Adenosine stopping the fetus' heart

[BlakeFabian]

Hello all-

My Paramedic course instructor assigned us an optional extra credit research paper about the effects of Adenosine on a pregnant females fetus; specifically whether is would stop the fetus heart as well while trying to correct a dysrhythmia in the mother.

I'm just now beginning my research into my pharmacology & cardiology books to find an answer, but I wanted to get some experienced Paramedics opinions on this as well.

Thanks in advance for your help!

-Blake Fabian

 

[Handsome Robb]

Look up pregnancy classes of drugs, then look up adenosine and it's pregnancy class, then read about it.

Not trying to be a douche but no one here is going to hand you answers. That's coming from a fellow medic student.

My thought is, yes adenosine has the risk of affecting the heart of the fetus BUT if the mother dies, the fetus dies. Risk vs. Reward. I've never experienced this issue in the field, but I have very limited experience.

 

[RocketMedic]

Look up pregnancy classes of drugs, then look up adenosine and it's pregnancy class, then read about it.

Not trying to be a douche but no one here is going to hand you answers. That's coming from a fellow medic student.

My thought is, yes adenosine has the risk of affecting the heart of the fetus BUT if the mother dies, the fetus dies. Risk vs. Reward. I've never experienced this issue in the field, but I have very limited experience.

I dont think it has the half-life to really diffuse correctly through the barrier, much less with low(er) doses.

 

[Shishkabob]

I dont think it has the half-life to really diffuse correctly through the barrier, much less with low(er) doses.

One thing you're missing: Adenosine is a naturally occurring compound in the human body.


Mother comes before baby. Mom dies, baby will die no matter what.




Having said that, a precaution, but NOT contraindication, of adenosine, is pregnancy. Without getting too specific about pregnancy categories and helping you TOO much with homework, take that as you will.

 

[BlakeFabian]

Not trying to be a douche but no one here is going to hand you answers. That's coming from a fellow medic student.

My thought is, yes adenosine has the risk of affecting the heart of the fetus BUT if the mother dies, the fetus dies. Risk vs. Reward. I've never experienced this issue in the field, but I have very limited experience.

I'm not looking for answers. I specifically said I'm looking for opinions.

Adenosine is pregnancy class c according to my field guide therefore there’s a risk of damage. Since posting, I've searched for information online and have found several different sites offering information. Some say it's safe, others don't.

Lord knows most of the people who wrights the educational stuff haven't been in a truck in years, so I'm asking for opinions & reasons why or why not an experienced Paramedic would or wouldn't administer it.

 

[JPINFV]

Lord knows most of the people who wrights the educational stuff haven't been in a truck in years

Experience in a truck (wouldn't experience in an ambulance be better anyways?) does not change whether a medication is or isn't dangerous to pregnant patients. Experience in a truck does not change chemistry, physiology, or pharmacology. What experience in a truck may do is provide a, "Well, by gosh, by golly, a long time ago some other paramedic said that his sister was told by a Doctor of Homeopathy to avoid this drug because it could hurt the baby growing in her stomach" response.

 

[Shishkabob]

Lord knows most of the people who wrights the educational stuff haven't been in a truck in years, so I'm asking for opinions & reasons why or why not an experienced Paramedic would or wouldn't administer it.

As put in my previous post, the mothers life comes first, and pregnancy is a precaution, not contraindication.


It's up to you as the Paramedic (or, your protocol writers) to weigh the risks with benefits and decide what to do from there. If mom is in SVT, I guarantee you baby is getting no blood anyhow, as the moms body is selfish and will shunt a crap load of blood away from baby when it freaks out.



Medicine is a million shades of gray.

 

[WTEngel]

Keep in mind, unstable tachycardias get immediate synchroniced cardioversion without delay. The Circulation journal recommend following standard ACLS with minimal modifications in certain area.

Adenosine administration and defibrillation/synchronized cardioversion are not listed as items that need to be modified in maternal cardiac arrest or peri arrest.

Check the 2-November Circulation Journal, section 14 titles "Cardiac Arrest in Special Situations." It details the AHA's current standpoint on the matter.

 

[Handsome Robb]

Adenosine is pregnancy class c according to my field guide therefore there’s a risk of damage. Since posting, I've searched for information online and have found several different sites offering information. Some say it's safe, others don't.

Lord knows most of the people who wrights the educational stuff haven't been in a truck in years, so I'm asking for opinions & reasons why or why not an experienced Paramedic would or wouldn't administer it.

if the mother dies, the fetus dies. Risk vs. Reward.

Mother comes before baby. Mom dies, baby will die no matter what.

So if mom dies, do not pass go, do not collect 200 dollars, go straight to jail.

Now,

Keep in mind, unstable tachycardias get immediate synchroniced cardioversion without delay. The Circulation journal recommend following standard ACLS with minimal modifications in certain area.

If she is asymptomatic and/or hemodynamically stable I'd try vagal maneuvers, toss the pads on in case something went south, start a line and monitor her condition closely during transport. Adenosine would be my second choice to sync'd cardioversion. But like I said, I have very limited experience.

 

[RocketMedic]

If mom is throwing stable SVT or V-tach at us, I'm in the same boat as NVRob in terms of treatment- I'm not adverse to adenosine, but I'm anticipating deterioration. Vagal>Adenosine>Sync. Cardioversion.

 

[firecoins]

I have seen this used ona pregnant woman in an ER successfully. I did not have the ability to follow up on childbirth.

If the patient is stable than it can wait until the ER and if they are unstable, you should be on the phone with medical control. Just my opinion.

 

[habibti74]

I have seen this used ona pregnant woman in an ER successfully. I did not have the ability to follow up on childbirth.

I've seen this done on pregnant patients in SVT in the ER when they've had L&D come down and put the baby on a fetal monitor. It doesnt really matter if its stable or unstable - even if theyre hemodynamically stable, leave them in SVT for too long and they'll become unstable and that won't do either mom or baby any good.

We've always had good success and no neonatal problems in the ER but I've never seen it done in the field.

 

[BlakeFabian]

If the patient is stable than it can wait until the ER and if they are unstable, you should be on the phone with medical control. Just my opinion.

That's exactly what every ALS tech on my service said as-well.

Thanks for everyones' input.

 

[Fish]

Mother comes first, and I do not see adenosine lasting long enough to make it to the baby. Even if it did, I wouldn't see it "stopping" the heart permanently.

 

[mycrofft]

Anytime a fetus is involved, get medical control online ASAP.

Yes, the mothership has to be maintained first, but the second you start having to weigh stuff like that the wiser heads need to be involved. Not just medically but legally and socially speaking.
ROT (rule of thumb): if it has to do with hands, eyes, genitals, fetuses or babies (and kids) get very cautious, very quickly.