Epi infusion during cardiac arrest

[DartmouthDave]

Hello,

I think code and post-code management is getting muddled here.

If you get a ROSC then one may need infusion(s) depending upon what is going on (i.e. brady, runs of VT, et al.).

As for the Bicarb gtts. I have never seen them run on any codes/post codes. Any pH problems in theory will slowly correct with decent profusion and oxygenation.

Cheers,

David

[AZCEP]

Basically we are discussing administering the infusion to take one step out of the equasion. It is just as easy to put 1mg into a 500ml bag giving you a 2mcg/ml concentration and having a constant infusion rather than incremental dosing. There is no literature to support this as far as I know, it was just a discussion we were having. The only answer to "why?" I can give is convienience, as there is no study on continuous infusion vs incremental dosing. If you were a lone medic, once the atropine is in you are free to do whatever else may need done because you are not pushing a drug every 5 min.

The discussion is a good one to have, but you might want to find out what your protocol allows first.

Your dosing is reasonable, but you won't be delivering enough medication with the mix you have outlined. AHA actually included an epinephrine infusion for cardiac arrest mix in the ACLS Principles and Practice book in 2004(?)

Take 30 mL out of a 250 mL bag of NS

Add 30 mg of 1:1000 epinephrine

Run the infusion at 17-20 gtt/min with 10 gtt/mL tubing until ROSC or efforts are terminated

The amount delivered is roughly the same as you will give using the more typical adminstration of 1 mg of 1:10 000 every 3-5 minutes.

This is especially useful for prolonged transports or when you have fewer providers to help with the work. You also have to be very careful with the use of the IV site for anything besides the epinephrine. Atropine shouldn't cause a problem, but Amiodarone and NaHCO3 tend to make the line garbage when mixed with epi.

[HellsBells]

What do you all think of giving vasopressin to replace the first or second dose of Epi in a code?

[Ridryder 911]

What do you all think of giving vasopressin to replace the first or second dose of Epi in a code?

Personally the only way I give med.'s and recommend my other partners to do so. Why not? It gives you time to get situated (LSB, ETI, load the patient, etc) then one can start the Epi route.

R/r 911

[CBEMT]

Our protocols have very specific circumstances for Epi drips, all requiring medical control contact, and none involving cardiac arrest.

[EMS_Cadet]

We currently have epi drips in our cardiac arrest protocol as a standing order.

[mobey]

We currently have epi drips in our cardiac arrest protocol as a standing order.

Care to expand?

Dose?

Concentration of solution?

Do you like it?

[akroeze]

Or a link to your protocols if they are online?

[EMS_Cadet]

http://www.wakegov.com/NR/rdonlyres/2F6EC7...0/2007Adult.pdf

Protocols are above.

This is our breakdown:

10gtt/set and a 250mL bag of NS.

Inject 12mL of epi 1:1000 into the bag of NS.

You can choose either 1mg/3min or 1mg/5 mins.

Also, if you look in the protocol, we also use epi drips in symptomatic adult bradycardia.

Let me know if you need any further.

[okmedic]

Take 30 mL out of a 250 mL bag of NS

Add 30 mg of 1:1000 epinephrine

Run the infusion at 17-20 gtt/min with 10 gtt/mL tubing until ROSC or efforts are terminated

This sounds great, but does anyone actually carry 30mg of 1:1000 on their truck? I know we don't.