Push Dose Pressors

[NomadicMedic]

In another thread, @Bullets mentioned that his service is using Epi as a push dose pressor in "not dead people". Anyone else doing this? Makes sense during a shorter transport.

Here's a JEMS article. (I know, don't shoot me. It had peer reviewed scholarly citations.)

http://www.jems.com/articles/print/...h-dose-epinephrine-temporizing-measure-0.html

 

[TransportJockey]

We have it for post code resus and for severely hypotensive patients as an alternative to levo. We don't carry Dope or dobutamine, so it's our only other option. I'm actually a big fan of Epi 1:100,000 for hypotension

 

[VentMonkey]

This has been "all the rage" in the SMACC/ FOAMED realm for the past few years.

I think it's worth a shot in certain situations such as what @TransportJockey mentions in his protocols above (I really do think Galveston EMS sounds more and more fitting for me).

Let's see what the good doc's spin on it is...
@ERDoc anyone?

 

[PotatoMedic]

In another thread, @Bullets mentioned that his service is using Epi as a push dose pressor in "not dead people". Anyone else doing this? Makes sense during a shorter transport.

Here's a JEMS article. (I know, don't shoot me. It had peer reviewed scholarly citations.)

http://www.jems.com/articles/print/...h-dose-epinephrine-temporizing-measure-0.html

I believe it will be in the new protocols for Pierce county. When, IF, they ever come out.

 

[NomadicMedic]

My only option is either Dope or an Epi drip, but I reckon I could get orders for push pressors.

 

[VentMonkey]

My only option is either Dope or an Epi drip, but I reckon I could get orders for push pressors.

We're in the same boat on the ground. CCT has a Levo (gtt) as a third pressor option.

PDP's just seem so much more practical, especially in a post-ROSC patient who is teetering between severe hypotension and re-arresting.

 

[Brandon O]

Either epi or neo pushes are very useful tools in an acute resuscitation or unstable patient.

The latter tend to be easier to come by (we have premade syringes in the Pyxis, anesthesia carries them around in their pocket, etc). Epi you usually have to use the code amps and just (preferably) push small aliquots of it. Never tried to mix it.

 

[TransportJockey]

Either epi or neo pushes are very useful tools in an acute resuscitation or unstable patient.

The latter tend to be easier to come by (we have premade syringes in the Pyxis, anesthesia carries them around in their pocket, etc). Epi you usually have to use the code amps and just (preferably) push small aliquots of it. Never tried to mix it.

We push out 1 mL from a flush and pull up 1mL from the 1:10,000 for ease of mixing. Doesn't take long either. I know when I run a code, whoever is doing drugs I tell to do that after one of their epi pushes

 

[Brandon O]

We push out 1 mL from a flush and pull up 1mL from the 1:10,000 for ease of mixing. Doesn't take long either. I know when I run a code, whoever is doing drugs I tell to do that after one of their epi pushes

Yeah, I've heard of that. Dumb question, how do you pull it up? A flush won't screw directly into the Bristojet, right? They're both male connectors.

 

[DesertMedic66]

Yeah, I've heard of that. Dumb question, how do you pull it up? A flush won't screw directly into the Bristojet, right? They're both male connectors.

3 way stopcock?

 

[NomadicMedic]

3 way stopcock?

That's Dr Antevy's thing.

 

[DesertMedic66]

That's Dr Antevy's thing.

That's where I got it from..

 

[NomadicMedic]

You could also stick an 18 on the flush and draw up from the amp. (Once you flip that yellow cap off, there's a rubber stopper in there)

 

[MonkeyArrow]

I feel like pharmacologically speaking, phenyl would be a better choice for push dose pressors due to its quick half life and relatively clean mechanism.

I know that it's not an option pre-hospitally for most (all?) of us, but I feel like would be a more appropriate in hospital drug choice.

 

[TransportJockey]

You could also stick an 18 on the flush and draw up from the amp. (Once you flip that yellow cap off, there's a rubber stopper in there)

This is how we usually do it. Stopcocks can be hard to come by on our trucks right now

Sent from my SM-N920P using Tapatalk

 

[NomadicMedic]

stopcock - the girl at the bar who's friends with the girl you're hitting on and keeps saying things like, "it's time to go Jennifer!"

 

[Brandon O]

You could also stick an 18 on the flush and draw up from the amp. (Once you flip that yellow cap off, there's a rubber stopper in there)

Needle through the stopper, or you remove the stopper?

I feel like pharmacologically speaking, phenyl would be a better choice for push dose pressors due to its quick half life and relatively clean mechanism.

Ehh. This is the initial feeling most of us have about phenylephrine -- seems like pure vasoconstriction is a good match for what we often want -- but really it's usually not the case. Its best fit is probably for purely sedative-related hypotension -- you gave some propofol or fentanyl or gas or whatever and dropped their pressure -- which is primarily related to reduced SVR (although even that's a simplification as most sedatives are also negative inotropes). Great, give some Neo. But in most situations, pure vasoconstriction is not actually ideal, because it increases their afterload without giving any inotropic assistance to push against that afterload. Someone with a really good young heart may be able to power through that high gear, but many need help.

That's largely why norepinephrine has become our go-to pressor drip for most situations; it gives vasoconstriction with just enough beta to stay balanced.

 

[StCEMT]

I'd like this. Often have a short transport time, being able to do this would be less cluttered.

 

[SpecialK]

We just put 1 mg of adrenaline in a 1 litre bag of NaCl and adjust the infusion rate to the patient condition. Single bolus doses of vasopressor from a syringe have been withdrawn. This approach is much easier than fart arseing around with syringe boluses and it has reduced dosing error.

 

[TXmed]

I just squeeze out 9ml of epi 1:10 pre-filled, hook it to a saline bag that is running and draw back 9ml of saline. (wasteful i know but fast and easy).

I love push-dose epi, i think epi as a whole is under utilized and often times people act scared of it. But i think epi drips and push-dose are a thing of the future for pre-hospital.