Pushing meds down the ET tube

Shishkabob

Shishkabob

Forum Chief
Messages
8,264
Reaction score
32
Points
48
So, I know it has fallen out of fashion, but does anyone still have LEAN for their ET tubes?


I ask for a simple reason: I suck at IVs as it is, let alone trying to stick someone that has no blood pressure and that I won't get a flash on (Cardiac arrest), and we don't have IOs for adults.

That pretty much leaves me with just drugs down the ET tube in an "OH CRAP THIS ISN'T GOOD" situation, of course after the other options are exhausted, including EJ.




I'm going to find my MCs email and ask him the question on its use as it's not in our protocols (obvious reasons), and I also don't see me having to worry *much* about a cardiac arrest call anytime soon, but just thought I'd ask.
 
well whats your main problem with iv's???? thats something you are gonna have to work on..
 
Actually yes. In Fresno, we can put drugs down the tube. I have to review what meds can go down, but can tell you for sure that it is allowed.
 
Rarely. If IVs are a problem, we just I/O them ( Jamshidi/Illinois or the Easy I/O ).

The only time I usually consider it, is EPI in the case of Status asthmaticus code. Works like a charm and improves compliance
 
This is one of those situations where practice hasnt caught up to science. Studies have shown that there is zero systemic absorption of meds put down the tube. There are exceptions for local acting meds like albuterol, or epi, which have a direct affect on the lungs.
 
No we have IO now but it sounds like you need lots of IV practice, Mr Laerdel might make a good patient I know he has at my station
 
My question is:

Why are you skilled at intubation, but not on IV's? In my experience intubation is the harder skill.
 
Mayhaps someone needs to get some time training in an ER. I'm betting your clinical educator can arrange for a few 8 hour shifts starting IVs at a local hospital.

Seriously dude? Are you just scared? can't get that AC go for the BICEP...

You think you won't be able to get an EJ?

Don't have adult IO in the protocols.... can't you call online medical control and get a verbal order?!


Linuss, after that last major chat session I was mucho impressed with your ... "resourcefulness..." don't make me start making fun of you!
 
Correct me if I am wrong but from what I`ve been told is when you ET someone they have a high chance of puking. If they puke and even though you suction there is still :censored::censored::censored::censored: that could be in there lung which in return could cause the drugs not to work. If I were you I would practice doing IV's until you can do it in your sleep. At least I plan on too (i just started P1)
 
You are right, there may be a chance. A high chance? Unlikely. If the person has coded, your chances of them actively puking are slim to none. But you will have the typical saliva, mucos, chicken noodle soup pooled down there.
On consious sedation, elective intibation, etc... yes, your chances are much greater... still not high though.
I only base this on a couple hundred intubations a year for the past 20 some years, and yes it does happen... not that much. ( some folks may have more experience with it, and the numbers may vary ).
As long as you don't forcefully ventilate without properly suctioning, you won't get a great deal in the lungs, and if you do.... a little tracheal suctioning works pretty good.
Pulmonary edema, pyrothorax can mess your world up directly effecting the drug absorption.
 
Intubation (while a difficult procedure at times) is easier than IV access imo. Intubation is all based on landmarks. IV access is practically blind... you are trying to slip a little tube inside of another little tube! However, on topic, meds down the ET tube are not preferable for several reasons. For one, there is no way for you to tell how much of the medication is actually absorbed. For another, you are typically doubling the dose for the ET route... that means 2mg Epi and 2mg Atropine for Asystole/PEA/EMD... that's 40cc of fluid PER ROUND of medications! Do me a favor... let me put 40ccs of fluid into your lungs every three to five minutes.

Linuss... have you considered pestering your employer to purchase adult IOs? If not, you can always go for an EJ. EJs can be really nice in a cardiac arrest... turn the head to the side, throw in the IV, secure it, turn the head straight, drop the tube... everything ALS is above the neck... now you can just sit at the head and do your thing and let the BLS providers do theirs! Also, have you considered this?: http://www.veinlite.com/pics/Veinlite EMS Flyer e-mail.jpg

EDIT: Just re-read your post and saw that EJ wasn't an option... my bad.
 
Last edited by a moderator:
Our protocols call for drugs down the tube as an ABSOLUTE last resort and only after MC has been contacted for orders. My service doesn't carry EZ IO, we only carry Jamshidi IO and while I've never done it I've been told they are nigh impossible to get placed on an adult patient. The ONE time I've done an EJ I didn't see the vein at all but I remembered where the thing ran so I went anatomical. For concern on flash I was taught to take the end cap off the IV Needle (the cap furthest from the needle) and attach a 3 or 10 cc syringe to it. Insert IV while aspirating,

I was surprised at how easy it was, if you know generally "OK the EJ runs from here to here" and line up your needle with that anatomical location you should hit it. If you don't see it that is.

What issues are you having with IV's? My biggest problem has been angle, I enter entirely too steep.
 
Linuss said:
So, I know it has fallen out of fashion, but does anyone still have LEAN for their ET tubes?


I ask for a simple reason: I suck at IVs as it is, let alone trying to stick someone that has no blood pressure and that I won't get a flash on (Cardiac arrest), and we don't have IOs for adults.

That pretty much leaves me with just drugs down the ET tube in an "OH CRAP THIS ISN'T GOOD" situation, of course after the other options are exhausted, including EJ.




I'm going to find my MCs email and ask him the question on its use as it's not in our protocols (obvious reasons), and I also don't see me having to worry *much* about a cardiac arrest call anytime soon, but just thought I'd ask.
Click to expand...

And then God said, for you.. I give you SQ / IM
 
Right Patient, Right Drug, Right Dose, Right Time, Right...

...Oh, crap.
 
he wasn't talking about ACLS. He mentioned Cardiac Arrest, but right there you can give Epi and Atropine 2 to 2.5x the dose down the ETT.
 
himynameismj said:
he wasn't talking about ACLS. He mentioned Cardiac Arrest, but right there you can give Epi and Atropine 2 to 2.5x the dose down the ETT.
Click to expand...

LEAN (or NAVEL) is what kind of drugs for the most part? That's right. ACLS. Lido, Epi, Atro, and Vasopressin, plus Narcan. Generally ACLS in an arrest means code drugs.
You said SQ/IM up there, nothing about give drugs ET.
 
oh damn, i should have read the first post in full. i thought he was just saying in general he was having trouble w/ iv access.
 
You must log in or register to reply here.
Back
Top