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Old 05-16-2012, 05:24 PM   #1
zzyzx
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Versed + hypotension


I'd like to get some opinions on this: say you had a patient in VT with pulses who was 80 systolic but still fully alert and oriented, would you use Versed 1 - 2 mg prior to cardioversion? How much impact could that amount of Versed have on the BP, esp. considering a scenario where after you shock the patient he/she does not convert out of VT?


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Old 05-16-2012, 05:47 PM   #2
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I'd like to get some opinions on this: say you had a patient in VT with pulses who was 80 systolic but still fully alert and oriented, would you use Versed 1 - 2 mg prior to cardioversion? How much impact could that amount of Versed have on the BP, esp. considering a scenario where after you shock the patient he/she does not convert out of VT?
Is Versed the only choice? Because I'd go to the Etomidate.
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Old 05-16-2012, 06:00 PM   #3
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Is Versed the only choice? Because I'd go to the Etomidate.
Why etomidate? No analgesic effects and causes hypotension. Just curious.
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Old 05-16-2012, 06:18 PM   #4
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I'd like to get some opinions on this: say you had a patient in VT with pulses who was 80 systolic but still fully alert and oriented, would you use Versed 1 - 2 mg prior to cardioversion? How much impact could that amount of Versed have on the BP, esp. considering a scenario where after you shock the patient he/she does not convert out of VT?
Versed or Valium. The only problem is it still will not help for pain much and the PT is still going to feel it. If it is my PT and they are not symptomatic (chest pn, nausea, etc) I wouldn't cardiovert unless absolutely necessary.
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Old 05-16-2012, 09:28 PM   #5
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Versed or Valium. The only problem is it still will not help for pain much and the PT is still going to feel it. If it is my PT and they are not symptomatic (chest pn, nausea, etc) I wouldn't cardiovert unless absolutely necessary.
I saw a guy having a STEMI in my ER rotations with a bp of 54/30 fully A&O. A&O isn't the only indicator of stability or hemodynamic stability. If you have hemodynamically unstable V-Tach with a pulse it wont be with a pulse much longer unless you do something.
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Old 05-16-2012, 09:45 PM   #6
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I saw a guy having a STEMI in my ER rotations with a bp of 54/30 fully A&O. A&O isn't the only indicator of stability or hemodynamic stability. If you have hemodynamically unstable V-Tach with a pulse it wont be with a pulse much longer unless you do something.
54/30 with a STEMI is unstable and requires immediate intervention. 80 systolic may be PT norm and if there are not symptomatic why cause the PT unnecessary pain? Or risk sending them into Asystole? I am not saying don't put on the combi-pads and be ready but hospitals have options with anti-disrhythmics as where we do not.
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Old 05-16-2012, 09:45 PM   #7
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This is going to sound cruel but who cares, shock him and keel the guy alive, sure it'll hurt but he's gonna be alive right?
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Old 05-16-2012, 09:54 PM   #8
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This is going to sound cruel but who cares, shock him and keel the guy alive, sure it'll hurt but he's gonna be alive right?
Hunter you are missing the point. Not every PT needs electricity. You could very well cardiovert him and kill him at the same time. It happens all of the time. Sometimes it is out of your control but sometimes it could have been avoided.
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Old 05-16-2012, 09:58 PM   #9
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Why etomidate? No analgesic effects and causes hypotension. Just curious.
Versed has no analgesic effect. And etomidate is more hemodynamicly neutral than versed. Once he's stable he gets some Fentanyl.

http://m.emj.bmj.com/content/21/6/700.abstract
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Old 05-16-2012, 09:59 PM   #10
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54/30 with a STEMI is unstable and requires immediate intervention. 80 systolic may be PT norm and if there are not symptomatic why cause the PT unnecessary pain? Or risk sending them into Asystole? I am not saying don't put on the combi-pads and be ready but hospitals have options with anti-disrhythmics as where we do not.
I'd be more worried about hypotension secondary to hanging an amiodorone drip more than I'd be worried about it from versed. Depending on where I am and my transport time is going to decide what I'd do.

What's their diastolic pressure? I want to know this person's MAP. 80 SBP is pretty low to be "normal" for a patient but weirder things have happened.

"stable" VT is a crap term, no one stays stable in VT. The last guy I saw in VT dropped 90 points SBP in <10 minutes, but I'm pretty sure the amio I hung had something to do with it as well.

With the pressure provided by the OP I'd be leaning towards cardioverting this guy sooner rather than defibrillating him later but my instructors have always stressed the point that we shouldn't be scared of electricity. I've seen more than a few patients get cardioverted in the hospital and had one man's AICD cardiovert him on my gurney as we were capturing a 12-lead.

Never seen someone cardioverted from VT with pulses into asystole. Not saying it can't happen though.

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This is going to sound cruel but who cares, shock him and keel the guy alive, sure it'll hurt but he's gonna be alive right?
Retrograde amnestic effects from versed are a wonderful thing.
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