CCT: what meds do you carry?

[Carlos Danger]

For those that do CCT or are familiar with CCT services, what drugs do you or they carry that aren't usually part of a prehospital ALS formulary?

- Blood products?
- Propofol?
- Antibiotics?
- Nipride / nitroglycerin?
- Esmolol?
- Phenylephrine / norepinephrine?

Anyone using any of the fentanyl analogues (remifentanil, sufentanil, alfentanil) in the field?

 

[Aprz]

In my area, CCT isn't too fancy. Typically they'll continue medications from the sending facility eg Propofol, blood products, Nicardipine (Cardene) but they have to take it from the sending facility; They will not have it stocked on the ambulance.

Unique drugs that ALS does not have that CCT does carry are:
Vecuronium bromide (Norcuron)
Labetolol
Nitroglycerin IV*
Levasalbutamol (Xoponex)
Flumazenil (Romazicon)
Verapamil / Diltiazem (Cardizem)
Vasopressin

*ALS has Nitrostat (Nitroglycerin) tablets, but not Nitroglycerin IV.

ALS and CCT used to carry Sodium Thiosulfate, but that was recently discontinued.

 

[NPO]

Our CCT rigs are pretty similar to our ALS units. I havent inventoried the RN drug bags, but I dont believe they have anything our ALS units dont.

Like Aprz said, we will take stuff from the sending. I remember one call in particular where we took 3 extra bottles of Propofol, and ran it close at the end.

Our nurses carry RSI kits, too. I believe the only time they are allowed to use them is when we have a doctor on board, which does happen semi-frequently.

We do not have any Paramedic-staffed CCT units.

 

[SeeNoMore]

You should ask them NPO, I supsect that there are in fact meds carried by your team that are not common on ALS units and that they are able to RSI without a doctor. If not that is a very limited CCT , not that that says anything about the quality of the providers. No offense is meant.

We carry all the RSI meds but those are found on many ALS units.

The meds not found on ALS units are mainly antihypertensives/beta blockers (cardene, lopressor, metoprolol, nipride, hyrdalazine) , some pressors (levophed, neosynephrine) , Dilantin, propofol.

We are more heavily weighted towards IFT and like most services will maintain / titrate meds , blood and blood products , balloon pumps , fetal heart monitors , invasive lines , transvenous pacemakers etc. Generally I have not found the need to carry more than we do, and usually sendng facilities are happy to either provide more of a med that will run out en route, hang blood or sedation meds/pressors or whatever.

Is anyone obtaining lab values en route? Putting in A lines (we only do central) or using ultrasound technology? Good thread thanks for starting it.

 

[NPO]

You should ask them NPO, I supsect that there are in fact meds carried by your team that are not common on ALS units and that they are able to RSI without a doctor. If not that is a very limited CCT , not that that says anything about the quality of the providers. No offense is meant.

I will. I never really thought about it until today.

I know the nurses cant intubate, we have had Paramedics pulled onto a CCT rig for respiratory patients that were doing poorly. (So I guess I should edit my statement above... We dont regularly staff Paramedic/CCT units.)

 

[SeeNoMore]

Huh. That is different. I much prefer a team approach where the Paramedic and RN act as a team and do not divide interventions or scope of practice, or even if there is formal divison you can still require each practicioner to be equally educated in order to better provide care. I really think RN/Paramedic is a good model for a team when they regard each other as equals. Each brings something different with RNs (generally speaking) having more initial experience with certain drips or interventions and paramedics (generally speaking) having more experience with scene work, intubation etc. Of course this gets very muddied with many RNS having ran 911 or been paramedics and many Critical Care paramedics having become very educated and proficient with education/interventions beyond most paramedic programs initial content.

 

[18G]

Many of the CCT level drugs we are permitted to primarily administer or titrate/monitor are hospital provided due to the patient already being on them when we arrive. This makes more sense then carrying these drugs onboard the unit. With IFT, the hospital has the legal responsibility to provide whatever drugs the patient will require during transport (i.e. EMTALA). But that's just my opinion.

Our medical director is pretty liberal.

Propofol
Vecuronium
Rocuronium
Succ
Fentanyl drip
Morphine drip
Ativan drip
Furosemide drip
Sandostatin
Nicardipine
Precedex
Labetalol
Metoprolol (unit carried)
Nitro drip
Nitroprusside
Levophed
Phenylephrine
Verapamil
Procainamide
Thrombolytics
Integrillin
Aggrastat
Cardizem
Etomidate
Insulin drip
Mag sulfate drip
Dilauded
Mannitol
Demerol
Flumazenil
Antibiotics
Blood products

And a few others.

 

[Aprz]

Is anyone obtaining lab values en route? Putting in A lines (we only do central) or using ultrasound technology? Good thread thanks for starting it.

We have dopplers for fetal heart tones and LVADs, which I think is cool. No iStats, or any point of care (POC) testing other than glucometers.

 

[CANMAN]

Many of the CCT level drugs we are permitted to primarily administer or titrate/monitor are hospital provided due to the patient already being on them when we arrive. This makes more sense then carrying these drugs onboard the unit. With IFT, the hospital has the legal responsibility to provide whatever drugs the patient will require during transport (i.e. EMTALA). But that's just my opinion.

Our medical director is pretty liberal.

Propofol
Vecuronium
Rocuronium
Succ
Fentanyl drip
Morphine drip
Ativan drip
Furosemide drip
Sandostatin
Nicardipine
Precedex
Labetalol
Metoprolol (unit carried)
Nitro drip
Nitroprusside
Levophed
Phenylephrine
Verapamil
Procainamide
Thrombolytics
Integrillin
Aggrastat
Cardizem
Etomidate
Insulin drip
Mag sulfate drip
Dilauded
Mannitol
Demerol
Flumazenil
Antibiotics
Blood products

And a few others.

My service is carrying these with a few additions or deletions. I work for two rotor wing services, one peds, one primary adult interfacility and scene work, so there are some patient specific meds. The peds service I work for carries a very large array of anti-botics, of which we use about 3 on the regular.

Adult rotor job we carry 2 units PRBC's on the A/C for all missions and getting ready to add FFP.

Peds service we do POCT for ABG's, VBG's, and Cap gases. We can also spin down a Chem 7 and basic CBC.