Diabetics are a very interesting bunch.

[medic53226]

I was called to a residence for a pt that was having a stroke. Before I got their are company EMS Director had arrived with the volunteer FD. He access the pt and called me confirming that it was a stroke, when I arrived he ( ems director ) had his bag packed and soon as me and my partner walked in the door, he left the house, before he did I asked did you get a BS on this pt he said, no but, the wife did and it was 124 and he left. So, I said to the wife so you got 124 for a BS and she said yes or it was 24 I can't remember it was couple of hours ago or at lunch time it is 18:00. PT was disoriented, sweaty, clammy, and cold to the touch. So, I took V/S which was 124/78 Resp 14, HR 78 and BS 32, so IV D50, and to the ambulance. As we are traveling down the 800 mile country road with no end, I have the pt on the monitor and doing my vital signs as the 78 y/o male is wakeing I notice couplets, then runs of VT, at which time I give him 100mg of Lidocaine 1 mg/kg which you know. It stoped it and the pt returned to sinus with occasional PVC. We have Amiodarone but I grabbed the Lidocaine since its prefilled and easy choice. I would also like to let you know that after this happened I asked the wife if he had chest pain and she said he had some this moring and around lunch time. Ok with what I told you would you have choose anything else, or any different med and how would you handeled the the EMS Director which is a Paramedic. Thank you.

[ERDoc]

The lido may or may not have been needed (I wasn't there, so I can't judge). The EMS director needs a little re-education (or as recently been discussed in other threads, some education period). I hear the vollies where I work always getting mad because we repeat things that they do when the pt arrives in the ER (retaking the history, doing our own EKG or our own finger stick). I think this is a perfect example of why. You should always do your own assessment, regardless of how much you trust the person that is giving you the info. If you document what they tell you and then it ends up in court, you will hang.

To make a short story long, this actually reminds me of a recent case. At the university hospital that I work at we have a code BAT (brain attack team) for when a stroke pt comes in that may be eligible for thrombolytics. When the code BAT is called it activates the stroke team (Neurology, CT, MRI, ICUs). We had a pt come in that was a code BAT. So she gets into the room and we start working on her. About 5 minutes after the neuro team is in the room our triage nurse announces that another code BAT is coming back. The neuro resident offers to go do the initial assessment. After I finish my part with the first pt, I walk into the other room and the neuro resident walks out saying that she is done. I ask her what she meant and she says the lady has a finger stick of 10. Yup, this particular nurse is a little over aggressive, but has the best intentions.

[medic53226]

I had not mentioned that I had him on NRB @ 15 LPM, and they were getting worst, that is the only reason because when he started having the runs of VT, I got a little worried, I would like to know as a ER doc would you have choose Lidocaine or Amiodarone in this case. I would just like this oppioion form a ER Doc so that I might have a feeling of the difference or the same ideal. Since you are Doc and ER at that in a big city you must have used both thousands of times and problaly have seen differences. Thank you for you time I know that you are busy.

[ERDoc]

I had not mentioned that I had him on NRB @ 15 LPM, and they were getting worst, that is the only reason because when he started having the runs of VT, I got a little worried, I would like to know as a ER doc would you have choose Lidocaine or Amiodarone in this case. I would just like this oppioion form a ER Doc so that I might have a feeling of the difference or the same ideal. Since you are Doc and ER at that in a big city you must have used both thousands of times and problaly have seen differences. Thank you for you time I know that you are busy.

I don't know about the big city part or the "thousands of times," but I think what you are describing would do fine with Lido. I must admit that I have never used Amio outside of a cardiac arrest. For situations like the one you presented I would always use Lido (can't say I have any evidence for it, just the way I learned).

[chbare]

ERDoc, you are not the only doc that thinks this way. Very few of our ER docs would have used lidocaine in this situation. medic53226, I am not a doc but I would have used lidocaine. I have had several patients develop bad reactions to amiadarone. Nothing scientific or research based, but I have had better outcomes with lidocaine. I like the fact that lidocaine has a much shorter half life and it seems like every patient that gets converted with amiadarone becomes a life long user. Just my opinion however.

Take care,

chbare.

[AZCEP]

You really have a 50-50 chance with either to actually convert the rhythm using only the medications.

No evidence exists showing that one is better than the other. For every study that says one works, there will be another that says it doesn't or the other choice does.

Can you say "crapshoot"? I knew you could.

[medic53226]

I value everyones opioion, because it just helps me in the field, why I asked about what choose other medical professional have choose and found out the goods and the bads. I like knowing these things because if your service gives you a choice of Drug to use like mine this will make me feel better about my choice. Thank you for your time.