Continuing doses on medication

[ParamedicStudent]

I have a question on continuing doses on medication, especially from a different provider and/or the type of medication.

Let's say you're working a cardiac arrest, and the 2nd drug given is Amio 300mg. If you don't have Amio for the 2nd time, you would use .5-.75mg/kg of Lidocaine right? Or would you use the starting dose for the drug because it's your first time using it?
What about voltages? If a provider shocked the pt at 360J, and they switch the care to you, you would continue to shock at 360J right? Or would you shock at 200J because it's your first time seeing this pt.

 

[DesertMedic66]

Everywhere I have heard of you either stick with amio or you stick with lido. I'd me more concerned about why you don't have the second dose of 150mg.

It's going to depend on what monitor they have. Ideally the patient should stay on the monitor they were first attached to but if for some reason that is not possible then it would depend on the monitor and where they left off for joule settings. Do they have a zoll where the max dose is 200J (I believe) and I have a LP15 where the max is 360? If they have already delivered shocks at 360J then I will just continue from there.

 

[SpecialK]

Use one or the other, not both. Mind you, I would be very surprised if anybody out there (except in some third world country) still uses lignocaine.

Cardiac arrest? Single shocks at maximum joules; whatever maximum is for the particular model of defibrillator you are using.

 

[DesertMedic66]

Use one or the other, not both. Mind you, I would be very surprised if anybody out there (except in some third world country) still uses lignocaine.

Cardiac arrest? Single shocks at maximum joules; whatever maximum is for the particular model of defibrillator you are using.

ICEMA (the largest county in CA) still uses lido

 

[Bullets]

Still carry Lido in NJ as a second line drug, though medical control seems to be back in favor of it and we are using it more. We had a arrest last week of over and hour of refractory v-fib and tach and gave both 450mg of Amio and lido afterwards. With that Procamio study, i suspect we will be moving away from Amio soon. Our new medical director seems unimpressed with Amio.

Also you stick with 360j and then i would start asking for 720j

 

[StCEMT]

Use one or the other, not both. Mind you, I would be very surprised if anybody out there (except in some third world country) still uses lignocaine.

Cardiac arrest? Single shocks at maximum joules; whatever maximum is for the particular model of defibrillator you are using.

Got lido where I work.

 

[VentMonkey]

ICEMA (the largest county in CA) still uses lido

Isn't it still the biggest county in the contiguous U.S.?

Also, same here, we have both; just have to "pick and stick". Honestly speaking the last arrests I can think of that were ventricular in nature responded much better to the ol' defib anyhow (imagine that).

Coincidentally, we hardly ever have to worry about placing them on a different monitor. We're a Zoll county, though I guess the guys who work in the two areas with ALS FD engines might; not sure what those two engines carry for monitors.

I really don't think it matters much, TBH. If you defibrillate a patient at 360 J on one monitor, then switch to another like the Zoll, the energy delivered taps out at a certain setting either way, TMK. I believe you can stick to 200 J across the board or follow the autosettings on the monitor, but not a whole lot of difference once it maxes out in terms of what is being delivered.

 

[TransportJockey]

Use one or the other, not both. Mind you, I would be very surprised if anybody out there (except in some third world country) still uses lignocaine.

Cardiac arrest? Single shocks at maximum joules; whatever maximum is for the particular model of defibrillator you are using.

With the new ILCOR recomendations in the last update of ACLS, plus the price of amio vs lidocaine, i can see lido making a comeback. I carry it as a second line in my county.

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[Tigger]

As far as I am aware, there is no difference in efficacy between lidocaine and amiodarone and lidocaine may be more effective in Vtach with pulses. We are also of the "pick and stick" mentality, though the local non-cardiac hospital enjoys the "kitchen sink" approach to dysrhythmics. When we are forced to bring them "arrested during transports," they enjoy maxing amio, lidociane, calcium, and mag. And attaching 400mg of dopamine to macro tubing...

As for the defib part, I am not sure if there is much literature. If one monitor has already been maxed I think I'd start with the max on mine.

 

[StCEMT]

I guess it depends on the study. This prompted me to look earlier and it seemed like amio was a few percent higher in better outcomes? I would have to recheck the study. Doesn't change much for me since all I got is lido.

 

[Underoath87]

The patient doesn't care who is in charge of his ACLS code. So you don't restart the treatment algorithm just because someone else assumed care or a similar drug was substituted.