A Questions For The Medics

[uglyEMT]

Ok folks been offline a while but still been active. Increased work load, extra shifts, education. Last night was the first night off in a while and went to the local watering hole with some EMS buddies. Well while dicussing EMS in general a show came on (dont know what it was, just reading some of the CC) basically a survior show (not the show survivor but about a survivor). Two guys camping in the wilderness, one has a heart attack, one gives CPR for god knows how long and finally the guy comes back. Now being we were all Basics we were dicussing this and couldn't believe without defib, meds, or advanced care it was possible.

Anyways, my one buddy asked about Epi. Which got us wondering say you were in a wilderness setting, a long duration of time away from advanced medical support and had Epi pens (auto injector basic type .3mg) would .6mg be enough to help? OK before all hell breaks loose we are NOT talking our day to day settings here. We are talking wilderness survival settings where you are your only help for hours or days. You know those shoe string and a branch splint, might have to knaw the limb off to survive settings (OK extreme but after some Jack what else is to be expected).

In honesty I don't know what amounts of meds you all push during an arrest. What we were thinking is .3 or .6mg would be an improvment then nothing at all. Would there be benifit or harm?

Just a question we through out there and passed around along with the rounds.

Admin: if this is in the wrong forum feel free to move.

Edited April 21, 2011 by UGLyEMT

[HERBIE1]

It certainly would not hurt to give that epi- even better if you could access a vein with the injector. Whether or not the dose is subtherapeutic is irrelevant- the person is already dead, and if that is enough to jump start the heart, great.

Possible to bring someone back with a ROSC, and full mentation with simple CPR- sure. Common? Nope.

[Just Plain Ruff]

you are out in the wilderness with a long way to go to get help? is that the scenario?

The person in arrest is dead. Simple as that.

Sure go ahead and give the epi but be prepared to explain the two needle marks to the medical examiner.

You will then after you realize that the epi didn't work, you will have to fashion a carry device to drag your friends body out of the woods. Or you could leave him and come back to him after you arrive to get assistance.

My thought's are, make it out to get a body recovery team.

The results of the scenario suck but sometimes it's what happens.

[uglyEMT]

Thanks for the responses guys. Yea I figured as much but wanted to ask the pros. It was more of a what if thing not something I would try.

Yes it was a wilderness survival type of question. We mulled it over thinking what if someone had their own epi pens with them. I know my partner is highly allergic to peanuts and carries one on her person at all times both on and off duty.

Many thanks and keep them coming if you like.

[Kiwiology]

Not really, have to remember that adrenaline is given in cardiac arrest as an adjunct to defibrillation. The only two things that have ever been proven to work in cardiac arrest are a combination of CPR and defibrillation.

Drugs might alter the environment a little bit to make defibrillation more effective only. Now, it was 1992 and Kiwi recalls that it was told in Mobile Intensive Care Officer training that drugs have never been proven effective in cardiac arrest, I think somehow the point was missed .....

Good to see you back mate, I was worried that perhaps the NWO had gotten you

Edited April 21, 2011 by kiwimedic

[Chief1C]

Wow, we always joke about starting training young... But taking such a stringent course, as a toddler? Amazing. How old were you? Four or five? Wow. . . . . .

[Richard B the EMT]

Wow, we always joke about starting training young... But taking such a stringent course, as a toddler? Amazing. How old were you? Four or five? Wow. . . . . .

There was a news item on the 5 PM news, a 9 year old saved his drowned 4 year old sister, using now outdated CPR copied from him watching the movie "Black Hawk Down" (outdated, perhaps, but it worked this time).

[Dustdevil]

In a cardiac arrest, you could probably make a decent case for breaking his leg if you think it might stimulate cardiac activity. Operating under that popular-but-dubious theory, it certainly wouldn't hurt to give an epi pen. However, there are many more negatives than positives.

Number one problem is that you don't know for sure what the rhythm is without a monitor. Consequently, you may actually be doing something to worsen the situation rather than improve it. Of course, as time passes, you can be more assured of what the underlying rhythm is, but by then, it's too late.

Next, we have the problems of drug uptake. If your patient isn't perfusing peripherally, then the chances of much of any of that already inadequate dosage making it to the myocardium from the sub-Q tissue is slim to none. That's a problem often seen even in anaphylaxis. We dump several doses of epi into the SQ, and it just sits there from lack of perfusion. Then, when the patient begins to compensate, and regains some peripheral perfusion, all that epi suddenly gets dumped into hid system, causing secondary problems as bad as the original problem.

Of course, this same phenomenon is also thought to be responsible for some "DOS" patients later being found with a pulse too, so it can theoretically go either way.

I can't really say what I would do without being there and having all the necessary info. But sometimes a shot into the dark can mysteriously pay off, I guess.

[Chief1C]

Ah yes, sometimes Hollywood School of Medical Aid does work.

[Kaisu]

And in the wilderness scenario described, try a precordial thump. I believe it generates approximately 4 joules - about the same under dosing as the epi pen... Can't hurt, might help.