What unusual medications have you given/seen given during a code?

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ParamedicStudent

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Now I'm not talking about the usual Epi and Amio/Lido drugs, and I know that different situations call for different things, and different places (ER for example) have different protocols.

During my hospital clinical, I've pushed Atropine and Sodium Bicarb (that thing was difficult to push) during a code, and I thought that was unusual due to us learning the standard ACLS. I remember Atropine being in a peds arrest protocol, but not for adult. And I remember back in the day they had a song like "everybody shock mama shock papa shock etc etc"
 
In aVF arrest backninbtbr day:

Shock, Shock, Shock, Everybody Shock, Little Shock, Big Shock, Momma Shock, Poppa Shock

Shock= Defibrillate
Everybody= Epinephine
Little= Lidocaine
Big= Bretylium
Momma= Mag
Poppa= Procainamide
 
One place I worked a couple years back had aminophylline in algorithm for asystolic arrest

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ParamedicStudent said:
Now I'm not talking about the usual Epi and Amio/Lido drugs, and I know that different situations call for different things, and different places (ER for example) have different protocols.

During my hospital clinical, I've pushed Atropine and Sodium Bicarb (that thing was difficult to push) during a code, and I thought that was unusual due to us learning the standard ACLS. I remember Atropine being in a peds arrest protocol, but not for adult. And I remember back in the day they had a song like "everybody shock mama shock papa shock etc etc"
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Atropine and bicarb used to be part of standard ACLS back in the day, so maybe the physician was using an older algorithm.

I still see glucose given every so often, despite it being taken out of the protocols and ACLS guidelines.
 
We give inline albuterol intra-arrest sometimes.

Well I do at least.


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VentMonkey said:
Across the board, or hyper-K+/ ESRD's only?
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HyperK/ESRD or if capno shows an obstructed waveform.


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We carry calcium gluconate for hyperkalemia arrests/pre-arrests, though I couldn't tell you if it's ever been used. I think the odd time we'll still get a Doc over the patch line order bicarb in a prolonged arrest (we have a strange requirement to patch after 3 rounds of epi. Not necessarily for a pronouncement, just because.)
 
Chase said:
Methylene Blue
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@Chase, I think you win this thread; curious, how much is that particular antidote going for these days? I can't imagine it's very cheap.
 
Of course I'm on the ED side, but I haven't used anything too outlandish. But some colleagues of mine have pushed TPA for presumed massive PE and esmolol has been given a number of times for refractory VF/VT. We started stocking intralipid at the recommendation of our toxicologist, but I don't think it has been given yet.
 
VentMonkey said:
@Chase, I think you win this thread; curious, how much is that particular antidote going for these days? I can't imagine it's very cheap.
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I am not sure how much it costs. It actually was used for post-CPB vasoplegia during that code. I personally have never seen it used for cyanide/methemoglobinemia, although I have not seen many of those patients. It is still used in cardiac surgery on rare occasions.
 
Methylene blue may also be used for calcium channel blocker overdose. It can also be used in septic shock.
 
medicsb said:
Of course I'm on the ED side, but I haven't used anything too outlandish. But some colleagues of mine have pushed TPA for presumed massive PE and esmolol has been given a number of times for refractory VF/VT. We started stocking intralipid at the recommendation of our toxicologist, but I don't think it has been given yet.
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I've done the tpa thing once. Early 30's collapsed in front of family. ROSC showed a narrow complex tachy in the 140s. Turned out not to be a PE but some dietary supplements he got online from Mexico that contained fentanyl and roc.

Are they still teaching to push meds down the tube anywhere?
 
medicsb said:
Methylene blue may also be used for calcium channel blocker overdose. It can also be used in septic shock.
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Apparently, it's got quite the versatility...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3087269/#!po=1.13636
medicsb said:
We started stocking intralipid at the recommendation of our toxicologist, but I don't think it has been given yet.
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I'd be interested to know if, or when you or your colleagues utilize this.
medicsb said:
some colleagues of mine have pushed TPA for presumed massive PE and esmolol has been given a number of times for refractory VF/VT.
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ERDoc said:
I've done the tpa thing once.
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Out of curiosity, at that point in such a code when it's thought to be (ruling out) a possible massive PE, what's the risk/ reward ratio, and their likelihood of survivability at that point?
 
ERDoc said:
Are they still teaching to push meds down the tube anywhere?
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It was mentioned in my program, but I'm not sure why you would with all the other options.

NAVEL...
 
Tigger said:
It was mentioned in my program, but I'm not sure why you would with all the other options.

NAVEL...
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I remember learning about NAVEL, but I don't think I know what half of it is off the top of my head anymore. Not that I ever see myself actually using it when I have multiple other options.
 
StCEMT said:
I remember learning about NAVEL, but I don't think I know what half of it is off the top of my head anymore. Not that I ever see myself actually using it when I have multiple other options.
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Narcan, Atropine, Valium, Epinephrine, Lidocaine.

I was thinking of that acronym earlier when I came across this thread and remembered ACLS still using something similar, either "LEAN", or "LANE".
 
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