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

[StCEMT]

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".

Huh....I was thinking Vasopressin was V, but it seemed like a weird one considering E.

 

[VentMonkey]

Huh....I was thinking Vasopressin was V, but it seemed like a weird one considering E.

When I first came to this county, ET medication administration was still very much a "thing", as was stacked shocks. Literally, it was written in our protocols as such.

ACLS had already switched to the current algorithm prior, but our paramedic protocols had yet to reflect it, so when I took my county protocol I asked our then EMS department coordinator which to abide by, and I was told either, or.

Thankfully, even the older paramedics eventually embraced IO over ETI med wash (it really was crap). Then even finally saw the importance of 12-lead ECG's once those were rolled out as well. I have been here just shy of 8 years now.

 

[StCEMT]

When I first came to this county, ET medication administration was still very much a "thing", as was stacked shocks. Literally, it was written in our protocols as such.

ACLS had already switched to the current algorithm prior, but our paramedic protocols had yet to reflect it, so when I took my county protocol I asked our then EMS department coordinator which to abide by, and I was told either, or.

Thankfully, even the older paramedics eventually embraced IO over ETI med wash (it really was crap). Then even finally saw the importance of 12-lead ECG's once those were rolled out as well. I have been here just shy of 8 years now.

We have nothing for ET meds, but DSD is a thing for my protocols in VF/VT. Our cardiac arrest protocols were just recently updated for CCR, but I am pretty sure they left DSD in their down the line, I need to get a new copy and check tomorrow.

 

[EpiEMS]

I was told either, or.

Either follow protocol or follow current ACLS guidelines?

 

[VentMonkey]

Either follow protocol or follow current ACLS guidelines?

Yes, this was years ago though. They eventually changed it.

It's funny, I haven't been a paramedic an incredibly long time but going down memory lane from the time I started altogether sure hasn't made me feel any younger.

The protocols when I started here alone were quite archaic, as were a lot of paramedics, but it's changed pretty much for the better.

 

[EpiEMS]

Yes, this was years ago though. They eventually changed it.

It's funny, I haven't been a paramedic an incredibly long time but going down memory lane from the time I started altogether sure hasn't made me feel any younger.

The protocols when I started here alone were quite archaic, as were a lot of paramedics, but it's changed pretty much for the better.

That's good to hear - I would hope that "Shock, Shock, Shock, Everybody Shock, Little Shock, Big Shock, Momma Shock, Poppa Shock" isn't in anybody's protocols any more.

How would you document that you didn't - strictly speaking - follow protocol, but were following standard of care / staying within your scope, etc.?

 

[VentMonkey]

How would you document that you didn't - strictly speaking - follow protocol, but were following standard of care / staying within your scope, etc.?

I would put in my narrative something to the effect of "per ACLS guidelines" in regards to my sequence of procedures performed.

The ET medications took a while, and I remember a former supervisor who swore by it. I've done it a few times as it was a last ditch measure (think heroin-induced arrests), and it was a hot mess of liquid meds going nowhere fast.

When I started in SoCal as a tech, I want to say that was still their first round "get it in them" route.

 

[EpiEMS]

I would put in my narrative something to the effect of "per ACLS guidelines" in regards to my sequence of procedures performed.

That makes sense, and it's certainly reasonable, given that ACLS is totally standard of care. If only CCR becomes the new CPR...then I'll see if I can get away with not ventilating!

The ET medications took a while, and I remember a former supervisor who swore by it. I've done it a few times as it was a last ditch measure (think heroin-induced arrests), and it was a hot mess of liquid meds going nowhere fast.

When I started in SoCal as a tech, I want to say that was still their first round "get it in them" route.

Wow. ET meds rather than IO, I feel like it's the 80s! Did you have IO at the time? I would imagine so if it hasn't been that long!

 

[ERDoc]

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?

There isn't a great amount of evidence either way. I was assisting in the code and wasn't the one to make the decision but the thought process was, "well, here's a young, healthy guy with no history of substance abuse who had a sudden collapse and now has a notable tachycardia (which there are a large number of explanations for). If I recall correctly, he complained of some pain in the chest just before he collapsed, so PE was high on the differential. Once he was stabilized a CT was done which showed no PE. He ended up with almost 100% neurological recovery. Here is an article from EMdocs:

http://www.emdocs.net/pushing-tpa-i...vidence-when-can-we-make-the-most-difference/

 

[ERDoc]

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

NAVEL...

There really is no reason but I know some things die hard so I was just curious. It was never mentioned in medical school and I'm not sure if some docs coming out of school know about it.

 

[VentMonkey]

Wow. ET meds rather than IO, I feel like it's the 80s! Did you have IO at the time? I would imagine so if it hasn't been that long!

It doesn't seem that long ago (to me), but ETI was the first thing in an arrest at the time, so many would intubate, and if it was in before their/ their partners IV, the first round of ACLS meds would be given this route.

I'm sure there are providers on here who recall this being common practice as well.

 

[Carlos Danger]

It doesn't seem that long ago (to me), but ETI was the first thing in an arrest at the time, so many would intubate, and if it was in before their/ their partners IV, the first round of ACLS meds would be given this route.

I'm sure there are providers on here who recall this being common practice as well.

Exactly how we did it when I started. I think that was standard ACLS at the time (mid-90's).

 

[VentMonkey]

Exactly how we did it when I started. I think that was standard ACLS at the time (mid-90's).

Thanks, I now feel slightly less older.

 

[NomadicMedic]

When I started way back when, all the code meds went down the tube. Granted, I wasn't a medic back in the Bretyllium days, but I remember it. (And shocked lots of asystole or as we interpreted it, "fine vf", with my LifePak 5)

Have you seen the Chicago fire department cardiac arrest video from the 90s? It's an awesome, hot mess of meds down the tube, putting the layrngoscope down on the slushy floor, one handed CPR, laconic defib shocks and mustaches. Watch it. It'll take you right back.

 

[medicsb]

Man, that was painful to watch.

 

[phideux]

Let's pre-oxygenate by suctioning him for a minute or 3.

 

[Bullets]

Probably the things thats getting the most controversial response around here is hands on defibrillation. Our ER staff is pretty evenly split about it and it usually causes a huge fight because everyone else has been trained to not touch anyone because their sister's brother's uncle's girlfriend was a nurse in a different hospital and saw someone get blown into the next county because they were touching a patients foot

 

[Carlos Danger]

Probably the things thats getting the most controversial response around here is hands on defibrillation. Our ER staff is pretty evenly split about it and it usually causes a huge fight because everyone else has been trained to not touch anyone because their sister's brother's uncle's girlfriend was a nurse in a different hospital and saw someone get blown into the next county because they were touching a patients foot

Not sure you can really blame folks for their skepticism. It's less an issue of hearsay and much more an issue of having always been trained specifically to "clear" before a shock is delivered.

We are all trained to put our own safety first. "Scene safety" and all that. It might not be technically correct in this case, but it is perfectly rational.

 

[Carlos Danger]

Not sure how "unusual" these are, but the case I remember giving the most stuff to included FFP, cryoprecip, PRBC's, and aminocaproic acid. And an epi drip, among other things.

Didn't work, BTW.

 

[EpiEMS]

Not sure how "unusual" these are, but the case I remember giving the most stuff to included FFP, cryoprecip, PRBC's, and aminocaproic acid. And an epi drip, among other things.

Didn't work, BTW.

Wow, that's some serious interventions. Traumatic arrest?