AZCEP Posted July 15, 2006 Posted July 15, 2006 Perfusing rhythm with good vitals, monitor as is and identify the cause of the arrest. If you find a cause, consider treating it, if not, leave well enough alone. Just because you can, doesn't mean you should.
squad51medic Posted July 15, 2006 Posted July 15, 2006 I will do some interjecting here as well; Treating foci in the field seems a little out of the norm for a paramedic, doesn't it? Aren't we treating the patient not the monitor? I mean, recognizing what the ailment is great, but what if you are wrong? Is your medical director going to stand by your decision? Stabilize and transport, don't play doctor. Some of us have limited resources at our disposal, the hospital has more. Don't try to figure out why he went into VFib, just treat the vfib. Perhaps the pt. was taking GHb, or Efedrin(?), you just won't know the answer to that until you do blood tests. Now don't get me wrong, I love to learn more and study emergency medicine to make me better in the field, but sometimes I think we over think a situation. Learning new stuff is scary! Appling it is dangerous. Just my two cents!
Ridryder 911 Posted July 15, 2006 Posted July 15, 2006 :wink: I will do some interjecting here as well; Treating foci in the field seems a little out of the norm for a paramedic, doesn't it? Aren't we treating the patient not the monitor? I mean, recognizing what the ailment is great, but what if you are wrong? Is your medical director going to stand by your decision? Stabilize and transport, don't play doctor. Some of us have limited resources at our disposal, the hospital has more. Don't try to figure out why he went into VFib, just treat the vfib. Perhaps the pt. was taking GHb, or Efedrin(?), you just won't know the answer to that until you do blood tests. Now don't get me wrong, I love to learn more and study emergency medicine to make me better in the field, but sometimes I think we over think a situation. Learning new stuff is scary! Appling it is dangerous. Just my two cents! Appearantly so is spelling :wink: Excuse me, but where did you determine that treating foci (actually it would be ectopic foci or irritable foci) is not the norm for the Paramedic? Ever heard of PVC's, V-Tach or how about A-fib, even V-fib?.. Those are can be caused by irritated foci.... ever heard of oxygen, antiarrythmic's? As well, I don't know what services you consider are at the hospital that might be different in inital emergency cardiac care?... I work at both, (EMS, ER & CCU) and really don't see any difference except for labs', which is really not going to change your initial treatment modality. The days of NOT THINKING, and load and go are gone!... If you wanted to be an ambulance driver, you missed it about 35 years. The problem is we do NOT think of the situation well enough, and most are not educated enough to know the difference! To answer the question, yes I would give her a bolus of Lido, I feel it is far better to, than have her go back into V-Fib again. Remember threshold levels of re-current V-Fib? The second time she might not be so lucky, to convert. In that short period of time, Lido levels will be slightly getting thereupatic level, so I am not going to be as concerned with the toxicity effects, as I am with possibility of recurrent V-Fib. This is a young person and "sudden death" syndromes occur and occur rapidly without any prior ECG changes. For example like PVC's, R on T, etc..You are right treat the patient, and part of that is help prevent the patient from having another period of V-Fib. Especially since we do not know the etiology. By the way, I don't play doctor... I am a Paramedic, and I treat emergencies, that's my job... if you don't like that, it's time to search a new career. R/r 911
AZCEP Posted July 15, 2006 Posted July 15, 2006 "Learning new stuff is scary."--ARE YOU KIDDING! I didn't suggest we try to calculate the terminal airspeed velocity of an unladen swallow, for crying out loud. A standard issue assessment can determine a good amount of possible causes for this event. Hypoxia, hypovolemia, hypo/hyperthermia, hyper-/hypoelectrolytes, even the stated GHB and ephedrine can be suspected with a history. Let's not forget the other causes: trauma, tablets, thrombus(cardiac and pulmonary). These are just the most basic possibilities. If we look a little closer at this patient's history, we just might find something else. Is this something new? Do we not perform this on most of our patients?
squad51medic Posted July 15, 2006 Posted July 15, 2006 I couldn’t agree more with the assessment (AZCEP). I Totally agree with the 6 Hs – 5T’s. I agree with the Pt. Assessment and HX. I believe that it is extremely important in treating the pt. to get good HX. But… Look again at scenario; “Should we be good and bolus him with Lidocaine or say "it probably wasn't an irritable foci that through in into v-fib, so lets not play with his heart rhythm since he's NSR." My thinking was to just leave the NSR alone and monitor for changes during transport. I agree you could treat the ectopic foci or irritable foci and there isn’t anything wrong with that, but suppose there was something else underling that’s causing the dysrhythmia. How would we in the field be able to determine this and when we supply the pt with Lidocaine are we treating for long-term effect? Why not give Amiodarone? Ok, my three cents!
Ridryder 911 Posted July 15, 2006 Posted July 15, 2006 Do realize Cordorone side effects? As well many studies are now defending that Cordorone works well as reducing ectopic beats, but in V-fib it has no higher benefits than Lidocaine. As well there is no"special study" to detect an irritable foci, unless we are checking electrolytes, checking hypoxia, observing ischemic changes...meanwhile. hoping she does not have another episode sudden death. Again, many are getting the knee jerk effect of giving Lidocaine. Please read the studies of the amount that was studied and what even is considered to be therapeutic level. A bolus of 100 mg, and even a drip 2 mg would not be considered enough to produce toxicity. Let's be reasonable. Again, if one is not able to obtain specific history on this individual, I would lean of administering an antiarrhythmic even if prophetically to reduce sudden V-fib. It would be hard to justify a "post arrest" and knowing she had a course of V-Fib, if had a re-current V-Fib and was unable to convert the rhythm again. Be safe, R/r 911
Scaramedic Posted July 15, 2006 Posted July 15, 2006 Ever heard of PVC's, V-Tach or how about A-fib, even V-fib? R/r 911 No, whats V-Fib? Seriously I would have to see the pt, check the vitals, get more history and see whats happening on the monitor before I decided on this scenario. My gut feeling is to go ahead with a Lido drip to be on the safe side. As far as protocol I would not (nor have not) worked in a system that does not allow wiggle room in protocols. We are not robots, we are thinking machines that are capable of making informed and intelligent decisions. Peace, Marty :joker: P.S. I didn't suggest we try to calculate the terminal airspeed velocity of an unladen swallow, for crying out loud. 22.36 miles per hour.
chbare Posted July 15, 2006 Posted July 15, 2006 "Do realize Cordorone side effects? As well many studies are now defending that Cordorone works well as reducing ectopic beats, but in V-fib it has no higher benefits than Lidocaine. As well there is no"special study" to detect an irritable foci, unless we are checking electrolytes, checking hypoxia, observing ischemic changes...meanwhile. hoping she does not have another episode sudden death. Again, many are getting the knee jerk effect of giving Lidocaine. Please read the studies of the amount that was studied and what even is considered to be therapeutic level. A bolus of 100 mg, and even a drip 2 mg would not be considered enough to produce toxicity. Let's be reasonable. Again, if one is not able to obtain specific history on this individual, I would lean of administering an antiarrhythmic even if prophetically to reduce sudden V-fib. It would be hard to justify a "post arrest" and knowing she had a course of V-Fib, if had a re-current V-Fib and was unable to convert the rhythm again. Be safe, R/r 911" Not to mention that Amiadarone has a longer half life than U-235. I agree with your assessment Ridryder 911. I still would have attempted to obtain some kind of history and obtain base line vitals before considering lidocaine. Hx of liver problems or allergies, you never know, even in a younger patient. However, I agree that in the absence of any other history I would strongly consider lidocaine. Take care, chbare.
Ridryder 911 Posted July 15, 2006 Posted July 15, 2006 FYI for those that not aware.. Corodorone can increase the Digoxin, Lanoxin levels by 70%, as well as patients on Coumadin, Corodorone can increase their INR (clotting time) by 100%...........something to consider! R/r 911
FormerEMSLT297 Posted July 15, 2006 Posted July 15, 2006 First let me say,,,, it's always good to treat the patient, not the monitor. Having said that a person who experiences V-fib or V-tach, is usually a victim of some irritable foci. I had a patient in V-bigeminy with runs of V-tach the other day with No CHEST Pain, and a bolus of 100 mg of lidocane, cleared him right up. The meds were given in the E.R. because he began to show ventricular ectopy a a run of 7 complexes of V-tach immediately after we transferred him over the the Hosp. stretcher. The ER Doc gave the lido even though the patient did not have chest pain or significant hypotension 112/72. The Doc explained that he wanted to prevent V-fib or R on T phenomenon and that's why he gave lido.. the patient went into sinus between 90-110, with no ectopy. I've seen lido work dozens of times, and i am a believer in it's use.
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