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

[STXmedic]

CaCl is uncommon?

 

[TransportJockey]

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

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[VentMonkey]

I would venture to guess any electrolyte given in excess is hardly benign.

 

[Carlos Danger]

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.

 

[TransportJockey]

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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[E tank]

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.

 

[EpiEMS]

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.

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?

 

[E tank]

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?

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.

 

[GMCmedic]

We give Calcium Chloride in dialysis arrests. Other than that, and dual sequential defibrillation, our arrest protocol is pretty standard.

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[Handsome Robb]

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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[RocKetamine]

Benadryl (not joking) for a suspected anaphylaxis induced cardiac arrest.

And no, it didn't help.

 

[Eden]

Salbutamol ett for hyperk/ obstructive etco2.. quite routine here