Use of Vasopressin

[ambogrl]

um isnt this why there should be a national standard?

just my two cents

~Ambo

[AZCEP]

If you have both available to you, first you should push yourself away from the table and consider yourself blessed.

With that out of the way, let's consider how the two drugs are different for a moment. Epi has alpha and beta stimulating properties that will make the myocardium work harder/faster with a limited amount of oxygen available, as well as increase the pressures that the heart has to work against. Just wait for the first ROSC that you get using just Epi. You will swear to all that what you see is SVT because of the chronotropic effects.

With Vasopressin, you get the benefit of increased vasoconstriction without the beta effects on the myocardium. More blood returning to the myocardium without the heart trying to rip itself out of the chest.

Each agent will have better times to use it. Vasopressin for the AMI patient that codes for example. Epi for the septic/anaphylactic/asthma patient that goes into hypoxic arrest.

Just because they show up in a protocol in a particular order doesn't mean that we should follow them blindly. An important line to remember from ACLS is "you will need to be a thinking cook".

[RichmondMedik]

We have a slightly diffrerent protocol

confirm arrest

90 sceonds of QUALITY CPR ( autopulse ) as the autopulse is applied put the patches on

check rythym --shock if indicated ( with autopulse running )

ETT -- IV -- leave autopulse running as much as possible

Vaso AND Amio ( if Amio indicated )

Epi AND Amio ( if Amio indicated )

alternate between Vaso and Epi every 5 minutes shocking when appropriate and Amio when appropriate

and yes as always check for a pulse and ventilate where appropriate

as we get into the code we can give the standard meds of atropine, bicarb,calcium, et al -- we have also been known to bag neb treatment or 2,depending on the patient

we shock our patients with the autopulse running and time it to the downstroke of the machine.

We have a very forward thinking Medical Director --- hell he is involved in half the studies for cardiac arrest going on out there

Paul

[vs-eh?]

I thought Vasopressin was given as a one time dose of like 40 units? What's with the repeat dosing and stuff?

This is from ACLS - Vasopressin (Class IIb) 40 U IV bolus (administered only once). If no response to vasopressin may resume epi after 10 or 20 minutes. Then epi q 3-5 after.

So me reading that it seems that if you decide to go with vasopressin, you a) don't give more than one dose ever, and wait 10-20 minutes before starting with the epi. Doesn't say anything about giving drugs concurrently and such.

[reaper]

That is how ACLS has it listed, but some MD don't feel like following AHA's protocols.

AHA does studies on these drugs and changes the protocols when they see hard facts that it works better. Most MD's follow ACLS, to cover their butts. Some push the boundaries, but leave themselves open to liability!!

All we can do is follow our protocols and hope for the best!

[AZCEP]

The standard that you are held to in following ACLS are guidelines only. Anyone with MD/DO behind their name, and the associated sheepskin on the wall can perform any number of things at their own discretion.

Even your medical director can change what he wants you to do based on his/her own feelings about how well the "guidelines" will work.

As providers, we need to be sure that we understand when and how something will or will not work. Then use it accordingly.

[RichmondMedik]

I thought Vasopressin was given as a one time dose of like 40 units? What's with the repeat dosing and stuff?

This is from ACLS - Vasopressin (Class IIb) 40 U IV bolus (administered only once). If no response to vasopressin may resume epi after 10 or 20 minutes. Then epi q 3-5 after.

My Medical Director is part of the ACLS committee -- his picture is in the top left hand corner of the old acls book ( stripe is covering him in the new one)

so with all the studies being done he adapts what we do in the field to the information avaliable -- reread a couple of posts up were the statement is made about being a thinking cook --- that is what we are encouraged to do -- think on our feet ---

the only thing taking a class does is give you the info needed to understand the job -- it is up to us to tailor it to our patients needs --

the first time one of my fellow providers heard that I "bagged" a neb treatment in he told my I was going to get fired --- what would you do if you heard from family members that the patient was on the way to get a breathing treatment and after he was inubated you had lousy compliance with the BVM ???

just because something is not done in one area that is done in another makes it neither right or wrong -- just happens to be the way it is

as always follow your own med directors protocols and you will be covered

Paul

[Ridryder 911]

Very good points Paul...... Our medical director would have our butts if we just followed protocols. In fact the protocols first page states " GUIDELINES ONLY!!!" Discretion upon the medic knowledge and diagnostic capability.

I work with several nationally known cardiologist and basically their opinion is that AHA is a joke. The studies are several years behind and are not up to peer. They do not criticize those for following the standards but; definitely do not follow them or adhere to them.. and yes once they were considered " the national standard" but now' it is more considered what AHA suggests. The same would to be following ACS standards on trauma... not saying everything they suggest is always the right way also.

Expand your knowledge, look outside the box.. read new research and see what may be coming. Yes, chances are we will adhere to AHA but different treatment modalities are not always wrong......actually they may be better.

Be safe,

Ridryder 911

[Nate]

The ability to have options when it comes to drugs. :shock:

WTF!

[Dustdevil]

What a concept, eh?

Here's the "options" my favourite medical director gave us:

• 1. Do whatever you think the patient needs.

2. Don't call me until you have done it and are enroute to the ER.