calcium chloride with intubation

[donedeal]

Has anyone heard of pushing calcium chloride prior to intubation in a spinal shock patient? I witnessed this in the ER today and later asked the anesthesiologist and he stated that the patient's systemic vascular resistance is compromised and basically it helps from dropping BP even more. My thinking is that since calcium causes an increase in contractility it will override any vagal effect intubation could cause? Intubation was successful and the BP rose from 80/50 to around 110/70. Is this use of calcium out of a Paramedic's scope of practice? Intubation wasn't listed under any of the emergency uses in any of my drug books for calcium chloride.

[AZCEP]

Has anyone heard of pushing calcium chloride prior to intubation in a spinal shock patient?

Nope, that's a new one for me.

I witnessed this in the ER today and later asked the anesthesiologist and he stated that the patient's systemic vascular resistance is compromised and basically it helps from dropping BP even more.

There are a great many things that will help with this, and calcium is near the bottom of the list.

My thinking is that since calcium causes an increase in contractility it will override any vagal effect intubation could cause?

Nope. The vagal effect is not blunted by calcium. In fact, the increased contractility can cause the heart rate to slow to the point of asystole.

Intubation was successful and the BP rose from 80/50 to around 110/70.

Was anything else done during/after the intubation attempt? Fluid boluses, other medications, maybe a pressor agent?

Is this use of calcium out of a Paramedic's scope of practice? Intubation wasn't listed under any of the emergency uses in any of my drug books for calcium chloride.

That will depend on your area, and what liability your medical control is willing to accept. On the whole, calcium is not a recommended premedication agent for intubation. Unless there is an underlying pathology, leave the calcium alone.

[chbare]

I have never hear of using CaCl- for premedication. The only plausible situation I can think of is using it if we inadvertently used succ on a patient with hyperkalemia or caused hyperkalemia on a patient with underlying pathology.

Take care,

chbare.

[Spock]

Calcium is not a standard premedication for intubation. In the world of anesthesia calcium is very frequently used to raise the BP in conjunction with other meds (ephedrine and neosynephrine.) Calcium will increase contractility and hence cardiac output which is why we use it. We consider it a vasopressor and I use it when coming off bypass for the CABG patient.

I wouldn't recommend paramedics using it unless they have hyperkalemic arrest patient (renal patients) in which case you would also give bicarb. I agree with chbare regarding calcium when succynlcholine is given in the face of hyperkalemia.

Live long and prosper.

Spock

[Mateo_1387]

I have never hear of using CaCl- for premedication. The only plausible situation I can think of is using it if we inadvertently used succ on a patient with hyperkalemia or caused hyperkalemia on a patient with underlying pathology.

Take care,

chbare.

why use calcium for a hyperkalemic patient who you used succ. on?

[chbare]

We do not use it on every patient who receives Succ. Remember the physiology of Succ. It is a non-competitive depolarizing NMB. So, it essentially creates a sustained state of depolarization. Remember when a cell depolarized, potassium shifts out of the cell. In patients who are hyperkalemic, (such as renal failure, burns, specific neuromuscular disorders, and electrical injuries) this additional increase in serum potassium can be enough to cause cardiac conduction problems.

High serum levels of serum potassium inhibits proper cell membrane repolarization. Calcium chloride provides a stop gap treatment that will temporarily stabilize the cardiac cell membrane. Essentially, it will help to stabilize the ionic cell membrane potential. However, you are only looking at about 45-60 minutes of bought time, so you will need to follow up with other treatments. (Insulin, dextrose, albuterol, etc.)

Take care,

chbare.

[p3medic]

You shouldn't be using succ's on pts prone to, or known to be hyperkalemic. With that being said, stuff happens, and recognizing it, and rapidly treating it are key. IMHO.