Pharmacology question

[chbare]

Just a guess-

Systemic cellular respiration continues to occur when in cardiac arrest, so why not try glucose in the same way bicarb is used..? You would ultimately be addressing 2 of the H's and T's with these interventions, and if you've exhausted all other options....

This (I think) would give the body more of a fighting chance for ROSC.

P.S. I haven't started medic school yet, so take that into consideration when reading my responses... :wink:

Not exactly. Unless you are giving bicarb to treat a specific condition, (Hyperkalemia, overdose to enhance protein binding, and the such) bicarb can actually complicate the cardiac arrest situation. Altered serum osmolality, increased Co2 levels and electrolyte alterations have been noted with bicarb administration.

Take care,

chbare.

[AZCEP]

Post resuscitation hyperglycemia is widely held to cause a negative influence on neurologic function. Using dextrose containing solutions, when not indicated, is not acceptable practice.

All of the medications used in an attempted resuscitation have indications for their use. Administration, "just to see what happens", is not listed for any of them. If you have reasonable suspicion of a cause you might be able to justify something. Otherwise, don't do it.

[EMT Foose]

I can't wait for school to start! 20 more days.

I'm only through 3 of the 14 various texts, so...yea. Not well educated yet.

[Just Plain Ruff]

ok, if they have a history of hypoglycemia I would give it but only after all my first line drugs were given. If you have time you could give it earlier. I think the prime indication for this was if they patient was confirmed prior to the arrest to have low blood sugar. What I mean is if the wife took his sugar prior to his arrest and it was low or in the 40's then I'd give d-50 sooner than later. But I'd make sure at least the first round drugs were in, and the pt was tubed and all that.

If there is no documentable history that the patient is hypoglycemic, no evidence of insulin or glucophage or byetta or any diabetic meds then giving sugar goes to the bottom of my list.

Just like narcan goes to the bottom of my list for arrest if the patient has no evidence of having taken any narcotics or heroin. But if I'm in a nasty dirty apartment with the trappings of a heroin user, syringes, needles, and spoons and all that crap then Narcan pops to the top of my list probably even before I tube the guy. But that's just me.

[firedoc5]

Post resuscitation hyperglycemia is widely held to cause a negative influence on neurologic function. Using dextrose containing solutions, when not indicated, is not acceptable practice.

All of the medications used in an attempted resuscitation have indications for their use. Administration, "just to see what happens", is not listed for any of them. If you have reasonable suspicion of a cause you might be able to justify something. Otherwise, don't do it.

Good call. :thumbup:

[Mateo_1387]

What I mean is if the wife took his sugar prior to his arrest and it was low or in the 40's then I'd give d-50 sooner than later. But I'd make sure at least the first round drugs were in, and the pt was tubed and all that.

Justst to clarify, is the above how you used to do things or how you would do it today?

The only reason I ask is that guidelines today are to push the intubation until later into the code, I would be weary of having a patient intubated if I had a strong suspicion that Narcan or D50 would reverse their cardiac arrest. If after administration they remained comatose after some time, then intubation would be warranted.

[Just Plain Ruff]

I always have 25 extra sets of hands so intubation can be done with nary a thought by some fireman or paramedic who hasn't gotten his required number of tubes.

It all can be done at one time, IV, ET, drugs, Defib and cpr all at the same time at least in my perfect world.

[firedoc5]

Just to clarify, is the above how you used to do things or how you would do it today?

The only reason I ask is that guidelines today are to push the intubation until later into the code, I would be weary of having a patient intubated if I had a strong suspicion that Narcan or D50 would reverse their cardiac arrest. If after administration they remained comatose after some time, then intubation would be warranted.

I'd rather have the pt. tubed, even if they do come out of the full arrest and then have to pull it. Airway #1. You need that tube in during the entire code, and if you are going to give the Narcan and/ or D50, that's way down the line of what you are going to do first. I doubt if anyone is going to come into a full arrest with the intention of giving those two drugs first no matter what the suspicions.

[Just Plain Ruff]

oh good lord no, cardiac arrest ACLS Guidelines, then go with the d-50 later if suspicion warrants.

[firedoc5]

oh good lord no, cardiac arrest ACLS Guidelines, then go with the d-50 later if suspicion warrants.

I have heard about it, but never seen it myself. But never heard of it in ACLS guidelines.