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New Lopressor protocol

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Our service has just updated our guidelines to include lopressor in our Acute Coronary Syndrome protocol.

Is anyone else doing this?

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I've never heard of Lopressor being used in a prehospital setting. I've seen it used in the ER but don't recall the exact amount of time it took for the meds to take effect. Is it really worth it to carry this drug on the ambulance considering the possible side effects and the extensive list of common drugs it can interact? What are your thoughts are carrying/using Lopressor?

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Out new medical director is proposing us to carry it. The standard dosage IV is 5mg q 5 minutes up to 15 mg .. of course one has to be sure not bottom out the pressor or bradycardia...

R/r 911

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I've never heard of Lopressor being used in a prehospital setting. I've seen it used in the ER but don't recall the exact amount of time it took for the meds to take effect. Is it really worth it to carry this drug on the ambulance considering the possible side effects and the extensive list of common drugs it can interact? What are your thoughts are carrying/using Lopressor?

Our medical direcor is a pretty smart guy and has alot of confidence in our medics. I am researching it now, but honestly if he thinks we should carry it he is probably right. Our agency sets standards throughout the country and our protocols are constantly being reviewed by our peers and complimented for being progressive. This could be a mistake, but I think it will probably be another advancement that we will start seeing other agencies mimic. Anything that decreases o2 demand during an MI is a good thing... and decreasing the HR is the best way of decreasing the workload. This is the drug that can do that, we have decreased o2 demand by vasodilation, now we are gonna hit the HR, I am for it.... so far.

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we carry it here, have for several years now, we use it in AMI and rate control for AF.....5mg q 5 min to a max of 15mg....

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Keep in mind the only drug proven to improve survivability in an AMI is ASA.

Not even fibrinolytics or PCI can tout that they improve morbitity/mortality numbers.

It's great that your medical control has the leeway to be able to decide what his medics will be allowed to do without answering to some higher bureaucracy, but try to consider that not everyone has the same level of autonomy. Medical directors can want, but until state or regional councils agree, nothing can happen.

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Keep in mind the only drug proven to improve survivability in an AMI is ASA.

Not even fibrinolytics or PCI can tout that they improve morbitity/mortality numbers.

It's great that your medical control has the leeway to be able to decide what his medics will be allowed to do without answering to some higher bureaucracy, but try to consider that not everyone has the same level of autonomy. Medical directors can want, but until state or regional councils agree, nothing can happen.

understood

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Lopressor- 5mg via IV over 5 minutes. May repeat after 5 minutes to a maximum dose of 15mg.

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Lopressor- 5mg via IV over 5 minutes. May repeat after 5 minutes to a maximum dose of 15mg.

what are your thaghts... we have the same dose.

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Lopressor is making its way into our trucks. My service isnt carring it yet, but some of the other medics i know have it on the truck and in their protocols.

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I think that it is a good idea, it gets us one step closer to fewer delays in the ED prior to cath lab. Also in my area they are researching bypassing the local hospitals and going directly to a hospital with a PCI.

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We have it on the trucks in Newark. I haven't used it yet. We have to be careful here with it due to the cokeheads we pick up. Something about runaway tachycardia doesn't sit well in my stomach.

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Soon, we will have "core measures" for EMS. :lol:

Take care,

chbare.

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We have had it on our ambulances since May of '06. It was only given in ACS WITH OLMC. Problem with that was that we could not get approval 8 out of 10 times with our STEMI pts. Personally in the last 2 years I have gotten permission for it 3 times and been shot down 10-12 times.

So, that being said instead of taking it offline we are doing away with it all together. Our medical director has sited a few studies that state Lopressor in early stages of AMI is not an absolute necessity, but Beta Blocker therapy is indicated to help reperfusion within 96 hours of AMI. I will have to find the study to support that.

The times I was able to use Lopressor, I liked the results I would see in the hypertensive patients, but my experience is limited. Hope you have better luck with it than I did by losing it. Keep us posted about your successes, and uses for it.

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Our service has just updated our guidelines to include lopressor in our Acute Coronary Syndrome protocol.

Is anyone else doing this?

We have had Lopressor for a while now. It replaced cardizem for Tx of AF w/ RVR. Cardizem in the powder form is not being produced any more and the mixed vial form can only be out of refrig for 30 days.

I myself HATED to see such a good calcium channel blocker replaced by a beta blocker. Cardizem is the Tx choice for 90% of the AF pt with RVR and now we don't have it :?

BUT now with STEMIs and reducing myocardial oxygen it is great, but as has been mentioned I think, there is no change in M/M. with that said, controlling hypertension in a AMI and decreasing myocardial oxygen demand can't be wrong.......

One of the HUGH down sides to a beta blockers and specifically Lopressor is that it is a negative inoptrope along with being a negative chronotrope. AND in your AFIB pt that have CHF as a result of the ineffect cardiac output d/t the AFIB, Lopressor is counter-indicated!!! and thus why cardizem is superior.

Also one of the hugh side effects to beta-blockers is it B2 effects in causing broncho-spams and must be carefully watched in your asthmatic and COPD pt.

Peace

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Most of the current generation beta blockers are beta 1 specific until you use unusually large doses. For the most part there is limited risk in COPD or Asthmatics from them.

Cardizem is also a negative inotrope/chronotrope. It will work much faster than most of the beta blockers and carries many of the same risks.

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We have had Lopressor for a while now. It replaced cardizem for Tx of AF w/ RVR. Cardizem in the powder form is not being produced any more and the mixed vial form can only be out of refrig for 30 days.

Funny, I was doing research on cardizem today and came across this from EMS Responder Web Site:

http://www.emsresponder.com/print/Emergenc...iltiazem/1$3822

Logistics of Administration

Diltiazem will be administered in the prehospital setting most frequently as an intravenous bolus. It is available in both liquid and lyophilized states, although the liquid version requires refrigeration.

Therefore you still can get some that does not require refrigeration and the 30 day window!

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Take a look at the date of the article you posted.

Since at least September 2007 diltiazem has been unavailable in the powder form. The only version that is still available is a prefilled syringe that has a shelf life of 30 days at room temperature.

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I would lean more towards amiodarone in the rapid a fib/flutter pt with pulmonary edema, since CCBs and BBs are both neg intotropes.

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5mg X3 q5min to 15 for STEMI with pulse >100... Statewide Standing order.... And it makes sense. It will <MVO2, and therefore decrease the damage. Also it is pretty much standard of care for all STEMI patients going to a cath lab when Dx in-hospital. If your medics are interp. 12leads, it's definitly makes sense... How are things in Ft Myers?

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We have Lopressor. Had it for like 10 years now. We can give up to 15mg without calling the doctor. AMI and atrial fibrillation/flutter are the most common diagnosis when it´s used.

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Also one of the hugh side effects to beta-blockers is it B2 effects in causing broncho-spams and must be carefully watched in your asthmatic and COPD pt.

Cause or make the effects of beta 2 agonists ineffective?

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WE have it on standing orders for STEMI's. We also have Heparin and if long transport times, we can call for tenecteplase. We have not used the Tenecteplase much, since the Cath labs are getting quicker on response times.

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