Mag Sulfate, do you give it and how?

[croaker260]

I have been tasked with reviewing a portion of our SWO's for the delivary methods of our Mag. If you could complete the above survey and add any additional comments below. This is for mag for all uses, i.e. cardiac arrest, asthma, pre eclampsia and actual eclampsia, etc.

[tcripp]

Our protocols don't fall within your nice survey. I can send you the drug formulary if you'd like...

[DwayneEMTP]

Yeah brother, two issues I see with getting participation.

First is that you've asked people to spend hours defining this for you...that's a big 'ask.'

Second, if you want them to take that time it will take some more effort on your part, though I can see that you expended quite a bit of effort already.

Perhaps open for discussion one type of pathology that it might be used for and explore that, asking appropriate questions as you go?

Not meaning to bust your balls...just trying to help you get what you're looking for.

Dwayne

[croaker260]

I apologize, I actually thought this would be easy. We already give it, I was simply tasked with finding out what other people are doing and to see how we compare.

I was anticipating a minute to complete the survey and a couple of minutes to cut and past from their protocols, I was specifically trying to avoid a lengthy discussion that might get off topic.

Our protocols don't fall within your nice survey. I can send you the drug formulary if you'd like...

Please feel free to send a link.

[tcripp]

Unfortunately, no link to send. Here is the excerpt.

• Eclamptic seizures – 10%; 2 to 4 grams slow IV push, at no greater than 1 gram per minute, until seizure stops or a maximum dose of 4 grams has been given.
  
• Hypomagnesemia (TdP) – 10%; 1 to 2 grams slow IV push (at 1 gram per minute), if SBP > 90 mm Hg.
  
  • May repeat same dose every 5 minutes until a maximum of 4 grams has been reached.
    
  • Large doses (i.e., up to 8-10 grams) of magnesium may be required to suppress arrhythmia; 
contact OLMC for further magnesium therapy.
    

  [*]Reactive airway disease – 2 grams IV added to 50 ml NS infused 
over 10-15 minutes if SBP is > 100 mm Hg.

  [*]Pulseless V-Tach (TdP) – 10%; For torsades de pointes (irregular polymorphic VT) associated with a long QT interval: Magnesium sulfate, 1 to 2 g diluted in 10 mL D5W IV/IO. (If torsade de pointes is not terminated by defibrillation, administer magnesium sulfate as soon as rhythm is recognized.)

Hope this helps the cause some...

Edited December 13, 2011 by tcripp

[croaker260]

Unfortunately, no link to send. Here is the excerpt.

• Eclamptic seizures – 10%; 2 to 4 grams slow IV push, at no greater than 1 gram per minute, until seizure stops or a maximum dose of 4 grams has been given.
  
• Hypomagnesemia (TdP) – 10%; 1 to 2 grams slow IV push (at 1 gram per minute), if SBP > 90 mm Hg.
  
  • May repeat same dose every 5 minutes until a maximum of 4 grams has been reached.
    
  • Large doses (i.e., up to 8-10 grams) of magnesium may be required to suppress arrhythmia; 
contact OLMC for further magnesium therapy.
    

  [*]Reactive airway disease – 2 grams IV added to 50 ml NS infused 
over 10-15 minutes if SBP is > 100 mm Hg.

  [*]Pulseless V-Tach (TdP) – 10%; For torsades de pointes (irregular polymorphic VT) associated with a long QT interval: Magnesium sulfate, 1 to 2 g diluted in 10 mL D5W IV/IO. (If torsade de pointes is not terminated by defibrillation, administer magnesium sulfate as soon as rhythm is recognized.)

Hope this helps the cause some...

Could you PM me with your agency and state, so I can reference it correctly?

Edited December 13, 2011 by croaker260

[JakeEMTP]

I guess we are lucky. Our mag. sulfate comes already pre-mixed in a 4g bag and a 1g bag. 4g for eclampsia and 1g bag for respiratory or pulseless V-Tach. We simply piggyback it on to the NS. Using a 10gtt for the NS and a 60gtt for the Mag Sulfate. The key is to have your Mag hanging higher than your NS.

Sorry for the short response, going on a call!

[mobey]

If you have an iphone/Android, you can download AHS EMS protocols app. (Alberta healthservices).

All your answers as well as evidence will be in there from my area.

[DwayneEMTP]

I've not used it very often..maybe 5 times, and each time I mixed what I considered the appropriate dose in a 250 mL bag of saline and let it run...and loved it every time!

No secret to the size of bag, we simply had 250/1000mL bags...

Dwayne

[p3medic]

The vast majority of my experience using mag has been with severe refractory asthma, state protocol calls for 1-2 Gms IVP over 5 minutes, which sounds completely wrong to me and most others (MD's included). In my typical adult patient I routinely place 2 Gms in 100 ml of NS or D5 w/a 10gtt set and infuse it over 10 minutes, which is still about twice as fast as recommended by most sources I've read.