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why do you think that the amio caused that sig. of a drop in systolic bp? Did you provide a loading does prior to the drip? Never heard of that causing such a drop like that.
Versed + hypotension
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why do you think that the amio caused that sig. of a drop in systolic bp? Did you provide a loading does prior to the drip? Never heard of that causing such a drop like that.
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Unfortunately I can't explain the patho behind it. I've hung amio twice on VT with pulses, once post ROSC, and seen it multiple times in the ER during clinicals and every time there was a significant drop in SBP after the amio was administered.
I suspect that drop also had something to do with the VT since my amio didn't convert it.
No loading dose on pulsatile VT.
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That was my guess at it.
It's labeled as a Class III however acts on all the classes. Reducing force of contraction secondary to Ca+ blocking effects would be the top on my list of answers for ya Ty.
hmm. strange. I cant count how many times ive used it. Although I prefer Lido. Your supposed to use a loading dose of 150mg. over ten min. Then hang a maintenance drip/infusion. Never heard of someone jumping to an infusion off the bat. Im guessing theres additional pathologies going to to cause that sig. drop in bp.
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That's what I've been hanging. Sorry for the confusion. My transport times are so short that we barely get our 150 in before getting to the ER.
I've never used lido, had the opportunity the other day but deferred it since we were backing into the ER. Only time we can use it is R-on-T PVCs.
I'm not doubting your experience at all, I'm just basing my comments on my experiences and *limited* understanding of the pharmacology behind it.
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copy that. true that. it does Possesses some vagolytic and/or calcium channel blocking activity.
When did Converting Vtach not become absolutely necessary whether it be chemically or electricity? I feel like I am missing something here.
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I remember everything after the versed admin, however I only received 2.5mg
I once received 7.5mg during a different procedure, I don't remember anything from that one.
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IIRC, out here, the dose of versed we give IV/IO or IM is 0.1mg/kg up to 6 mg for sedation for pacing or for seizure. Basically, most adults will get close to or right at 6 mg, so their recollection of events will likely be quite limited, if the retrograde amnesia is dose-related rather than route-related.
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You have to take into account that we are all healthier, younger(ish) 
individuals so we can process me meds much better than an older person who you'd more than likely see this person in can.
With that said I watched 2 mg IV put a decent sized 35 year old on their ***. On the other hand I've seen an angry, delusional 60 year old take 4 mg IV 2mg x2 and keep fighting with us. It depends on the person. That's assuming you have IV access though and you aren't going IM.
individuals so we can process me meds much better than an older person who you'd more than likely see this person in can. With that said I watched 2 mg IV put a decent sized 35 year old on their ***. On the other hand I've seen an angry, delusional 60 year old take 4 mg IV 2mg x2 and keep fighting with us. It depends on the person. That's assuming you have IV access though and you aren't going IM.
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When the potential risk outweighs the potential benefits.
As was mentioned before, some people can remain in v-tach for hours.
I have even paced a person out of v-tach and no idea how long he was in it, but it had to be at least an hour.
I have said many times, medicine is not an if:then type of situation.
Just because paramedics are drilled on what they can do, doesn't always make it the right thing to do.
mycrofft
Still crazy but elsewhere
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Can the average paramedic decide when the benefit outweighs the risk?
NomadicMedic
I know a guy who knows a guy.
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The average paramedic? No.
That is why we continue to operate under if:then protocols and on line medical control.
What do you consider hemodynamically stable??
I certainly wouldn't sit on this guy too long. And I don't necessarily agree that the risks would outweighs the benefit in this case.
are other factors that I would want to know as well.... is he symptomatic at all, diaphoretic, chest pain, cardiac history?
He can still be AOx3 but with a BP of 80 and having active chest pain, something like that I'm not going to sit on. Yea, there's always the risk of putting them into VF which you would then shock out of it, but if you're waiting and watching and he then codes you bet you're going to be questioned on why you sat on a hypotensive Vtach.......
Do you have any data/guidelines/studies you're going off of?
Admitted a pt here just in past week who presented with weakness, found by EMS to be in VT, was diaphoretic/weak. Don't think he was hypotension but I'll have to check. Was urgently shocked in field after some versed and then found to be a STEMI in the ED.
The maintaining of perfusion to the heart and the brain without decompensation.
What case? You have 1 sentence and a host of information missing. U submitted that always jumping on a patient and cardioverting may not always be the best thing EMS can do. Particularly with a short transport time.
Yea, me too.
That is not in the evidence here.
Shouldn't sometime in that waiting and watching, especially in the 1 on 1 patient ratio of EMS, wouldn't you notice if there were any signs of decompensation?
I mentioned pacing a pt in vtach earlier. That patient had a pacemaker that failed. Could this patient also have the same condition? from the 1 sentence given, let us not add "what if's"
Data for what?
Listening potential outcomes of cardioversion?
So you shocked an unstable patient in vtach, based on more than just a blood pressure number. So what?
That's why I said I wanted more information in this case. All I have to go on is hypotension so right off the bat I'm leaning towards earlier treatment since that's all I have to go on. I was just playing a little devil's advocate since you had taken more of the opposite stance with the same limited information.
It's hypothetical anyway since we would have more information than just what was presented so its kind of a mute point.
It's hypothetical anyway since we would have more information than just what was presented so its kind of a mute point.
NomadicMedic
I know a guy who knows a guy.
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