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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

[quote name='P_Instructor' timestamp='1355764774' post='291694']
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.
[/quote]

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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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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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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