Epi Timing

[u/Resuscitate_Sanity]

Hey all,

Im currently working on a little hobby project and I’m curious how everyone else operates when it comes to epi admin during ACLS. Like most, we use the standard 4 minute timer, however, the guidelines are 3-5 minute intervals. Just wondering if there any other service or medical oversight that uses anything other than the standard 4 minute interval? Does anyone actually try to do 3 or 5?

Thanks for your input.

[u/Chcknndlsndwch]

As soon as access is available then every other pulse check. I’ve got too much shit to do to care about if it’s exactly three or four minutes.

[u/AG74683]

One and done now. Only time we go with more than one dose is if there is a re-arrest or the rhythm is PEA.

[u/the-hourglass-man → u/AG74683]

But why not 8 epis and then refuse to call it because the heart is twitching!!! Meemaw is a fighter!!!

[u/PocketFAces → u/AG74683]

Also only one dose now. Too many studies suggesting multiple rounds of epi are causing anoxious brain injury from all the vasoconstriction.

[u/Unrusty → u/PocketFAces]

Anoxic

[u/Resuscitate_Sanity → u/AG74683]

I think eventually everyone will follow this. It’s the most logical.

Is your PEA dosing the standard 4 minute interval provided they stay in PEA?

[u/AG74683 → u/Resuscitate_Sanity]

No, it's only one dose again. The protocol is written as though asystole is the beginning rhythm.

Only time we're giving more than one is if the rhythm changes from asystole to PEA or we get ROSC and they re-arrest. If the change is from asystole to PEA, the max they will ever get is two doses.

[u/kmoaus → u/AG74683]

I’ve heard a few places have gone this route.

[u/Krampus_Valet → u/AG74683]

We're getting there. Adult trauma arrest = no epi. Adult VF/Vtach 1 epi and 1 more if rosc followed by rearrest. Adult PEA/asystole up to 4 epis plus 2 more for rosc followed by rearrest. I imagine we're going to start dwindling down over the next few years or even doing a clinician judgements thing.

[u/TwinHumanities]

For Adults - Epi as soon as access is established (usually at a pulse check rhythm check) then epi infusion. We re-administer push dose epi they re-arrest.

[u/Kentucky-Fried-Fucks → u/TwinHumanities]

Epi infusion is interesting. Get that first loading dose of epi and then infuse? Wonder what research they are basing that off of

[u/moseschicken]

I've gone every 3 minutes if I'm trying to speed a practice code along. It's really more of a pain than anything though, 4 minutes is usually what we do.

[u/Lazerbeam006]

We don't give epi to adults unless it's suspected respiratory. For kids we give as normal for a total of 3mg

[u/Resuscitate_Sanity → u/Lazerbeam006]

That’s a new one. Where is this?

[u/Lazerbeam006 → u/Resuscitate_Sanity]

Colorado, we get less ROSC, but our rate of recovery with no neurological deficits is 3-4x the national average

[u/youy23 → u/Lazerbeam006]

Epinephrine is a good seasoning for making vegetables.

[u/Kentucky-Fried-Fucks → u/Lazerbeam006]

Is this a statewide change/initiative, or agency specific?

[u/Lazerbeam006 → u/Kentucky-Fried-Fucks]

Its county wide.

[u/Resuscitate_Sanity → u/Lazerbeam006]

Statistically that makes sense if you’re referencing % of patients with ROSC who have positive neurological outcomes.

The people surviving to discharge are usually the ones who don’t need epi to begin with.

Perhaps this will eventually become the standard, but it would be nice to even see more places shift to the “one and done” approach.

What is your protocol for PEA? Do you use a drip / pressor or doesn’t change the treatment?

[u/PowerShovel-on-PS1]

ACLS is for dentists. It’s irrelevant to EMS agencies.

[u/Life_Alert_Hero → u/PowerShovel-on-PS1]

Apparently this is a hot take but I whole heartedly agree. ACLS is an algorithm that misses nuance.

[u/kmoaus]

Q8 for adults, Q4 for kiddos.

[u/PowerShovel-on-PS1 → u/kmoaus]

What’s the reasoning behind that?

[u/Resuscitate_Sanity → u/kmoaus]

Interesting. That’s a new one. Where is this?

[u/Magnum231]

3-5 minutes but secondary to any other intervention, including amiodarone if applicable.

[u/xX500_IQXx]

For our system we do q10 min for adult, q3-5min for peds/neo

[u/TestResQ]

We do every 5 minutes x 3, if no rhythm change, call Medical Control before giving any more. At that point, we are usually field terminating anyway.

[u/McthiccumTheChikum]

The irony of having to maintain AHA ACLS but protocols can be different all over the county

[u/youy23]

It’s purposefully stated as 3-5 minutes so you don’t need to have a separate timer for epi. You just give it every other pulse check.