Acls Meds

[skyemt]

if participants are willing,

i would like to discuss (read learn) about the physiological effects of the ACLS meds... how exactly they work on the body...

i have some understanding of the Beta 1 and 2 receptors, the Alpha receptors, the sodium/potassium pump, and the role of calcium for contractibility...

to start, I'll just throw out Lidocaine, Amiodarone, and Cardizem, Vasopressin...

but, please... feel free to discuss any that you use...

thanks in advance!

 

[rmellish]

Its not in depth, but theres a little pharmacology here: http://www.randylarson.com/acls/drugs/

 

[AZFF/EMT]

do you have the ACLS provider book? The one I have has all of the drugs and all of the answers to your questions. Also have a book titled Prehospital Drug Therapy that will answer you questions as well.

what exactly do you want to now about them?

Also go to flashcardexchange.com search paramedic. Go through the list and find Paramedic drugs, or acls drug ect and open the cards up. You will find a lot of info too. And for $20 you can print as many cards as you want. For free ypu can view them.

 

[skyemt]

do you have the ACLS provider book? The one I have has all of the drugs and all of the answers to your questions. Also have a book titled Prehospital Drug Therapy that will answer you questions as well.

what exactly do you want to now about them?

Also go to flashcardexchange.com search paramedic. Go through the list and find Paramedic drugs, or acls drug ect and open the cards up. You will find a lot of info too. And for $20 you can print as many cards as you want. For free ypu can view them.

i have the book... it says what the meds are, and what systems they work on, but it doesn't say exactly HOW they work...

i guess i would like to know the "how" and the "why"...

 

[skyemt]

for example....
take Lidocaine...

ok, so i know it is a first line ACLS drug...

to supress V-tach and V-fib...

what i would like to discuss is exactly how it does this...

 

[fma08]

Lidocaine is a class IB sodium channel blocker, so what it does is increase the rate of repolarization while decreasing the automaticity of the ventricles. So it is used in VF and VT because in those rhythms, the ventricles are going crazy. Lidocaine... for lack of a better analogy, kinda numbs them up, so they aren't so excitable. That what you were looking for?

 

[VentMedic]

First, take at least one semester or preferably 2 of basic college level pharmacology. At least start with a basic pharmacology book.

If not, you are going to fall into the same pit that I think you are trying to avoid. Many paramedic books take small exerts from different professions and skip alot of the true meat and potatoes of many subjects. I think you saw that with PaO2, but even that is just a very small exert somewhere near the middle of the story.

Learning just small portions or exerts fails to give you the broad picture. Correct me if I am wrong, but I sense you are already aware of where EMS education for the most part has failed to provide a solid foundation. People are presented with small pieces of the puzzle in a way that leads them to believe that is all there is to that subject. Paramedic books also do not go into great detail about drug interactions since there are not that many drugs in the curriculum.

For most any health profession that is college degreed, at least two semesters of basic pharmacology is required. There may also be a separate Drug calculation class. Then, you may have another semester or two for your specialty. That is just for the 2 year degree. I got my initial degree in EMS as a Paramedic and then spent almost two more years for another degree in RT with another specialized pharmacology. When I got my B.S. in Cardiopulmonary, another two semesters of pharmacology was required. When I got my Masters, yet another semester of pharmacology. That is besides all the semesters of chemistry, specialized A&Ps and pathophysiology classes.

The same with PaO2. I have over 6 years of formal education studying PaO2 which was barely if at all mentioned in my Paramedic degree except for the Respiratory chapter in a college level A&P class. I am still learning even more each day by mandated reading material from my Medical Directors and just every day working with disease processes that have yet to be clearly defined in text books. Even the new technology for just ventilation/oxygen that appears constantly is almost overwhelming to think about even for the most progressive ICUs.

I am introduced to new medications at least a couple times a month and often more. Since I learned from the ground up, it is easy to see the chemical differences and if it may be worth the cost over what is already on the market. For some patients with diseases like HIV, there may not be a choice depending on what else is going on.

If you learn something solidly, you will be able to converse at a different level than "I know amiodarone works because I had two saves with it".

Xopenex was another medication that gave me a chuckle when I read about it on the EMS forums. It just takes reading the chemical make up of the drug to know that it was not cost effective to scrap the albuterol to go with a very expensive med at that time because of some very impressive advertising.

I love your enthusiasm for more knowledge about medicine. But, slow down and create a foundation. Don't fall into that pit that you have already recognized as a weak link in EMS education which is more than I can say for some others. Even if all the academic types on this forum provided endless posts about the ACLS medications, a lot of information would still be missed. Give yourself a chance to really understand pharmacology.

 

[Ridryder911]

Lidocaine... for lack of a better analogy, kinda numbs them up, so they aren't so excitable.

No, no, no......I fired an clinical instructor for saying that..

Please read Vent's post again...

R/r 911

 

[skyemt]

Vent...

i have read your post several times...

i realize that my question was at the same time naive, and arrogant as well, to think it could even be answered in this way...

the thing is, there is apparently a huge gap between the medical explanations in the paramedic texts, ACLS books, etc and a true medical understanding.
it gives me the distinct impression that EMS really operates only on the fringe of medicine.

perhaps it could be argued that it doesn't matter for Medics to know this stuff, or it would be in the very texts they study from and are tested from.

i personally don't feel that way, but there is not really an step in-between medic and medical degree...

it is as if you climb a ridge of knowledge, learning...thinking you are understanding and getting somewhere... only at the top of the ridge to find a huge mountain ahead, and the realization that you really have not gotten very far at all...

there is just soooooooo much more to this job....

again, only my perspective... i'm sure there are those that do not share this point of view, nor do they think it important...

 

[MSDeltaFlt]

"Mechanism of action/Effect:

Antiarrhythmic—Lidocaine decreases the depolarization, automaticity, and excitability in the ventricles during the diastolic phase by a direct action on the tissues, especially the Purkinje network, without involvement of the autonomic system. Neither contractility, systolic arterial blood pressure, atrioventricular (AV) conduction velocity, nor absolute refractory period is altered by usual therapeutic doses. In the Vaughan Williams classification of antiarrhythmics, lidocaine is a class IB agent."

From wikipedia.org

This is why saying that Lido basically "numbs" the heart up is wrong. This is a basic explanation of the drug. Which is also the reason Vent's right. If you are wanting more, take the pharmacology classes.

My humble thoughts.

 

[fma08]

alright... Rid, what am I missing then? (not trying to sound pissed off just wanting the info that i dont have) and Sky i feel the same way as you, i've been posting what i've learned, in class no less, on here only to have it be shot down at most turns and told was wrong. i get mad at the staff where i'm at school at for not actually learning the "whole" story. which also shows that ems in its education is not standardized or even at times enough. it does seem that we are taught, for this we do this, and not always why or how it works.

 

[skyemt]

thank you all for your feedback...
it is obvious to me at this point that i am trying to lift a boulder with a spoon.

is there a good pharmacology text someone could recommend?

 

[MSDeltaFlt]

Guys, if I may?

Anytime you "numb" a muscle up, it doesn't work. Remember trying to smile when you leave the dentist? And when the Novacaine wears off, you tend to get that weird feeling in your cheek? That would be not unlike an increased excitability. When dealing with Vt and/or VF, an increased excitability is the exact opposite of what you're looking for.

We have all heard about what cocaine does. Cocaine has multiple functions. Taken topically it is an anesthetic. Taken vascularly, it is a stimilant.

Lidocaine has multiple functions. Taken topically it is an anesthetic. Taken vascularly it decreases the excitability of the myocardium.

There's no real simple answer; especially when it comes to pharmacology. One drug can do different things through different routes and at different dosages.

Rid, Vent, I hope I explained it properly. Again, my humble thoughts.

 

[skyemt]

in many ways, even though i will be without the answers to my original post (for now), this thread has been eye opening...

i have been surprised at the lack of explanations in the paramedic texts...

i also have trouble grasping the concept of administering meds without knowing exactly how they work on the body...

i know we act under the license of the medical director, and he knows how they work, and entrusts us under certain conditions...

but if the foundation was better, would that not lead to better and faster decision making in the field? and if so, would that not lead to better patient outcomes?

i know i am not yet a medic, so maybe i shouldn't be talking too much about it... but it doesn't really make sense to me.

 

[VentMedic]

EMS has endured some educational "dumbing" throughout the past 3 decades. The text books have not progressed and the expected educational level is barely high school.

As much as I admire the work and dedication of Dr. Nancy Caroline in the many aspects of her career, Emergency Care in the Streets introduced us to Sidney Sinus node as a way to learn EKGs. If Dale Dubin had not written "Rapid Interpretation of EKGs" to become a supplement the Paramedic texts, I don't know if I could have taken much more Sidney Sinus adventures.

 

[JPINFV]

I agree with building a foundation first. The great thing about a foundation is that you can use it to infer information that you don't directly know. When we encounter something new, we try to build that into the foundation of what we already know (schemata (singular schema)). If someone is telling you something that doesn't fit into the schema that you have already have, then you will be more likely to reject it because it "doesn't sound right." Hence the arguments put forth by other people (not directed at anyone in particular) of "what their instructor told them."

It's also much easier to build off of a foundation than to build a foundation under information. For example, if you already know the importance of sodium channels (not saying you don't), then it's easier to understand what blocking a channel will do. Hence when learning about drugs you end up having to learn less new material (i.e. blocks sodium channels vs blocking sodium channels AND the result).

 

[JPINFV]

I don't know if I could have taken much more Sidney Sinus adventures.

[insert comment about women and cutesie stories and things]

ducks from Vent's smacking ^_^

 

[VentMedic]

[insert comment about women and cutesie stories and things]

And in 1979, the stories were read by and to mostly males.

 

[Ridryder911]

What the upsetting problem of "numbing the heart" is it has nothing to do with receptor sites of neuro transmitter of sensory pathways, such as lidocaine does in its action(s) of use as a analgesic effect. Saying such or attempting to describe it as the actions, really defines that one does not truly understand the pharmodynamics or actions used for treatment in either case.

This is why a true separate pharmacology course should be added to any Paramedic program. At the least half of the course spent on receptor and cellular level actions.

EMS forums are designed to spark interest, inform, and attempt to educate to certain degree. They cannot or are expected to replace true education programs as the fundamentals. So if you feel shot down, that is your interpertation, as I would see it as a recommendation or alarm to increase your awareness, more in-depth studies needed, to master the fundamentals needed.

I would find it much better for one of us to inform you than as I described that Paramedic did. Unfortunately, he made such statement about Lidocaine in front of his former medical director.

One can just get by, if they choose to. We all know those types. We also know the one's we rather have take care of our family if need be.

R/r 911

 

[skyemt]

the issue i am having, i guess, is the lack of a good "foundation", as has been referenced here...

the education i am getting in "pre-hospital" medicine, is very much a Top Down approach, rather than bottom up...

you are given the same conclusions in Basic class, as Medic class for the most part...

the medic class goes into more detail, more skills, more of the why...

however, there doesn't seem to be a solid foundation there either, at least from what i am gleaming from the Paramedic texts.

i suppose, much of what i have been asking on my last few threads, is not going to be of much use if i don't have a solid grasp of the cellular level...
the pharmacology of how medications even work, and the cellular properties of those that they work on.

it is somewhat disturbing to be administering powerful meds, without such understanding... but, that is for another thread...

so, back to a question i asked earlier, in the efforts of "foundation building",

can i get a couple of good text recommendations?

thanks.