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

Remi said:
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.
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The case I remember where we gave the most stuff was just the other day. Epi drip along with epi boluses, bicarb drip and bicarb boluses, FFP, platelets, PRBC, fluids, and calcium chloride. Morphine drip after the patient went comfort, along with ketamine bolus for palliative care. Outcome was the same as if we hadn't done any of that, but good learning experience.
 
EpiEMS said:
Wow, that's some serious interventions. Traumatic arrest?
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Massive DIC in a 24 year old mom about 24 hours after she gave birth.

She kept pulses as long as the epi drip was on and both Level Ones were infusing blood. But whenever we turned off the Level Ones to switch to pressure bags to load her into the helicopter, she'd arrest. The hospital was running out of type-specific blood, so we finally realized it was futile and they called her husband in to say goodbye to her before we turned everything off for the last time.

Saddest thing I've ever seen. And I've seen some really bad situations in the SICU and TICU.
 
Remi said:
Massive DIC in a 24 year old mom about 24 hours after she gave birth.

She kept pulses as long as the epi drip was on and both Level Ones were infusing blood. But whenever we turned off the Level Ones to switch to pressure bags to load her into the helicopter, she'd arrest. The hospital was running out of type-specific blood, so we finally realized it was futile and they called her husband in to say goodbye to her before we turned everything off for the last time.

Saddest thing I've ever seen. And I've seen some really bad situations in the SICU and TICU.
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Darn, that's really sad. Was she being transported to a higher level facility for some sort of definitive treatment?
 
Remi said:
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.
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I get that this is what everyone has been trained to do, im clear you're clear everyone's clear, ect. But when i have challenged people as to WHY thats the training most come up with some apocryphal story, ect. Of course, you cant bring science to the discussion
 
EpiEMS said:
Darn, that's really sad. Was she being transported to a higher level facility for some sort of definitive treatment?
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Yeah, she had been to the OR twice, IIRC, since delivery. Then she went into DIC and they called us to take her to the mother ship, but it was too late.
 
Remi said:
Massive DIC in a 24 year old mom about 24 hours after she gave birth.

She kept pulses as long as the epi drip was on and both Level Ones were infusing blood. But whenever we turned off the Level Ones to switch to pressure bags to load her into the helicopter, she'd arrest. The hospital was running out of type-specific blood, so we finally realized it was futile and they called her husband in to say goodbye to her before we turned everything off for the last time.

Saddest thing I've ever seen. And I've seen some really bad situations in the SICU and TICU.
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Very similar to a couple patients I have seen, going back to the AFE discussion. I am sure they would have died without ECMO.
 
Remi said:
Massive DIC in a 24 year old mom about 24 hours after she gave birth.

She kept pulses as long as the epi drip was on and both Level Ones were infusing blood. But whenever we turned off the Level Ones to switch to pressure bags to load her into the helicopter, she'd arrest. The hospital was running out of type-specific blood, so we finally realized it was futile and they called her husband in to say goodbye to her before we turned everything off for the last time.

Saddest thing I've ever seen. And I've seen some really bad situations in the SICU and TICU.
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I agree, these are the absolutle worst. I have participated in similar a transport, and it was one of very few calls that has ever rattled me. Thats after years of doing pediatrics. My worst fear of when my wife and I have kids.
 
Not sure of any unusual meds, just older protocols.
 
Remi said:
Massive DIC in a 24 year old mom about 24 hours after she gave birth.

She kept pulses as long as the epi drip was on and both Level Ones were infusing blood. But whenever we turned off the Level Ones to switch to pressure bags to load her into the helicopter, she'd arrest. The hospital was running out of type-specific blood, so we finally realized it was futile and they called her husband in to say goodbye to her before we turned everything off for the last time.

Saddest thing I've ever seen. And I've seen some really bad situations in the SICU and TICU.
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So having kids sounds a lot scarier now....damn that's rough though...
 
DEmedic said:
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.
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Ooofta...guy never had a chance....but that distended belly from the Robert Shaw demand valve brought back some pretty warm and fuzzy memories..
 
E tank said:
ECMO=game changer
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I really hope adult retrieval / salvage ECMO becomes more common like it is in Peds.

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Chase said:
I really hope adult retrieval / salvage ECMO becomes more common like it is in Peds.

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I think ECMO and transport is a mixed bag with alot of variables. We have been doing ECMO with the Cardiohelp for a good while now, and logistically it can be a huge pain in the ***, especially when you toss in a Balloon pump into the mix. Alot of the MD's who are cannulating in the community hospital setting then requesting transport to tertiary facility don't account for the time to move these people. Often times (not always) it is much faster to max patient on pressor support and rapidly move the patient to said ECMO facility, rapid deploy, then wean off the pressor support than to deploy and then move the patient.
 
CANMAN said:
I think ECMO and transport is a mixed bag with alot of variables. We have been doing ECMO with the Cardiohelp for a good while now, and logistically it can be a huge pain in the ***, especially when you toss in a Balloon pump into the mix. Alot of the MD's who are cannulating in the community hospital setting then requesting transport to tertiary facility don't account for the time to move these people. Often times (not always) it is much faster to max patient on pressor support and rapidly move the patient to said ECMO facility, rapid deploy, then wean off the pressor support than to deploy and then move the patient.
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Yeah but then the referring doc doesn't get to be all cutting edge and aggressive and heroic and stuff.
 
EpiEMS said:
How would you document that you didn't - strictly speaking - follow protocol, but were following standard of care / staying within your scope, etc.?
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I work in the same system as @VentMonkey and I asked our medical director that very same question one day in the ED.

His response?

"Generally, if you can justify what you're doing...Do it. I won't care."



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Calcium chloride. I have seen an intensivist and EM doc give empiric calcium in refractory arrest patients. I think there is a good use case for empiric calcium in cardiac arrest which covers hyperkalemia and CCB toxicity; calcium can also increase contractility. Calcium is also pretty benign.
 
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