Vasopressin/Epi question in arrest

SandpitMedic said:
Yeah I don't know... I just feel like this topic is a little rediculous. This is basic ALS provider stuff. In some places this is ILS stuff.

I don't get the confusion. The confusion is confusing me. If that makes sense. It's not a grey area, it's cut-and-dry.
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SandpitMedic said:
Well, we're all telling you. It is the guideline. And it is in print right in the ACLS book under cardiac arrest. Look in the book and you should see it.

I believe you're reading too much into it. Seeking "unicorns" where there are not any. You should keep in mind that what is being taught to you in your ACLS class is what you need to do on scene. It is not as organized everytime like those scenario videos, but the steps are the same.
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Keep in mind ACLS is a set of guidelines, not a religion.

When I was a new paramedic, I knew ACLS cold. I had every line of the protocols memorized perfectly. I could draw the algorithms in my sleep. I felt like it was important to know them that well if I wanted to be a good paramedic.

Fast forward a bunch of years, and it's been quite a while since I worried so much about ACLS. The truth is, outside of EMS, codes are rarely run perfectly according to ACLS. I doubt any of the intensivists or anesthesiologist that I work with know ACLS nearly as well as most paramedics. The in-house clinicians generally adhere to the basic principles (do good CPR, shock VF/VT as soon as possible, give pressors, look for reversible causes), but are not sticklers for the protocols because, frankly, everyone knows that aside from the aforementioned basics, they are BS.

The point is, the ACLS guidelines are simply meant to provide a framework. And while we are responsible for following our protocols, maybe we shouldn't take them so seriously that we get all riled up when someone doesn't have every_single_word of the algorithms memorized perfectly.
 
For what it's worth if we give vasopressin it's 40 UI x1 and that's it. Either Epi OR vasopressin. This contradicts the AHA guidelines though so don't let it confuse you.

With that said, we can only give vasopressin if we don't have any Epi...
 
IU sorry phone is dumb and I didn't catch it before I couldn't edit it.
 
...(do good CPR, shock VF/VT as soon as possible, give pressors, look for reversible causes), but are not sticklers for the protocols because, frankly, everyone knows that aside from the aforementioned basics, they are BS.
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Yes, absolutely right. We all know high quality CPR/rapid defibrillation is good for business and the (proven)most effective treatment... However, going against the grain (on paper) will land you in hot water if an issue arises. You're supposed to follow those guidelines... We're not talking about the Pirates' code here. If you fail to do so you risk your Cert. Also, it is essential to be that new guy who knows every word and line and can draw algorithms in his sleep. That way when you fast forward a bunch of years you have a good base from which you came.

.... we shouldn't take them so seriously that we get all riled up when someone doesn't have every_single_word of the algorithms memorized perfectly.
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Touché. Right you are good sir.
 
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Of course, your local protocols trump all. That should go without saying. But I'm saying it anyways.
 
SandpitMedic said:
Of course, your local protocols trump all. That should go without saying. But I'm saying it anyways.
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That's alright. Part of our protocol update this year included the phrase, "the attending paramedic assumes any and all responsibility for treatments and care rendered by their EMT partner."

No way!!!!! Who knew!?!?!? ;)
 
Lol. Shenanigans... So I'm supposed to drive and keep an eye on that guy back there...
;)

Don't tell that to the texting and driving snitch guy....
 
Shots fired!!!
 
My Department protocols state that the first round of drug administration in Codes is 40U of Vaso otherwise we get wrote up on protocol Violation. After that no matter if there is ROSC and they go back into cardiac arrest it's Epi every 3-5 minutes per ACLS Guidelines!
 
Sandpit, you need to check the date on the algorithm you posted. Not that it changes anything you said regarding this particular conversation, your answer to the OP is correct...but the posted algorithm contains incorrect info regarding asystole care.

You posted an ECC 2005 algorithm, not the most current ECC 2010 algorithm. ECC 2015 should be out in a year and a half or so.
 
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WTEngel said:
Sandpit, you need to check the date on the algorithm you posted. Not that it changes anything you said regarding this particular conversation, your answer to the OP is correct...but the posted algorithm contains incorrect info regarding asystole care.

You posted an ECC 2005 algorithm, not the most current ECC 2010 algorithm. ECC 2015 should be out in a year and a half or so.
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Yes, yes. You are very right. My apologies for the old algorithm, Google images and my failure to double check it.

I soon as I looked again and saw Atropine I was like uh oh.
 
Where I am at, it is another vaso.

The reason for this, is that vaso works better in an oxygen deficient environment.

We give vaso first round, then epi, then vaso. We rotate in that fashion until out. To ensure we have enough vaso, we carry a plano box of vaso. If the rhythm is vfib or vtach, we flush the epi or vaso with amio.
 
Is RVA under the BREMS Council or another district?
 
The greater Richmond area is under ODEMSA, however the City of Richmond has their own protocols.
 
I'd like to see those protocols. Are they posted on line?
 
Maybe some of the OPs question comes from the half-life of vasopressin and epinephrine. The reason we dose epinephrine every 3-5mins is due to its short half-life. It needs to be dosed at the q3-5min intervals to maintain a therapeutic level.

Vasopressin on the other hand exerts its effects longer. So if you give vasopressin right off the bat you're good and don't need to worry about giving a vasopressor until about 20mins into the arrest.

So if I give vasopressin right now, get ROSC, and patient arrest two minutes later. I'm gonna hold off on epinephrine for at least ten minutes or so since the vasopressin is still working.

Does it really matter? Doubt it. But its a good question to ask.
 
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