MrSpykes Posted July 16, 2006 Share Posted July 16, 2006 But look at the patient in the scenario. They converted to a beautiful NSR. There was no ectopy at all. We cant determine if the patient is experiencing any pain or funny feelings because they are tubed. I would want to actually see the patient for myself before i make an exact decision but from the info thus far I would just monitor the patient search for the reason of the arrest and provide supportive measures. I would continue to control the airway and if the monitor shows some ectopy then i would bolus some Lido and hang a maintenance drip. I don't believe from what has been presented here that this patient would truly benefit from receiving a bolus of Lidocaine prophylacticly. Link to comment Share on other sites More sharing options...
Ridryder 911 Posted July 17, 2006 Share Posted July 17, 2006 I understand your point and respect it as well. Remember"sudden death" syndromes, has no pre-cursor of arrhythmia's, as well more prominent in younger females, and ventricular fibrillation threshold decreases with each conversion. R/r 911 Link to comment Share on other sites More sharing options...
mediccjh Posted July 17, 2006 Share Posted July 17, 2006 I'm sticking with Rid on this one. And I know what Asys' protocols are too. Give the Lido. With transport time, and the assumption that the medic knows basic math, the dose would not be enough to worry about toxicity. Along with the lower threshold, that's an increased of chance of the next V-Fib conversion going into Asystole. Treat the patient, not the monitor. Link to comment Share on other sites More sharing options...
Ace844 Posted July 24, 2006 Share Posted July 24, 2006 Here's a loosely related study to 'Asy's' question: It's amazing what happens when you do essentially te same thing a different way...ISN'T IT?!?!? (Prehospital Emergency Care Publisher: Taylor & Francis Health Sciences @ part of the Taylor & Francis Group Issue: Volume 10, Number 3 / July-September 2006 Pages: 403 - 408 URL: Linking Options DOI: 10.1080/10903120600726023 Intermittent Bolus Dosing of Lidocaine in Emergency Medical Services—An Alternative to Bolus Followed by a Drip Michael G. Millin A1, Samuel Kim A1, Terri A. Schmidt A1, Mohamud R. Daya A1, Brad Fujisaki A2 A1 Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Portland, OR A2 Department of Pharmacy Services, Oregon Health & Science University, Portland, OR) Abstract: Objective. To determine the effectiveness and safety, in an emergency medical services setting, of intermittent bolus dosing of lidocaine versus a bolus followed by a drip. Methods. This was a prechange and postchange observational study, following a protocol change. Patients 18 years or older treated with lidocaine for cardiac dysrhythmia were included in the study. Patients were excluded for lidocaine for intubation, cardiac arrest without return of spontaneous circulation, trauma, interhospital transport, and incomplete charts. Patients were divided into two groups. The drip group (January 1, 2002, to January 14, 2003) was treated with lidocaine 1.0–1.5 mg/kg intravenous bolus up to 3 mg/kg until the dysrhythmia resolved and then a 2–4 mg/min drip. The bolus group (January 15, 2003 to December 31, 2003) was treated with lidocaine 1.5 mg/kg intravenous bolus, followed by 0.75 mg/kg bolus every five minutes up to 3 mg/kg until the dysrhythmia resolved; once the dysrhythmia resolved, intermittent boluses of 0.75 mg/kg every 10 minutes were adminstered. Outcome variables studied were maintenance of rhythm of nonventricular origin, occurrence of complications, and adherence to written protocols. Complications considered were seizures, respiratory depression, and cardiac arrest. Results. The study included 146 patients in the drip group and 113 patients in the bolus group. Overall, 119 of 146 patients (81.5%) in the drip group and 101 of 113 patients (89.3%) in the bolus group maintained a rhythm of nonventricular origin (p = 0.079). There was no statistical difference between the two groups in complications or protocol variance: one of 146 patients (0.7%) in the drip group and one of 113 patients (0.9%) in the bolus group had a serious complication; 64 of 146 patients (43.8%) in the drip group and 54 of 113 patients (47.8%) in the bolus group had a protocol variance. Conclusions. Intermittent bolus dosing protocol was associated with an equivalent effectiveness in maintaining rhythms of nonventricular origin without an increase in complications. Link to comment Share on other sites More sharing options...
AZCEP Posted July 24, 2006 Share Posted July 24, 2006 This method is becoming more and more popular prehospital. I would suppose there is a lower cost associated with carrying more pre-filled syringes than there is with a pre-mixed drip. If the providers can maintain the vigilence that is required to re-bolus when required, good alternative. If, however, the providers aren't to cogniscent of what time it is, this could get a bit hairy. I also like the fact that there is no evidence that neither Amiodarone or Lidocaine have been shown to be terribly effective at acute termination of Ventricular dysrhythmias, and they have identical survivability at one year. Anyone for drawing straws? Can't be any less effective, right? Link to comment Share on other sites More sharing options...
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