone jumps on me I will remain in my seat eating my peanuts and watching the movie but in a real MacGyver style pinch could that be efficient reasoning?

 

[KEVD18]

btw, look at the list of required gear again, this time focus on the quantities.

that amount of stuff would last long enough to get the medics there if the plane was still on the ground.

 

[traumateam1]

So it turns into a liability now? Lesser of a chance major airlines are going to get successfully sued over a person dying on their planes?

Well your honor, we did have ACLS drugs, and an AED on board.

I see. Thanks for clarifying it

 

[exon111]

I can tell you I definitely wouldn't be the one risking my behind to do it but just wondering if you might be able to get away with thinking on the most basic terms. With either V-tach or V-fib our first line drug is Epi. So if the AED came back and said it was a shockable rhythm could you technically go ahead and push the drug blind. Also if a patient is PNB with a non-shockable rhythm both Atropine and Epi are indicated so if the AED came back and said no shock advised could you give the drugs?

Again before everyone jumps on me I will remain in my seat eating my peanuts and watching the movie but in a real MacGyver style pinch could that be efficient reasoning?

That's what I was thinking too.

 

[traumateam1]

btw, look at the list of required gear again, this time focus on the quantities.

that amount of stuff would last long enough to get the medics there if the plane was still on the ground.

Thats what I thought too Kev.. not a whole lot of supplies there, just enough to hopefully get the job done.

 

[KEVD18]

Thats what I thought too Kev.. not a whole lot of supplies there, just enough to hopefully get the job done.

nope. just enough to make it look like you could possibly get the job done while keeping it to a cost effective minimum.

 

[traumateam1]

So moral of the story:

Don't have "the big one" on an airplane.

 

[FF894]

In a hypothetical world I would say to the person next to me that has no idea who I am and could not identify my later as having anything to do with EMS so they can't go after me "I think you should push the one that says "Epinephrine" yeah that one, try 1mg - should be the full ampule. Yeah just like that, I saw it on House once." Okay, no shock advised? "OK, now try the one that says "Atropine" that might work..." B)

 

[FF894]

So moral of the story:

Don't have "the big one" on an airplane.

True that...

 

[TomB]

I worked a full arrest on a Delta jet on the tarmac at Savannah International Airport (SAV). It was an early morning flight and the plane was boarding when the patient coded. I used the AED (Philips HeartStart with monitor screen) and drug kit from the plane (I was impressed with the drugs in the box). The airway equipment was supplied by Crash Fire Rescue who seemed perfectly content to have me continue patient care until a ground EMS unit arrived on the scene. That took a long time. Apparently you can't just drive onto a major airport's tarmac without jumping through some hoops. I should add that there were several doctors and nurses on the plane also. In fact an anesthesiologist intubated. Having said that, I directed the code with the support of the other medical professionals on board the plane. By the time the ground unit showed up, the patient was bucking the tube, so when the local paramedic showed up and wanted to move the patient, we protested and suggested that he medicate the patient to maintain the tube first. I can't believe I was on the receiving end of this comment, but the paramedic gave me "that look" and said, "are you a doctor"? Before I could answer, one the doctors on the plane said (in his best "I'm about to bite your head off" voice) "I'm a doctor!" The paramedic left and returned a minute later with a prefilled syringe of Valium. It was passed down the line, and a nurse gave all 10 mg which calmed the patient down and helped maintain the tube. The paramedic looked at the doctor and said, "You'll need to come with us" at which time the doctor laughed directly in his face like he had just told a really funny joke. The paramedics loaded the patient on a long spine board with spider straps and carried the patient out from in front of the flight deck, out the side door of the plane, down the side stairs of the jetway, and away they went. The patient was awake and talking by arrival in the emergency department, but the flight left 45 minutes late because of the commontion and the fact that the pilot would not leave until the medical kit was restocked (no one seemed to know how to accomplish this). Needless to say, we all missed our connections.

 

[TomB]

Oh yeah, all this to say, there are much MUCH worse places to have "the big one" than a commercial jet airliner! At home for example.

 

[FF894]

Strong work... Dont worry- how do you know there's a doctor on the plane? Oh, they'll tell ya!

 

[KEVD18]

the trick becomes seperating the dermatologists from the intensivists.

 

[mycrofft]

Or podiatrists (fell victim to that once)

Back to original question.
No.
Even Welch Allyn, who makes super-duper VS monitors, says when you ask them directly that their machines are for monitoring, not directing care. (With an allowance for 10 mmHg in diastolic for their clinical machines as "acceptable", darn well better not be). The rudimentary scope on an AED and using two leads for your "ekg" can't help things along. I also don't think that their ratio of screen refresh to display may be a little high also.

If it was OK, they would be selling automated paramdics which would be placed on the chest and a bluetooth BP cuff put on the arm, the rest up to circuitboards.

 

[FF894]

a bluetooth BP cuff

Now you are talking...

 

[AlaskaEMT]

I would think you could run the V-fib/V-tach algorithm based on an AED's analysis. You'll probably never need to, but if you had to...

Interesting topic.

 

[reaper]

Lets look at it this way. If the pt has no pulse and not breathing, they are in arrest. Start normal CPR.

First drug in any rhythm is Epi, so why not push it. From there you would be blind on second drug. If the AED advises shock, then that would suggest VT/VF. So you could determine that Lido would be next. If no shock advised, then next would be Atropine.

I have talked with an FAA investigator about this very issue. If you are qualified to use the equipment and the ACLS drugs(ie-Paramedic,Rn,Dr,Rt), then you will not be held liable for their use. As long as you follow ACLS guidelines. I think you can justify the reason for your decision on Lido or Atropine in a case like this.

It is all up to what you as a provider feel comfortable doing!

 

[MedicMeJJB]

:blink::blink:

anybody who would treat based on a guess should have their ticket pulled the mintue the plane lands.

Agreeeeeed!:blink: