ems.rockstar2013 Posted September 4, 2013 Author Posted September 4, 2013 Yeah, being onscene is the key to saving arrests. When I used to keep track, which has been several years back now, I had over 50% of patients that I got pulses back on, but none that I'm aware of that ever left the hospital. On arrests that we've transported secondary to getting pulses back I've tried to keep it a secret until after getting in the ambulance. And man, a system that sends BLS who then calls for ALS, I hate that so bad. Why does a lower level of care decide whether or not a higher level is necessary? Send the medics and then allow them to downgrade the call to BLS for care and transport if they want...but the other way around? That just seems like insanity to me.. But, it sounds like there is a lot of interesting stuff going on with cardiac arrest resusc, save rates in the 30%ish, I think that I've seen in some experimental groups...Be interesting to see how they come along. I hope they hurry up..I'm getting old... Dwayne, the BLS service was the service for the area, they called for ALS that was from a different area, an assist? But anyways dispatch sent both rigs out at the same time. Hahaha, I don't think your really getting that old that fast! 1
chbare Posted September 4, 2013 Posted September 4, 2013 Sodium bicarbonate is not a front line medication unless the potential cause of the arrest can be managed with Sodium bicarbonate (TCA overdose for example). There are many potential pitfalls associated with Sodium bicarbonate. One issue has to do with a very important chemical reaction involved in CO2 transport. (H2O + CO2 <-> H2CO3 <-> H3O + HCO3- <-> H2O + CO2) This equation is typically used to explain how the body transports CO2 to the lungs. However, the reaction is known as an equilibrium reaction. Adding products and reactants to the mix can shift it left or right. Adding bicarbonate can shift it to the left and actually create more CO2. This means you are potentially increasing CO2 levels in an arrest patient who may not be able to effectively ventilate in the first place. Additionally, the possible tonicity and pH changes associated with adding bicarbonate to the mix can cause problems. Rockstar, all flattery will get you nowhere. I've seen Dwayne mature into a "senior" medic. He's paid his dues and has earned the right to be called "old." Do not deny him this title, he's an old fart and by God we should acknowledge his...maturity.
jwiley40 Posted September 4, 2013 Posted September 4, 2013 Thanks paramedicMike! I actually gave it one time before this last code and actually got a pulse rate. granted, he never went home (died at a nearby trauma center after cryo treatment) but I know it can help. I spoke to a doc in St Louis last night, after dropping off a pedi and he told me he would rather his responding medics give it NO MATTER HOW LONG THE PT WAS DOWN because you really don't know how long unless the arrest was witnessed. I'll just keep trying to explain it to the administrator and with the information you sent me, at least I have some evidentiary information to back up my practice.
Just Plain Ruff Posted September 4, 2013 Posted September 4, 2013 My God, I've known dwayne for at least 5 years and he really isn't as old as he seems, by PNG standards at least. 1
paramedicmike Posted September 5, 2013 Posted September 5, 2013 Thanks paramedicMike! I actually gave it one time before this last code and actually got a pulse rate. granted, he never went home (died at a nearby trauma center after cryo treatment) but I know it can help. I spoke to a doc in St Louis last night, after dropping off a pedi and he told me he would rather his responding medics give it NO MATTER HOW LONG THE PT WAS DOWN because you really don't know how long unless the arrest was witnessed. I'll just keep trying to explain it to the administrator and with the information you sent me, at least I have some evidentiary information to back up my practice. Did you read what was included in the content I linked? Did you read CHBARE's post towards the top of this page? I think there may be a misunderstanding regarding the drug and what happens. Please read the information a little more closely. Please discuss this with your medical director (under whose license you work). Then go from there.
jwiley40 Posted September 7, 2013 Posted September 7, 2013 I did read the information that you linked. I know that only a couple of studies related any improvement during recusitation and others said there wasn't really any positive effect. As far as being speaking with our medical director, he hasn't responded. AHA doesn't have in the algorhythms, but as I said, ER docs have told me they would rather I tried to use it instead of not trying it. I am looking for other links to more information so that I can really have the informed decision when, and i mean when, it happens again.
Just Plain Ruff Posted September 9, 2013 Posted September 9, 2013 , ER docs have told me they would rather I tried to use it instead of not trying it. But those same ER docs won't cover your ass when you get sued, only your Medical director will do that and ONLY If you followed protocol. What if you had a viable patient and you gave that drug or a drug that the "ER Docs have told me they would rather I tried to use it instead of not trying it" and it caused significant harm to that patient. Do you believe that those ER docs are going to stick up for you? They more than likely will NOT and it will be you and your medical director's butt's on the line and then your service will be paying a big judgement because you did what you did. Be really careful on this one, you are on a slippery slope and you gave a drug that was not on your approved medication list in your protocols for cardiac arrest and you went beyond your purveyance as a provider and you got lucky this time. Be really careful for the next time you might get an ER doc who might just lodge a complaint against you for going outside your licensure and then you are up a creek because you have no standing and your medical director really won't be in any position to help you. Just be careful and judicious, you don't want to get a reputation of being a rogue medic,
jwiley40 Posted September 9, 2013 Posted September 9, 2013 I don't either. I actually have been going through our protocols and looking to see when they allow for the use of bicarb. I put in a call to my medical director to get his take on the use of bicarb in cardiac arrest of unknown downtime. The last thing I want to be known as is a rogue medic.
Eydawn Posted September 10, 2013 Posted September 10, 2013 Score one for the guy who actually went to read his protocols and talk to his medical director! All aside, that shows a LOT of potential for you, friend... major kudos. Let us know what the MD says, eh? I'm curious. Wendy CO EMT-B RN-ADN 1
Just Plain Ruff Posted September 10, 2013 Posted September 10, 2013 I don't either. I actually have been going through our protocols and looking to see when they allow for the use of bicarb. I put in a call to my medical director to get his take on the use of bicarb in cardiac arrest of unknown downtime. The last thing I want to be known as is a rogue medic. JWiley, I'm impressed, some would have slinked off away from this thread and never returned. The fact that you are calling your medical director and looking through your protocols, well hell, you just don't see that anymore from many people. Good on you. Please let me and others(Wendy included) know what your medical director says to you. I'd be interested to hear his response.
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