Do you stop vasopressors(/inotropes) during a code?

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    I'm new to the CCU and have a question.....
    (not my patient just heard about it)
    pt was on 60 of levo, 300 of neo, and maxed out on vasopressin. The pt ended up coding, etc. I didnt ask, but now was wondering....would they have stopped all of those medications/vasopressors and then started all ACLS meds per protocol if there was limited access??
    Or...would they have kept those meds infusing and started new lines/use different ports to infuse the ACLS drugs. Sorry if this is a stupid question, just wanted to know if I was in that situation... Thanks- Also, has anyone ever had a similiar situation, I would love to hear some similiar stories...
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    Someone should start another line but in the meantime I've disconnected the gtts, pushed the drug, and reconnected the gtt. Probably not the "right" thing to do but essentially your stopping the gtts for a split second only to bolus them with more vasopressors (in the case of epi or vaso at least).
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    60 of levo and 300 of neo and "maxed" on vasopressin. You do realize that they are all are WAY past max right? LOL.. Just pointing it out. I have seen them that high... but they are pretty much pointless to keep going higher on them. Anyway...back to the question!
    Don't stop them!
    If there is no open NS line for piggybacks (usually there is one), then disconnect, flush, then reconnect when done. Someone usually grabs a IV start kit and tries to get something just for fluid bolus wide open that can be used for ACLS drugs. No need to stop 'em.
  6. 1
    Quote from Sedate&intubate
    I'm new to the CCU and have a question.....
    (not my patient just heard about it)
    pt was on 60 of levo, 300 of neo, and maxed out on vasopressin. The pt ended up coding, etc. I didnt ask, but now was wondering....would they have stopped all of those medications/vasopressors and then started all ACLS meds per protocol if there was limited access??
    Or...would they have kept those meds infusing and started new lines/use different ports to infuse the ACLS drugs. Sorry if this is a stupid question, just wanted to know if I was in that situation... Thanks- Also, has anyone ever had a similiar situation, I would love to hear some similiar stories...
    *** The levo and neo where useless anyway. I would guess the patient was very acidic. When their Ph get very acidic the levo and neo might as well be just slow running IV fluids. Vassopressing does work in acidic patients. If possible I would keep the vaso going and start a new line for ACLS drugs. If that isn't possible then just give in the line the vaso is going in.
    Sedate&intubate likes this.
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    Bella- I do realize that they were "maxed" beyond the recommended amount. thanks Not ideal situation, very sick patient, as I'm assuming it was. Just wanted to know what to do with the ACLS drugs/lines/vasopressors/etc, in this type of situation, and I like to hear real examples-
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    Haha, I figured surely you did. I just thought it was funny how you worded it.
    One time at shift change a pt was going south. He was on levo and neo, trying to call a doc to get something else and I just had the nurse crank them up past max to something like that. Of course, it only helped a slight bit more until we got the new gtt.
    And last month had a surgeon come in to put in a central line and dialysis cath. Then he refused to do both, but did the dialysis cath first. What am I gonna do with that if I can't get meds into a central line?? Jerk. Finally got him to do it. In a code situation and you have all that stuff running through a central... you can.. in an emergency, use the dialysis cath. Just aspirate the heparin out before using. Then you wouldn't have to stop em.
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    I've had the same thought even after 25 yrs in critical care. As a rule- no- if you have the line access for ACLS push drugs there is no reason to stop the meds that were supporting the patients VS pre-code. The exception is if one of the meds may have contributed to the code- I would stop that med or get direction from the code leader. Also, make sure the code leader knows what meds are running- it may be a moot point but once the patient is coding it iis thier call to keep them running or take a new tract.
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    yeah way past max probably wasnt helping anymore
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    Keep in mind that every hospital has a different MAX to their vasopressors and sedation. Not every hospital has the same concentration for instance. I transferred from one hospital where their MAX on versed and fentanyl gtts was 20mg/hr each to a hospital that was only 5mg/hr. Odd I know. Also there was a vast difference to the vasopressor MAX as well.
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    There are many who don't really believe in a "max" dose. Sure, if you have time, then stop at the "max" and start another gtt. But if you don't have time, then don't stop at the max dose and just let them hypoperfuse their entire body! Keep using whatever you've got to work with (provided it wasn't causing the problem in the first place and etc etc.)


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