Drug administration - asystole, occasional VF/PEA

[Achromatic]

Please note: this is for the purposes of writing up a report on a PT contact during my ED rotation where I did not have access to the full MIR from incoming ALS unit. As such, I'm only looking for "possible" answers, and not looking to set off a debate!

PT is 84YO M, in full arrest. Upon arrival in ED, has had at least two rounds of atropine (pupils blown). Other meds unknown. CPR has been in progress approximately 20 minutes, with a largely asystole ECG (periodic flutters of VF, PEA lasting up to 5 seconds every minute or so).

What other drugs may have been pushed (see above disclaimer)?

Upon arrival in ED, crash cart was readied, two MDs, two RNs, respiratory tech, and me, EMT student. CPR continued for approximately 15 minutes, ET tubed dropped, before PT was called. What meds may have been pushed in this situation?

 

[Onceamedic]

Epi because it's indicated for both VF/VT and for asystole, possibly a ventricular anti-arrhythmic (lidocaine or amiodarone), for afib. Must have been asystole or a brady PEA for the atropine.

Do you know if shocks were delivered?

 

[Achromatic]

Epi because it's indicated for both VF/VT and for asystole, possibly a ventricular anti-arrhythmic (lidocaine or amiodarone), for afib. Must have been asystole or a brady PEA for the atropine.

Do you know if shocks were delivered?

Definitely not in ED, and I don't believe pre-hospital (MD asked about burn marks, was informed they were old, grenade-related - PT had lost 3 fingers to one in Korea/Vietnam).

We never saw a rhythm in ED other than 95% asystole, with those flutters of maybe 3-4 pulses of VF, some PEA. Heard no mention of Afib on the incoming reports, but I was alternating between CPR and cricoid for the tube drop, so might have been there.

 

[Onceamedic]

I meant vfib not afib... so sorry.. nothing indicated afib. Just posted before I proof read...

with no shocks delivered, the rhythm was probably asystole or brady PEA, thus epi and atropine would have been the only drugs I would have pushed

 

[Achromatic]

Thanks, much appreciated (and a good early headstart - I'm going to be going on to EMT-P asap).

 

[medicdan]

Procedures such as this fall under standard ACLS protocols... check them out online for a good order.
One site: http://www.acls.net/aclsalg.htm

 

[Shishkabob]

Could have also had Sodium Bicarb, or any other number of drugs used to rule out the Hs and Ts, like Nalaxone, etc.

 

[boingo]

What Linuss said. What kind of hx does he have?

 

[Onceamedic]

Could have also had Sodium Bicarb, or any other number of drugs used to rule out the Hs and Ts, like Nalaxone, etc.

Absolutely correct!

 

[R.O.P.]

Sounds just like a call we ran yesterday, Pt. brady PEA, Hx HTN, DM.
We pushed a total of 3 mg atropine & 3 mg epi, and 25 meq sodium bicarb. Zero shocks.

 

[Achromatic]

Sounds just like a call we ran yesterday, Pt. brady PEA, Hx HTN, DM.
We pushed a total of 3 mg atropine & 3 mg epi, and 25 meq sodium bicarb. Zero shocks.

Followed up with the ED... this is what happened. 3mg atropine, 3mg epi pre-hospital. More atropine, epi and sodium bicarb in ED, zero shocks administered, 44 mins of CPR in totality.

Pt Hx unknown (was with VA, unavailable to us, family unable to help) - as such the county coroner had to take possession of the body until either Hx / records became available, or autopsy was performed.

Thanks all, for your help!