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

CaCl is uncommon?
 
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Maybe he's used to seeing gluconate and no chloride?

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I would venture to guess any electrolyte given in excess is hardly benign.
 
A gram of CaCl is pretty safe. I've used it in the OR with great success for hypotension that is refractory to pretty much everything else. I don't know about using it during arrest, though. It used to be standard ACLS but I haven't seen it used during CPR in a long time.

My thinking is that just like so many other things that have been daily practice in anesthesia for decades ("push dose" pressors, ketamine, intubating on long-acting NMB's, etc.) but were just recently "discovered" by ED and ICU folks, giving some calcium post-arrest or for otherwise refractory hypotension might someday be a pretty routine thing.
 
We tend to use calcium in dialysis arrests, but that's the extent of it for daily uses except some very unusual calls or CCB overdoses

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An empiric whack of calcium is de rigueur for coming off of the bypass pump. Almost a rabbits foot. Definitely improves contractility after a bunch of banked blood products (citrate preservative binding of free calcium). Good for dilutional hypocalcemia too. All that being said, the effect is transient and IME, it doesn't do what a slug of epi wouldn't MOST times. Your results may vary.
 
Remi said:
I don't know about using it during arrest, though. It used to be standard ACLS but I haven't seen it used during CPR in a long time.
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ACLS says "Studies of calcium during cardiac arrest have found variable results on ROSC, and no trial has found a beneficial effect on survival either in or out of hospital. Routine administration of calcium for treatment of in-hospital and out-of-hospital cardiac arrest is not recommended. (Class III, LOE B)"

The most recent study they cite is from 1998, though...so, you know, science progresses?
 
EpiEMS said:
ACLS says "Studies of calcium during cardiac arrest have found variable results on ROSC, and no trial has found a beneficial effect on survival either in or out of hospital. Routine administration of calcium for treatment of in-hospital and out-of-hospital cardiac arrest is not recommended. (Class III, LOE B)"
The most recent study they cite is from 1998, though...so, you know, science progresses?
Click to expand...

I don't think it works well in an ischemic heart. If the reason for the fall in contractility is something other than ischemia, you'll see some response with calcium, in my experience.
 
We give Calcium Chloride in dialysis arrests. Other than that, and dual sequential defibrillation, our arrest protocol is pretty standard.

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We're adding esmolol for refractory VF with a consult with our Medical Director. Depending on the results it may become a standing order or may get scrapped.


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Benadryl (not joking) for a suspected anaphylaxis induced cardiac arrest. o_O:eek::confused:

And no, it didn't help.
 
Salbutamol ett for hyperk/ obstructive etco2.. quite routine here
 
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