Medication calculation question

[DartmouthDave]

Hello,

Just watch the bag and it should be 1/2 done in 5 minutes. If not, speed it up some and have it all wrapped by the 10 minute mark.

In all reality, trying to counts drips in a back of an ambulance over a 10-minute run isn't practical or particularly accurate. Plus, the Amio is well diluted in a 250cc dag.

Oh, don't forget a filter as well.

Lazy math

[fiznat]

If you really have a hard time doing the math in the "heat of a call," just set yourself up some reference charts ahead of time and carry them with you. I imagine there are preceptors out there that would give you big balls for it, but personally I don't feel that there is any shame in having this kind of aid if you aren't confident with the math.

Also pay attention to what people are saying here. There are a lot of shortcuts that people use to remember this stuff instead of doing the actual math. Making a 1:1 mixture or using something like the lido clock are good examples. There are lots of aids out there for drip calcs because it is very common for people to have an issue with them.

[akroeze]

My preceptor didn't allow charts, didn't allow calculators and frowned if calculations were done on paper. To him you should be able to do it in your head.

[DartmouthDave]

Hello,

That is crazy. What is wrong with using a reference card. Your preceptor may be comfortable with the medications that

your protocols have. I am sure if a odd medication needed to be run the preceptor would have to bust out a calculator.

D

[firedoc5]

Let's see. Nope, everything I was going to say has been said. Make sure you have a macro-drip and not a micro-drip set up, pump would help. Personally, I'd stick with a Lido drip.

[akroeze]

Hello,

That is crazy. What is wrong with using a reference card. Your preceptor may be comfortable with the medications that

your protocols have. I am sure if a odd medication needed to be run the preceptor would have to bust out a calculator.

D

We only carry two things that can be given in drip form:

Dopamine (by protocol)

Epinephrine (have to talk to the doc.... even then it would be soooo rare to do)

I suppose we could also do a Versed drip but I really doubt it unless there is a very long transport with a status seizure.

No lido for mixing for a drip, no amio.

[firedoc5]

We only carry two things that can be given in drip form:

Dopamine (by protocol)

Epinephrine (have to talk to the doc.... even then it would be soooo rare to do)

I suppose we could also do a Versed drip but I really doubt it unless there is a very long transport with a status seizure.

No lido for mixing for a drip, no amio.

No lido for drips, not even pre-mixed bags? We didn't have the pre-mixed bags, but we were able to mix them for a drip. And actually we didn't carry amio. But I think they do now. I'll have to check with them.

[fiznat]

^^ You give lido but don't have the means to do a maintenance infusion? What form do you get the drug in?

What about cardizem, procanimide, magnesium, zofran, promethazine, and a few others I'm sure I forgot haha? You dont have or don't drip any of those?

[akroeze]

^^ You give lido but don't have the means to do a maintenance infusion? What form do you get the drug in?

By protocol the only time I give Lidocaine is during an arrest or 3mins pre-intubation with suspected increased ICP. In my protocols I can patch for stable V-tach and on direction of physician I give 1.5mg/kg over 2 minutes. If no response in 5 minutes I give 0.75mg/kg over two minutes.

Where I did my preceptorship we only carried 6 pre-loads of Lidocaine so not really enough to do any kind of drip with (even if the doc wanted one).

What about cardizem, procanimide, magnesium, zofran, promethazine, and a few others I'm sure I forgot haha? You dont have or don't drip any of those?

Don't carry any of those. As an ALS provider I carry:

Adenosine (well, the service I did preceptorship didn't carry it but most do)

Amiodarone (optional)

ASA

Atropine

Dextrose 50%

Dimenhydrinate

Diphenhydramine

Dopamine (premixed)

Epinephrine (1:10,000 and 1:1000)

Fentanyl (optional)

Furosemide (optional)

Glucagon

Glucose Paste

Midazolam (optional)

Morphine

Naloxone

Nitro Spray

Salbutamol nebs and MDI (That's right CB... I said SALBUTAMOL)

Sodium Bicarbonate

Xylometazoline (or phenylephrine) spray

Pretty limited list.

Here is something that Ottawa put out for their service:

[fiznat]

That's a weird lido protocol. ALCS says that if you use any antidisrhythmic during a code resus you need to back it up with a maintenance infusion at ROSC. Aren't you guys following ACLS protocol in every other way?

The preloaded jets we've got of lido come in 100mg. 6 of those should be plenty to do the initial loading and then set up a drip that will last till you get to most hospitals, no? You only need a few mg/min... assuming you use 100 for the loading that means you've still got enough for more than two hours at even the highest drip rate.

On a side note how well does the IV Dramamine work for n/v?