Lido post defib

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mc400

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I have a question about Lido post succesful defib.

Call was a 67 year old male who while on a long bike ride collapsed in front of a store. Compressions initiated on scene prior to our arrival. Response time was about 7.5 minutes It was our engines 2nd due and we arrived the same time as our rescue.
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U/A pt was in V-fib with gasps. CCR was started, 200 compressions, then Defib, then 200 compressions, after the compressions pt was in Sinus Tach at 104, strong pulses still trying to breathe on his own. IV access was delayed and an IO was placed and pt was bolused 500cc. Pt held a strong BP and Pulse and Advanced airway was not possible due to pt's gag so supported bls airway was continued e/r.

Now here is the question. Would you have/should we have bolused Lido once access was established? PT was converted
with no drugs on board.

When we arrived at the hospital the pt was breathing about 12 times a minute on his own, still awake but not really responsive and holding a great rate and BP. Docs gave Calcium and BiCarb.
 
Was there an indication for lidocaine? It doesn't sound like it to me, so why give stuff that may have significant adverse effects when there are no positives to be gained?
 
Many protocols state to administer a lido bolus and lido drip upon ROSC from VF/VT with the thinking that the lido will raise the threshold for ventricular ectopy and prevent the patient from going back into arrest.

To answer your questions I would have to say do what your protocols say or better yet consult with the receiving hospital. Here we need command prior to starting a lido drip on a post-arrest patient. I know many don't like the "do what your protocols say to do" answer but ultimately that is what you have to do unless consult with med command.

You have to ask your self, "why did this patient arrest"? It sounds like he had an MI because his supply of oxygen wasn't able to keep up with the demand of being on the long bike ride. So the patient prob had a coronary vessel occlusion. Although could have been electrolyte too. I had a patient... a 21 year old working construction in extreme heat that went into arrest... later found out he arrested from hyponatremia.

Were you guy's able to do a 12-lead?

To answer your question I would have consulted with the doc and asked him if he wanted a lido drip.
 
That is what I was thinking but another medic after the call said we should have given lido. If we would have had IV access faster then yes Epi and Lido would have been given but we literally walked up, shocked and had a good rate, rhythym and BP and PT was starting to breathe on his own. His reasoning was to prevent the return of v-fib.
 
Like stated, some protocols state after conversion, even if no drugs were used, to do a lido / amio drip. If that's what yours state, consider it.

Mine don't state that and want you to treat the current post-resuscitation presentation, but I know many agencies DO state that.
 
Sounds like ya'll did well. Lido post-defib was all the rage years ago, now, not so much. Unless you have a reason to believe it will help prevent the return of v-fib, no reason to give it.
 
Based on the info here, with a presumed short transport, getting the pt to the ED and allowing the docs pick up Tx from there is appropriate.
However, in my service with considerably longer transport, application of Lido (or Amiodorone) would be a good idea...to stave off probable post-ROSC ectopies. Were there post-resus ectopies? What was happening with the ECG? What was pt outcome?
 
There was no ectopies. Seemingly perfect sinus/sinus tach around 95-105. Just talked with ICU nurse, Pt is being extubated, and weened down on propofol and is responding to everything and they expect a great recovery. Monitor showed Sinus with ST depression and a significant Q wave.
 
Also when the wife arrived at the ER she said he was at the doc 2 days ago and recieved a clean bill of health. Pt cycles over 150 miles a week and looked to be in better shape than 95% of our population. Hopefully we will hear more soon.

Transport was about 15 minutes. All vitals held steady no ectopy, pulses got stronger and resp effort increased. Pretty rare we see an arrest with like this. Most of the time it is asystole/unknown downtime or a trauma code. Was nice to find a pt with compressions in progress and still agonal resps/gasps.
 
That is an awesome call! Great job you guys did. Your training and education paid off... and who said EMS doesn't save lives :)
 
You know we don't save many once they reach this point but I believe we do save many before it becomes a code. Thank you.
 
The hospital tx with CaCl and Bicarb, sounds like hyperkalemia was their concern. If that were the problem, Lidocaine may have been a very bad idea. All's well that ends well.
 
Pt was discharged after 4 days and has called to thank us and is going to come by our station soon. Pretty good feeling.
 
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