More harm than good

[chbare]

Fair enough.......perhaps I was trying to over simplifiy the process......

No worries, I was placing emphasis on how different the two concepts were.

Take care,

chbare.

[HERBIE1]

I guess it would depend on the underlying conditions of the patient. Is this a "simple" cardiac issue or is the person hypovolemic for some reason? Did they arrest because they were already in fluid overload- dialysis, CHF, electrolyte imbalance?

I recall the push in years past for massive fluids for most trauma patients. These people would end up in the ICU with ARDS, massive peripheral and pulmonary edema, and would more likely succumb to the complications from that vs their original injuries.

I'm sure we all have had penetrating trauma patients-ie GSW's or stabbings- who were so volume depleted that by the time we got to the ER, they were bleeding pink. They had the fluid, but not the Hg and blood products they really needed, and we do not carry.

To me, as long as you are able to circulate the medications with good CPR and proper ventilation, fluid overload seems to be counterproductive.

[Richard B the EMT]

I'm BLS (EMT-B in New York State and City), and I'm trying to establish a background re the question of this string.

I recall, years ago, my ALS providers giving an automatic dose of Lasix to all cardiac arrest patients, even before attaining ROSC (Return of Spontaneous Circulation), via the "KVO (Keep Vein Open) line". Now, after establishing ROSC, they deliver a cold saline IV bag.

The delivery of cold saline is new, under a pilot program.

When did they stop with the automatic infusion of Lasix?

[armymedic571]

I'm BLS (EMT-B in New York State and City), and I'm trying to establish a background re the question of this string.

I recall, years ago, my ALS providers giving an automatic dose of Lasix to all cardiac arrest patients, even before attaining ROSC (Return of Spontaneous Circulation), via the "KVO (Keep Vein Open) line". Now, after establishing ROSC, they deliver a cold saline IV bag.

The delivery of cold saline is new, under a pilot program.

When did they stop with the automatic infusion of Lasix?

Richard,

I have never heard of a cardiac arrest protocol that allowed lasix without some definable reasoning, however I haven't been in the game nearing as long as some of the others.

The only reason I can think to give Lasix in an Arrest is if exacerbation of heart failure is thought to be the underlying etiology behind the arrest. However, Lasix's (Furosemide) action of onset is about 5 minutes or so.....approx......

I hae heard of this being done once, but have never seens it done, or done it myself.......

[Richard B the EMT]

I haven't been in the game nearing as long as some of the others.

Over my 37 years on, protocols, obviously, have changed. Extrapolate for the dudes and dudettes just starting out, referring back to 2010 from 2047, and what changes will they have witnessed?

[Kiwiology]

We hang one litre of fluid to use as a running flush for drugs but thats about it.

For a traumatic hypovolaemic arrest or cardiotoxic levels of tricyclics yeah tnen I might infuse a couple of litres and wrap the BP cuff around the bags ....

Pressure infusor ambo style! Gangsta

[daedalus]

I have always looked at it as addressing one of "the Hs and Ts". I run my bag wide open during codes, but it is purely an empirical intervention and I have no data to back it up. I would stop doing it if evidence to suggest it has a negative effect on outcomes becomes available.

As a side note, I have protocols to infuse iced saline wide open if ROSC.

Edited July 11, 2010 by daedalus

[Richard B the EMT]

Nothing personal,daedalus, but I often ask members of the city to avoid acronyms, as what you use might be different from mine. Well, I have no recall of what is/are "the Hs and Ts", so could you translate, please?

[daedalus]

<br>Nothing personal,daedalus, but I often ask members of the city to avoid acronyms, as what you use might be different from mine. Well, I have no recall of what is/are "the Hs and Ts", so could you translate, please?<br>

<br><br>While I agree that local acronyms should be avoided, and I do try to avoid them, Hs and Ts are really a nationwide (possibly worldwide in english speaking countries) acronym used in the American Heart Association materials for emergency cardiac care, and mean the same to everyone everywhere. These are taught in the standard ACLS course. Similarly, I have never heard of ROSC being used to describe anything other then return of spontaneous circulation. I do understand the advantage of spelling things out and will opt for that in the future. <br><br>Six Hs and five Ts are common etiologies of cardiac arrest:<br>Hypovolemia, hypoxia, hydrogen ions (acidosis), hypo/hyper kalemia, hypothermia<br>Toxins, tamponade, tension pneumo, thrombosis, trauma.

<div><br></div><div>Now you can see why it is&nbsp;convenient&nbsp;to refer to the above group as just the Hs and Ts, as it would be an exercise in redundancy for the AHA to make students rehash this list during megacodes.&nbsp;</div>

Edited July 12, 2010 by daedalus

[Just Plain Ruff]

I think that my main concern with fluids adminstration during arrest is after 2-3 liters (yes I've seen that much) infused into a very compromised patient, do we do them harm?

I think that we do but unfortunately, the empirical evidence just isnt there but I have seen patients post code who's chest x-ray looks like a white sheet of X-ray film where their lungs are supposed to be and I'm suctioning copious amounts of pink frothy sputum from their ET tubes.

Did the pulmonary edema come before the arrest and that's what caused the arrest or did it come after with the overinfusing of Saline in the code?

That's where I'm coming from?

I'd like to see the AHA Come out with some sort of definitive recommendation on this very point.