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

[medichopeful]

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.

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.

 

[Carlos Danger]

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

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.

 

[EpiEMS]

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.

Darn, that's really sad. Was she being transported to a higher level facility for some sort of definitive treatment?

 

[Bullets]

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.

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]

Of course, you cant bring science to the discussion

I've tried to - I always get shot down. I know that nitrile gloves are likely not enough to protect us, but I'm generally convinced that I wouldn't feel the shock nor would it likely adversely (see: one, two - not strictly about HOD, but is relevant, and three - this is very anecdotal ) impact me (especially with certain precautions).

 

[Carlos Danger]

Darn, that's really sad. Was she being transported to a higher level facility for some sort of definitive treatment?

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.

 

[VFlutter]

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.

Very similar to a couple patients I have seen, going back to the AFE discussion. I am sure they would have died without ECMO.

 

[CANMAN]

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.

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.

 

[E tank]

1:1000 Escalating Epi down the tube

Ahhhh those were the days of ignorance.

that's what our kids are going to say about us! ; )

 

[firecoins]

Not sure of any unusual meds, just older protocols.

 

[Flight-LP]

One place I worked a couple years back had aminophylline in algorithm for asystolic arrest

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And that was the first drug I yanked from the formulary when I arrived. Absolutely pointless.

 

[StCEMT]

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.

So having kids sounds a lot scarier now....damn that's rough though...

 

[E tank]

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.

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]

I am sure they would have died without ECMO.

ECMO=game changer

 

[VFlutter]

ECMO=game changer

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

 

[CANMAN]

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

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.

 

[Carlos Danger]

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.

Yeah but then the referring doc doesn't get to be all cutting edge and aggressive and heroic and stuff.

 

[CANMAN]

Yeah but then the referring doc doesn't get to be all cutting edge and aggressive and heroic and stuff.

This is true!

 

[NPO]

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

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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[18G]

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.