Use of Vasopressin

[Ridryder 911]

Wonder if you use Vasopressin much ?

[RichmondMedik]

Vasopression is actually our first line drug we alternate between that amio and epi -- my Medical Director has found that it is the actual combination of the drugs that work best and not one or the other

Paul

[medstudent30]

Since I have just completed the ACLS standards for the first time, we were taught that you can use either or, but since your going to end up using Epi q 3-5 minutes, why not use Epi to begin with?

[MidwestMedic]

Yeah, we follow ACLS, like most people. But, I like the idea of vasopressin giving me one less thing to keep track of for a bit.

But, we do not use vasopressin for asystole. Mayeb for the next set of protocols.

What we have found locally is a very good save rate IF we arrive with a patient in v-fib and they are still in v-fib after the stacked shocks, that epi-shock followed by bicarb-shock. Note: by the time we arrive (average of 8 min or less) and we get that far in the protocol, the pt has already been down at least 10 minutes.

[THE_DITCH_DOCTOR]

Epi-shock, bicarb-shock? Uh........

[canuckEMT]

I have a question.....Why are some of you using Bicarb so early in your algorhythm? Is it not, Epi - shock, Amio or vasopressin - shock etc.

I was under the impression that Bicarb was a last choice in ACLS resuss just prior to terminating efforts ( if that is in your protocol).

I am just learning this right now, and the question is just off the top of my head.

[THE_DITCH_DOCTOR]

The use of sodium bicarbonate should be restricted to cases where an arterial blood gas has revealed significant metabolic acidosis, or in cases of TCA, aspirin or diphenhydramine overdose

[MidwestMedic]

yeah, I know what the ACLS protocol says. Our services protocol has a slight alteration for some study. If the pt has been down for at least 10 min and is intubated, you can give bi-carb as early as you can fit it in without slowing down your other treatments.

[THE_DITCH_DOCTOR]

Sounds like a well constructed study.... :? I'd like to see a full protocol for that.

[medstudent30]

According to the way we were taught ACLS, the algorhythm is:

Check for responsiveness

ABC's, etc.

CPR

Stacked set of 3 shocks

Epi or Vasopressin

CPR

Shock

CPR

Epi

CPR

Amiodarone

CPR

Shock

CPR

Either 2nd dose of Amiodarone or Lidocaine

CPR

Shock

CPR

Either 2nd dose of Lidocaine (if Applicable) or Mag Sulfate

All with your pulse checks and Epi q 3-5 minutes

by that time you may have been in your code for about 15-20 minutes if you have been then you can give your Sodium Bicarb at that time to possibly reverse the alkalotic/acidotic state that they may be in.

But then again that is how we were taught. Everyone is different.