Ace844 Posted June 16, 2006 Share Posted June 16, 2006 JPINFV: Does it matter if I know. What I do know. Is that it has no business being in any prehospital protocols. Can you say things like automatic indicator for admittence to hospital for severe rebound effects. And possible link with Miocardial Infarction I dont want to turn this into a pissing contest. If you dont have anything to add, please dont clutter the thread. "Whit72," How much of a concern is this for you clinically? What is your V/S's threshold and index of concern in this patient population? What exaclty would be the rate of incidence, mechanisim of action, and 'pharmacokinetics' in which 'racemic epi' causes MI's in childern who are experiencing severe asthma attacks. Could you also post some links and sources to literature which support your stance? Anyone else notice how there was no mention of levalbuterol, methylxanthines, steriods, mag, etc....???Thanks, ACE844 Link to comment Share on other sites More sharing options...
whit72 Posted June 16, 2006 Author Share Posted June 16, 2006 Thanks for the glucagon answer doc. RID: they were kept in the drug bag, used them maybe a handfull of times. Never had an issue with them melting. Link to comment Share on other sites More sharing options...
TechMedic05 Posted June 16, 2006 Share Posted June 16, 2006 JPINFV: Does it matter if I know. What I do know. Is that it has no business being in any prehospital protocols. Can you say things like automatic indicator for admittence to hospital for severe rebound effects. And possible link with Miocardial Infarction I dont want to turn this into a pissing contest. If you dont have anything to add, please dont clutter the thread. Well, if it was in your protocol for any period of time, and you've been active for a while, then you at least should have known. Racemic Epi has it's place. I'd say a good number of medications administered could be linked to Myocardial infarction, no? Definitely Epinephrine, any concentration. Hell, dopamine can worsen a MI, but is also used to treat MI's. Weird. Are you implying that only medications you deem as 'dangerous' should be given by Paramedics? Or just remove them all together because you aren't comfortable with them? Link to comment Share on other sites More sharing options...
ERDoc Posted June 16, 2006 Share Posted June 16, 2006 JPINFV: Does it matter if I know. What I do know. Is that it has no business being in any prehospital protocols. Can you say things like automatic indicator for admittence to hospital for severe rebound effects. And possible link with Miocardial Infarction I dont want to turn this into a pissing contest. If you dont have anything to add, please dont clutter the thread. Racemic epi does not equal an automatic admission. It means at least a 2-4 hours observation in the ER, although some will automatically admit. My concern with giving it in the field is that I will not be able to fully evaluate the pt and make the best decision. That field provider has committed the pt to at minimum a 2hr ER visit. Link to comment Share on other sites More sharing options...
JPINFV Posted June 16, 2006 Share Posted June 16, 2006 JPINFV: Does it matter if I know. What I do know. Is that it has no business being in any prehospital protocols. Can you say things like automatic indicator for admittence to hospital for severe rebound effects. And possible link with Miocardial Infarction I dont want to turn this into a pissing contest. If you dont have anything to add, please dont clutter the thread. Its not that hard of a difference to understand, and since you have both racemic and another type (I believe L, but I'm not sure, nor is epi in my scope of practice anyways. There is a difference between not understanding something above your scope and not understanding something in your scope of practice). If you don't understand the difference between racemic and nonracemic, then how could you even begin to understand why there is a difference with how it works? Link to comment Share on other sites More sharing options...
whit72 Posted June 16, 2006 Author Share Posted June 16, 2006 http://pediatrics.aappublications.org/cgi/...t/full/104/1/e9 Here you go ACE but im sure you already familiar with this. I Link to comment Share on other sites More sharing options...
Ace844 Posted June 16, 2006 Share Posted June 16, 2006 http://pediatrics.aappublications.org/cgi/...t/full/104/1/e9 Here you go ACE but im sure you already familiar with this. I "Whit," The entire width and breadth of your support and data for this 'stance' is a single case report ('99), is that correct since that is all you posted? Next could you kindly answer the other questions as well? Thanks, ACE844 Link to comment Share on other sites More sharing options...
JPINFV Posted June 16, 2006 Share Posted June 16, 2006 http://pediatrics.aappublications.org/cgi/...t/full/104/1/e9 Here you go ACE but im sure you already familiar with this. I This is the first report describing myocardial infarction in the pediatric age range associated with nebulized racemic epinephrine administration An alternative explanation is that systemically absorbed epinephrine, in the presence of severe respiratory distress, possible hypercarbia, and an already stressed heart, caused an imbalance between myocardial oxygen consumption and oxygen delivery leading to ischemia and myocardial necrosis. This phenomenon has been encountered in pediatric patients with severe asthma given intravenous isoproterenol and may also account for some adverse cardiac sequelae after cocaine abuse. Based on our experience with the above patient, we concur with previous recommendations that the administration of nebulized epinephrine, if given more frequently than every 1 to 2 hours, requires continuous heart rate and electrocardiographic monitoring. In addition, continued work is needed to explore the efficacy of alternative therapies, such as nebulized budesonide, for the acute treatment of croup and bronchiolitis. Some one needs to know the difference between a case report and study. Link to comment Share on other sites More sharing options...
TechMedic05 Posted June 16, 2006 Share Posted June 16, 2006 Whit, you are bringing up one case presentation. Do you have a larger study? We all understand Racemic Epinephrine can be a dangerous drug. Some considerations: Do many patients receive 3 doses prehospitally? I hope not. Should everyone have Racemic Epinephrine? Absolutely not. Does Racemic Epinephrine have a place and appropriate use? Absolutely. If one case study is enough for you to believe racemic epinephrine is a dangerous/ bad/ shouldn't be used drug, then why do others need to produce volumes of information regarding other medications that you can ignore and keep arguing? Link to comment Share on other sites More sharing options...
whit72 Posted June 16, 2006 Author Share Posted June 16, 2006 You guys are funny read your posts. I just stated some of the medications that were in and previously in the protocols. for discussion purposes because you had such and issue with EMT administering glucagon Im. I think the doc has cleared it up for you. Link to comment Share on other sites More sharing options...
Recommended Posts