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Old Medics, Old Drugs

27 posts in this topic

Posted · Report post

Just a question out there.....how many of you 'old' medics ever have Physostigmine and Nifedipine in your drug boxes. Then, did you ever have the chance in using one or both of them before. This is purely a question in 'wondering'. Oh yeah, I'm talking prehospital, not in house.

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Posted · Report post

Just a question out there.....how many of you 'old' medics ever have Physostigmine and Nifedipine in your drug boxes. Then, did you ever have the chance in using one or both of them before. This is purely a question in 'wondering'. Oh yeah, I'm talking prehospital, not in house.

I don't know if I count as an "old" medic. I graduated 11 years ago, but I had nifedipine on the truck when I was a new grad. I don't miss it. I never had the need to use it, and heard of too many situations where it was given inappropriately.

Nowadays if I wanted to decrease MAP, I could use IV NTG, but I can't think of too many situations where I'd want to.

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Posted · Report post

Never used nifedipine but I did have it on my truck when I first started

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Posted · Report post

It was never available to us since the inception of ALS in the province.

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Posted · Report post

I used the Procardia capsules way back when I was a LPN at a nursing home. It was not uncommon for us to puncture the capsules and administer SL. I shutter at how things were done.

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Posted · Report post

I used the Procardia capsules way back when I was a LPN at a nursing home. It was not uncommon for us to puncture the capsules and administer SL. I shutter at how things were done.

Yeah, good ole times. Remember all the Verapamil that was given for SVT? Stuff actually worked good.

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Posted · Report post

I'm not old, only birthdaily challenged. :)

have Physostigmine and Nifedipine in your drug boxes. Then, did you ever have the chance in using one or both of them before. This is purely a question in 'wondering'. Oh yeah, I'm talking prehospital, not in house.

Had and partly still have. Physostigmine was in our tox box until they threw the box away (never in use and we have tox specialists & equipment within ~10min by air, ~30min by ground). Nifedipine is in the regular drug box, I used it on several occasions (hypertensive crisis) - but very rarely, can't remember the last time (indication: hypertensive crisis & no i.v. access possible & no contraindications present).

Are there any news other than contraindication in MI/AP (some years ago N. was banned from using in those cases), I should be aware of?

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Posted · Report post

Yep used to give it all the time for hypertensive crisis. It did a fine job in dropping the b/p's of these patients but sometimes, albeit sometimes, we did more harm than good and even one time after giving it the patient crashed and stroked. This was 15 years ago. BAD BAD JUJU.

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Posted · Report post

Looking back I'm ashamed: Who knew a precipitous drop in blood pressure would be harmful? It's nearly axiomatically true that doing so would be problematic, yet we did it and probably harmed many people in the process...

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Posted (edited) · Report post

Never had physostigmine, but I recall "fondly" squeezing Procardia capsules. Another drug that I was extremely excited to see go by the wayside- at least for prehospital use- was Verapamil. Never had a chance to use it on the streets, but YEARS ago(25+), I was working in an ER and a 25 year old kid walked in off the street, c/o being dizzy. Turned out he was in SVT and being a pretty new medic, I had only witnessed a couple cardioversions- chemical or otherwise, so I was really interested. The ER used Verapamil, and to make a long story short, after the drug was pushed, the kid's BP immediately bottomed out, he coded and died. To this day I recall that incident like it happened yesterday.

I thanked the EMS gods when adenosine became available.

Edited by HERBIE1
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Posted · Report post

Wasn't it levophed that produced the vomiting seen in the Exorcist? I can't remember the drug we pushed but one night we had a really sick patient, was told to give this drug to this patient, then I gave it, and the patient emptied their stomach contents against the far wall. I do remember that there were small chili beans or some type of bean in the vomit that our housekeeping department was OH SO Happy that they got to clean up.

The patient didn't survive the night.

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Posted · Report post

Wasn't it levophed that produced the vomiting seen in the Exorcist? I can't remember the drug we pushed but one night we had a really sick patient, was told to give this drug to this patient, then I gave it, and the patient emptied their stomach contents against the far wall. I do remember that there were small chili beans or some type of bean in the vomit that our housekeeping department was OH SO Happy that they got to clean up.

The patient didn't survive the night.

Not sure if it caused emesis, but I did always hear it referred to as "Leave'em dead". LOL

Aminophyline was another one famous for causing projectile vomiting- not a good thing for someone already in respiratory distress. . Sadly, I recall times when aminophylline and epinephrine were the only medications we had on board to treat asthma. Lots of people died because we were so behind the times.

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Yeah, one of my doctors (old school - but he's since passed on) favorite cocktails for CHF was 125 of solumedrol or 100mg solucortef and then a bottle of aminophylline.

Amazingly, we usually brought the patients into the ED better than they were at home with that cocktail. Through in CHF and Emphysema and we usually made em worse or dead.

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Posted · Report post

Not sure if it caused emesis, but I did always hear it referred to as "Leave'em dead". LOL.

As an aside, levophed is still alive and well, and widely used in the ICU and even ER. It's a decent pressor, and gets a lot of use in sepsis.

Unfortunately I don't have it on my ambulance, but most people I'd likely use it for need a few liters of saline first. Granted, these people are sick and have a high mortality.

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Posted · Report post

We also have levophed (norepinephrine) as an option for sepsis, and it's my preference over Dopamine because of the MOA.

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The whole "leave'em dead" saying is outdated. It used to be the case that levophed was only used in refractory hypotension and was the last resort pressor before the patient expired. We have gotten much better at selecting pressors and levophed is now used in a wider scope.

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Posted (edited) · Report post

I used Levo a couple weeks ago in Cardiogenic Shock.

I have also used it in Sepsis.

We don't carry it though, gotta consult OLMC then pick it up somewhere.

How about Activated Charcoal?

Edited by mobey
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Posted · Report post

The whole "leave'em dead" saying is outdated. It used to be the case that levophed was only used in refractory hypotension and was the last resort pressor before the patient expired. We have gotten much better at selecting pressors and levophed is now used in a wider scope.

I thought I posted this before but it seems to have disappeared. The leave 'em dead thing was a JOKE- from years ago. It was not a comment on the drug's efficacy. I haven't been here in awhile and I forgot how flip comments are too often misinterpreted.I thought this was a more lighthearted thread- my bad.

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Ok, here is a useless drug, before we had Albuterol we had...... Trebutaline!!! Give it sub Q and wait for nothing to happen. And who remembers High dose Epi? My highest score was 38mg on a cardiac arrest.

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I would not call terbutaline worthless. If you look at the literature instead of anecdote, you will find that terbutaline is effective. A study in the mid 1990's compared pre-hospital terbutaline to albuterol. Quantatitive measurements of respiratory severity were similar between the two groups and both groups had improvement but the albuterol group reported "feeling" better. You have a case for albuterol being a better agent, but it would be difficult to call terbutaline worthless.

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Posted · Report post

I'm no OB wonderkind but isn't it still used in pre-term labor or something in the OB realm?

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I'm no OB wonderkind but isn't it still used in pre-term labor or something in the OB realm?

Actually I found out the hard way the effects of albuterol on labor. The wife was in labor, and she is an asthmatic. We waited until contractions were pretty close- 5 minutes apart- before we went to the hospital- 10 minutes away. (2nd kid)

Only 3-4cms dilated, so we did laps around the floor for awhile, and things were progressing nicely. Of course she got winded, took some albuterol, and things came to a grinding halt. I asked why the slowdown, and they told me exactly that- albuterol is similar to something used to stop preterm labor. Took about an hour to wear off, and then things went into overdrive- to the point where I almost delivered my daughter on my own in the birthing room.LOL

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Posted (edited) · Report post

Speaking of old; I recently got a look at some stuff from the bad old days (1996) and oh my how archaic things were back then and how far we have come

1996

Ambulance Officer (Proficiency Ambulance Aid Certificate - six weeks)

OPA, oxygen, entonox, aspirin, salbutamol

Intermediate Care Officer (Post-Proficiency Ambulance Aid Certificate - ten weeks)

AO plus manual defibrillation, cardioversion, IV cannulation, NaCl 0.9% IV, GTN spray, IM glucagon

Paramedic (Advanced Ambulance Aid Certificate - one year)

ICO plus nasopharyngeal airway, laryngoscopy, intubation, cricothyrotomy, chest decompression, intraosseous access, adrenaline, atropine, lignocaine, stesolid, morphine, nalbuphine, naloxone, frusemide

2012

Emergency Medical Technician (Diploma - up to two years)

OPA, NPA, LMA, entonox, methoxyflurane, nasopharyngeal airway, nebulised salbutamol, nebulised ipratropium, GTN spray, IM glucagon, oral ondansetron, oral loratadine, nebulised adrenaline, PEEP valve, tourniquet.

Paramedic (Degree - three years)
EMT plus manual defibrillation, synchronised cardioversion, IV cannulation, IV fluid administration, IV glucose, morphine, fentanyl, naloxone, ondansetron, IM adrenaline, IV adrenaline for cardiac arrest, IV amiodarone for cardiac arrest, ceftriaxone, naloxone, midazolam (seizures).

Intensive Care Paramedic (Degree + PGDip - one additional year)
Paramedic plus laryngoscopy, endotracheal intubation, capnography, cricothyrotomy, chest decompression, IO access, IO lignocaine, IV adrenaline, atropine, amiodarone, adenosine, midazolam (sedation), ketamine, pacing, vecuronium, suxamethonium (selected personnel only).

Edited by Kiwiology
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Posted · Report post

I thought I posted this before but it seems to have disappeared. The leave 'em dead thing was a JOKE- from years ago. It was not a comment on the drug's efficacy. I haven't been here in awhile and I forgot how flip comments are too often misinterpreted.I thought this was a more lighthearted thread- my bad.

I think we all know that you've been doing this since before many of us were born and have a wealth of knowledge to share. I didn't intend to be disrespectful in any way, I just like talking pharm.

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I think we all know that you've been doing this since before many of us were born and have a wealth of knowledge to share. I didn't intend to be disrespectful in any way, I just like talking pharm.

I'm not THAT old.

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