RICollegeEMT
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I was hoping to get some opinions here from those who have quite a bit more knowledge than me on this matter.
The company I work for has been ordered by the state to put cardizem in all the ALS trucks. The formulary calls for 50mg prefilled vials. However since Dilt requires refrigeration (and they don't want to spend the money) they've placed 100mg reconstitutionable vials instead and claims they've spoken to the state and are in "discussions".
Now my concern is this. Protocol calls for straight bolusing followed by maintenance infusions as needed. The drug packaging says "for continuous infusion, not for bolus" or to that effect.
They're telling us we reconstitute it in a 100cc bag of saline and can draw our boluses from that bag. Part of me says it's simply creating an admixture, but part of me worries theres something about it that makes it safe only at a slow drip as opposed to a slug of 20mg +/-
The other concern is the reconstitute contains mannitol-- I believe it's 75mg but I could be mistaken. All I know about mannitol is that it's a sugar complex and that it absorbs poorly thus limiting its glycemic properties. But I don't know enough about it to be comfortable pushing it without finding out more. Is it necrotic like dextrose if it infiltrates? How about other concerns at that dose?
Is this an acceptable practice? Or is this us being set up to get called in front of an inquiry?
I appreciate any guidance you can provide. I don't want to make a stink if this is simply a practice I am not familiar with. But likewise I do if it's risking us being sanctioned because of our company.
Thank you for any knowledge and guidance you can provide.
The company I work for has been ordered by the state to put cardizem in all the ALS trucks. The formulary calls for 50mg prefilled vials. However since Dilt requires refrigeration (and they don't want to spend the money) they've placed 100mg reconstitutionable vials instead and claims they've spoken to the state and are in "discussions".
Now my concern is this. Protocol calls for straight bolusing followed by maintenance infusions as needed. The drug packaging says "for continuous infusion, not for bolus" or to that effect.
They're telling us we reconstitute it in a 100cc bag of saline and can draw our boluses from that bag. Part of me says it's simply creating an admixture, but part of me worries theres something about it that makes it safe only at a slow drip as opposed to a slug of 20mg +/-
The other concern is the reconstitute contains mannitol-- I believe it's 75mg but I could be mistaken. All I know about mannitol is that it's a sugar complex and that it absorbs poorly thus limiting its glycemic properties. But I don't know enough about it to be comfortable pushing it without finding out more. Is it necrotic like dextrose if it infiltrates? How about other concerns at that dose?
Is this an acceptable practice? Or is this us being set up to get called in front of an inquiry?
I appreciate any guidance you can provide. I don't want to make a stink if this is simply a practice I am not familiar with. But likewise I do if it's risking us being sanctioned because of our company.
Thank you for any knowledge and guidance you can provide.
