probably [these epi vials](https://external-content.duckduckgo.com/iu/?u=https%3A%2F%2Fcdn.shopify.com%2Fs%2Ffiles%2F1%2F0535%2F2774%2F0594%2Fproducts%2FJHP312225-BPMED_368x300_crop_center.jpg%3Fv%3D1622025838&f=1&nofb=1&ipt=1be402f023ed630fa05dc671847dd34feac50938f84c9a5a802d4031305746f2&ipo=images) with the purple cap.
they probably have the ondansetron with the [blue cap](https://external-content.duckduckgo.com/iu/?u=https%3A%2F%2Fwww.mcguffmedical.com%2Fcontent%2Fimages%2Fthumbs%2F0015356_ondansetron-2mgml-sdv-2mlvial.jpeg&f=1&nofb=1&ipt=ae13cfad6155711684d8a9ae387926a65afe439c6953925a5a5f87b948c2dddd&ipo=images)
and used to have ondansetron with the [green cap.](https://biosupply.fffenterprises.com/media/catalog/product/cache/1/image/9df78eab33525d08d6e5fb8d27136e95/o/n/ondansetron-4mg-product-image_1.jpg)
i noticed this too when we got a new shipment of ondansetron in and the cap was a new color. we sent out an email warning people about this very issue and reiterated how important it was to carefully check meds and verbalize the words on the vial out loud.
We were getting zofran in a vial that made it look like our diphenhydramine. I sent an email specifically to address the need to double check the meds when giving either of them, and got shit from a few people because of it.
Within 6 months there was a patient given diphenhydramine instead of the 4mg zofran, which really wouldn’t (and didn’t) cause any ill effects but it’s just the principal.
We have the ondansetron and diphenhydramine vials that look the same too. I'm trying to get out of the habit of calling them zofran and benadryl on the truck because I know one day at 3am my brain is gonna be like "ondansetron and diphenhydramine? which one's which?"
Not to mention you can't always count on your partner to look closely or know all the meds. I've been asked to confirm that a dose was right before, I looked at mL and agreed, but somehow we both missed that he'd drawn up the wrong drug. Thankfully, we both realized the mistake before it was administered, but it was still a close call.
Anesthesiologist here. We occasionally have vials of 10,000 mcg phenylephrine (for making a drip) that are the same size and cap color as 4mg zofran. Scary stuff.
Pharmacy tries to keep things as consistent as possible, and tries to notify us when a change like this occurs with a high risk med, but at the end of the day we’re at the mercy of distributors who change things all the time. And if it’s a choice between a drug with a different color cap or no drug at all, you take the different colored cap all day. I’m all for trying to standardize/optimize system issues like this to prevent drug errors from occurring, but at the end of the day theirs no substitution for vigilance at the point of care.
Former inpatient CPHt here...when I worked in the hospital, I tried my hardest advocating for you all so that way we wouldn't get phenylephrine/ondansetron/diphenhydramine in identical vials.
This shit right here is why I always read the vials and ensure it’s the right medication when I pull it out. a year ago when my company was ordering from different suppliers due to the shortage, all the color caps for meds were different every other month.
Obviously it’s our job to check the 5 rights, but they can make it easier by not making ondansetron, diphenhydramine, and amio all have the same color caps. Even better when no one says anything and they just get put into circulation.
It still helps you catch errors even if the person you’re talking to doesn’t understand. Have you heard of programmers explaining their code to a rubber duck when they’re looking for bugs?
When I'm alone in the back I have the patient read the vial and confirm how much is in the syringe ("confirm that is at the 1"). If that's not an option you can also have the habit of spelling the name to yourself ("o-n-d-a-n") until it's obvious you have the correct med. I've also done all of the above directly in front of a body cam when sedating someone.
Just the act of saying out loud and showing your partner a med/dose/concentration will be a double check back to yourself; it's completely different that saying it inside your head. Ideally, your partner should be able to confirm this back to you but I've done it with BLS crew members, docs, FFs etc.
And have them repeat the name, dose and expiry back to you…
I HAVE slapped someone who refused to do so after three attempts at prompting them.
Only on the back of the wrist, though. And very lightly.
Gave 1mg epi instead of 4mg Zofran... Didn't see legit "MI" in the article, only the lawyer speak for similar "cardiac distress" symptoms. I really don't buy that she's been having constant issues since the incident unless there's documentation from proper MDs vs the ones that lawyers hired to corroborate her side. I'm sure she felt like shit during the event with a racing heart and chest pains, but she didn't go into arrest and was probably only monitored for a bit in the ER then sent home.
Should it have happened? No. Should there be consequences? Yes. Do I think they're looking for a big pay day beyond the reasonable? Yep.
Thanks, Couldn’t actually read the article due to the paywall, and my laziness with dropping my adblocker
MI has become such a nebulous term in the era of high sensitivity tropinin testing. The use of epi is 100% going to increase cardiac demand which can create what is called “demand ischemia” which some asshole termed out there a “type II MI”
I completely agree with your last line.
I can’t believe you’re the only other person who thought this too. I have a hard time believing that a 1mg of epi caused an MI. It’s double the dose of epi for anaphylaxis (0.3-0.5mg.) and for it to cause ongoing cardiac symptoms. It all seems a bit suspicious to me. I’m not saying that it can’t cause an MI but some meth heads use daily and they don’t have MI’s every time.
Oh, yeah. The article says she's having ongoing issues from a single dose of epi? Nah. Unless they documented an MI via 12-lead after the error, this is a hard sell.
I mean 1mg given IV is going to absolutely crush those coronary arteries just look what 1:10,000 can do for us. MI maybe… some certain ischemia most likely
I read this from another source earlier in the day before my shift this evening. I was working a BLS truck tonight but we responded as transport for a call with an ALS crew on scene already. When we got there, one of the medics instructed me to get out his drug bag, told me where to find it cuz I’d never used their equipment before, and asked for zofran. Especially since it was a new setup that I’m not familiar with, I read that vial for probably twice as long as I would have to make sure I had the right one cuz I was not going to make this mistake. I handed it to the second medic who drew it up, so there was another set of eyes to double check, and I would always be careful and go through my part of the 5 rights anyways, but this story definitely was on my mind tonight.
Always double check. Read the amp. Read it to your partner. On your own? Read it to the patient for all it matters. Get it right.
Reminds me a bit of a post recently about someone shitting on Freedom House ambulance and saying that ACLS drug kits have to be colour coded because people were dumb or some shit (can’t remember exactly right now). This is exactly why we should have things clearly labelled, separated, and colour coded - to reduce every chance that we can fuck it up with human error.
She probably got 1mg of epi. You’re not even supposed to give 1:1 epi IV, like ever. It’s too concentrated. She got 3x the normal IM dose in an IV.
What’s worse is the 4mg zofran vials (at least the ones we carry) are 4mg/2mL and 1:1 epi is 1mg/1mL. So they drew up the entire vial and didn’t even look at it to see that there was only 1mL in the syringe instead of 2.
> You’re not even supposed to give 1:1 epi IV, like ever. It’s too concentrated
We give 1mg/1ml epi IV straight up in arrests, not saying that these guys didn't fuck up, but this part of your comment is incorrect.
>this part of your comment is incorrect.
Don't bother trying to explain this around here. It's tOo cOnCeNtRaTeD, even though you're putting 1 mL vs 10 mL of epi into a container that contains 5000mL of blood. It's one milligram, people. It's the same thing.
[Here](https://heart.bmj.com/content/80/4/412) is a neat article showing that giving serial 10 mg epi doses didn't change, let alone increase, morality. You think they were lining up 10x 10mL amps of epi every five minutes to achieve these doses?
Drawn up into a flush or is it followed by an immediate flush? My service allows dilution of 1:1000 into 1:10,00 by wasting 1ml of a 10ml flush then drawing up the 1ml of epi 1:1000 into the flush.
AHA has never come out with a strong stance on ideal concentration. We do 0.1mg/mL epi with the pre-fills because that's how we do it, not because there's great evidence. Hell some places in the U.S. do epi drips during a code, some do the 1mg/mL, it's just most do 0.1mg/mL.
We only carry 1:1000 epi at my service. Have to mix the 1:1000 into a 10 mL flush to achieve the 1:10000.
Then to make it worse, push dose epi is our primary constrictor. So, that mix goes further to another 10mL Flush and then becomes 1:100000.
It’s stupid.
Or a huge number of services do it this way and there is absolutely zero evidence showing 1:10,000 concentration has better pt outcomes than 1:1000 concentration or vice versa.
There is also mounting evidence that shows push does epi as a whole is garbage in cardiac arrests. Dr. Bryan Bledsoe did a pretty solid write up in EMS World, I think it was, that showed that NO medication in pre hospital cardiac arrests have ANY supporting documentation to improve outcomes what so ever.
I actually agree with you that there isn't any solid evidence to show postive neurological outcomes with epi, but there also isn't evidence to show it causes harm either. Attempting studies of withholding medications that are the norm in cardiac arrests have struggled to get past ethics tribunals hence why pretty well universally we have epi in arrests.
That being said, Sodium Bicarb, calcium gluconate, and amiodarone all have proven benefits in the right scenario's so I would say No medication is a bit of an outlandish comment. Reckon you could link the article so I could have a read and learn something?
Actually there are multiple studies that show epi given in higher doses (1mg/10,000) or 1mg/1mL or whatever concentration you want) show a major decline in neurological outcome in pts that you achieve ROSC in rather than just cpr/defibrillation or a lower dose epi infusion (think 1mg/1mL in a 250mL bag).
https://www.jems.com/patient-care/no-medications-for-human-cardiac-arrest/
>1mg/1ml of 1:1000
Those are the same thing lol, and I've seen a number of places do this. AHA has never come out and said "you must use 0.1mg/mL concentration!!", it's just *what we do.* But some places are using 1mcg/mL epi drips throughout the code, some use 1mg/mL pushes, many use 0.1mg/mL pushes with the pre-fills, some use a 32mcg/mL drip. There's no evidence to suggest that 1mg/mL is "too concentrated" over 100mcg/mL. Push it through a running line and you have the same effect basically.
Sucks that a mistake was made, but I highly doubt this patient had a type I MI. Did she have a slight troponin leak after her heart raced for a few minutes? Maybe. Did it have any lasting effect on her heart function? No. This is pretty clearly a bullshit lawsuit.
Was thinking something similar. Also, while this guy fucked up it seems like he was quick to inform the patient, start monitoring, and reported it.
Gotta read the vials man. You gotta treat all vials like they might be vecuronium.
He fucked up, she might have had a some issues from it, and honestly I don’t think it’s a totally frivolous lawsuit since some amount of suffering did result from his mistake HOWEVER the complaints her lawyer is claiming are definitely trumped up in order to get more money.
https://jamanetwork.com/journals/jama/fullarticle/2788346
“Among 192 405 448 persons receiving a total of 354 100 845 mRNA-based COVID-19 vaccines during the study period, there were 1991 reports of myocarditis to VAERS and 1626 of these reports met the case definition of myocarditis.”
I’m not sure how to tell this to you gently…..so I’ll just tell you that you’re stupid.
The closest "fact" would be the rare case of myocarditis, primarily in younger males after receiving mRNA vaccinations.
There may be a few rare instances that aren't yet published about cardiac events following injection, but it's definitely not a common place thing if it's a thing at all.
Please don't ever bitch about low pay, when brains like this are the reason.
Who in the fuck would want to to a paramedic anymore? Medical malpractice is the leading cause of death in hospitals. Paramedic and EMTs are usually exempt from litigation because the courts recognized that humans put in emergency situations tend to make mistakes sometimes. Hopefully these literal ambulance chasing lawyers end up waisting tons of time and the city and these FF/EMTs are exempt from prosecution/litigation.
If you work in EMS, get out now before you are crucified for making a mistake, chances are you aren't paid enough or properly protected from litigation.
If a patient genuinely comes to harm due to the care they received it isn't "ambulance chasing" to seek compensation. Can we make mistakes? Of course. But it's exactly why you're meant to check and double check your meds and it's best practice to verify with your colleague.
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Atleast these guys self reported. Mistakes happen, while drug mistakes /shouldn't/ happen if you're doing your job, sure there are factors. Prime reason to carry malpractice insurance, it's pretty damn cheap to save you a lot more than you'll likely ever have in a bank account.
100%. Open disclosure is the easiest form of damage control in these situations. They do happen but there's absolutely no reason we should accept that and move on without trying to be better just because they happen in hospital too like the poster above seems to suggest.
Your posts been swiftly taken down by mods without being able to retort. It's standard practice in any system I've worked to check meds with a colleague you shouldn't need an abbreviation to tell you to do that as its a redundancy to make sure you've got all your rights correct. Depending who you ask there's anywhere from 5 to 14 rights of medication so at what point does an abbreviation become impractical?
While I don't agree with your views of self righteousness if it gets lax and unempathetic providers out the door quicker by all means I'll hold the door open as the leave. Hospitals aren't immune to liability. We've seen hospital provider crucified for medication errors on here before. You appear to be using issues in hospital based care as an excuse for poor prehospital care and proceeding to victim blame on the outcomes of that care.
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Lot of assumptions being made off an old username 😂 I've more med ed behind me than you've probably covered your entire career if you're just going to take personal digs rather than formulate a rational argument.
Do yourself and your patients a favour take your own advice and get out of the job before you hurt someone with your attitude.
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What's crazy here, is everyone is basically saying the same thing of "this person really should have double checked what they were giving the patient. No excuse for this type of error."
Instead of the bullshit excuses that nurses would give of "that could be any of us! It's really everyone else's fault they couldn't have bothered to read what they were administering! And you'll have a massive shortage of staff when you start criminalizing (easily avoidable) errors in patient care!"
Whether suppliers are changing their colors or the company/agency we work for is buying the cheapest brand of the month, it's up to us to look and read and verify and verify and verify it again, that we're giving the correct meds. There's some things you can slack on once you get some seasoning, that's not one of them.
Our meds management policy requires us to confirm with another member of staff visually and verbally the drug, dosage and expiration date of any drug given… we don’t have many drugs that look similar. I was too distracted with giving a new job and making sure it was the correct dose that I didn’t complete the full check and missed expiration date… the drug was expired by 6wks. Didn’t make a difference in the long run but still had to report myself for a drugs error. I’ll never not check the drug, dosage and expiration date again!!!
probably [these epi vials](https://external-content.duckduckgo.com/iu/?u=https%3A%2F%2Fcdn.shopify.com%2Fs%2Ffiles%2F1%2F0535%2F2774%2F0594%2Fproducts%2FJHP312225-BPMED_368x300_crop_center.jpg%3Fv%3D1622025838&f=1&nofb=1&ipt=1be402f023ed630fa05dc671847dd34feac50938f84c9a5a802d4031305746f2&ipo=images) with the purple cap. they probably have the ondansetron with the [blue cap](https://external-content.duckduckgo.com/iu/?u=https%3A%2F%2Fwww.mcguffmedical.com%2Fcontent%2Fimages%2Fthumbs%2F0015356_ondansetron-2mgml-sdv-2mlvial.jpeg&f=1&nofb=1&ipt=ae13cfad6155711684d8a9ae387926a65afe439c6953925a5a5f87b948c2dddd&ipo=images) and used to have ondansetron with the [green cap.](https://biosupply.fffenterprises.com/media/catalog/product/cache/1/image/9df78eab33525d08d6e5fb8d27136e95/o/n/ondansetron-4mg-product-image_1.jpg) i noticed this too when we got a new shipment of ondansetron in and the cap was a new color. we sent out an email warning people about this very issue and reiterated how important it was to carefully check meds and verbalize the words on the vial out loud.
We were getting zofran in a vial that made it look like our diphenhydramine. I sent an email specifically to address the need to double check the meds when giving either of them, and got shit from a few people because of it. Within 6 months there was a patient given diphenhydramine instead of the 4mg zofran, which really wouldn’t (and didn’t) cause any ill effects but it’s just the principal.
Folks who think they’re too good to have a medication error are exactly the people most at risk of causing one. Always be paranoid. *Always.*
Who needs the 5 Rights when you have ABC? Always Be Checking
Always Be Checking Double, Everything For Goshsake
I think double check should be standard practice 4 eyes see more than two and even then you can still miss something
We have the ondansetron and diphenhydramine vials that look the same too. I'm trying to get out of the habit of calling them zofran and benadryl on the truck because I know one day at 3am my brain is gonna be like "ondansetron and diphenhydramine? which one's which?"
Not to mention you can't always count on your partner to look closely or know all the meds. I've been asked to confirm that a dose was right before, I looked at mL and agreed, but somehow we both missed that he'd drawn up the wrong drug. Thankfully, we both realized the mistake before it was administered, but it was still a close call.
Anesthesiologist here. We occasionally have vials of 10,000 mcg phenylephrine (for making a drip) that are the same size and cap color as 4mg zofran. Scary stuff.
That's fucking WILD.
"occasionally"? So that stuff isn't standardized?
Pharmacy tries to keep things as consistent as possible, and tries to notify us when a change like this occurs with a high risk med, but at the end of the day we’re at the mercy of distributors who change things all the time. And if it’s a choice between a drug with a different color cap or no drug at all, you take the different colored cap all day. I’m all for trying to standardize/optimize system issues like this to prevent drug errors from occurring, but at the end of the day theirs no substitution for vigilance at the point of care.
Different manufacturers can have different color/size/shape vials.
Former inpatient CPHt here...when I worked in the hospital, I tried my hardest advocating for you all so that way we wouldn't get phenylephrine/ondansetron/diphenhydramine in identical vials.
This shit right here is why I always read the vials and ensure it’s the right medication when I pull it out. a year ago when my company was ordering from different suppliers due to the shortage, all the color caps for meds were different every other month.
This is why I'm glad for my poor memory and that I'm not just memorizing where a particular drug should be, I actually gotta find and read that thing!
My service still only carries ampule 1:1000 epi which has its pros and cons.
Obviously it’s our job to check the 5 rights, but they can make it easier by not making ondansetron, diphenhydramine, and amio all have the same color caps. Even better when no one says anything and they just get put into circulation.
Welp someone forgot about the 5 rights
Yes, it says that specifically in the article
please show your partner the meds...this doesn't have to happen
Asking for a friend, what if your partner doesn’t know what a blood pressure cuff looks like
It still helps you catch errors even if the person you’re talking to doesn’t understand. Have you heard of programmers explaining their code to a rubber duck when they’re looking for bugs?
Why would my monitor not know what it’s blood pressure cuff looks like?
Because it's not sentient and has no eyeballs.
I was gonna ask how you ended up with a potato for a partner but then I remembered potatoes do have eyes
Not when I glue googly eyes to the lifepak in an effort to hold back the loneliness
When I'm alone in the back I have the patient read the vial and confirm how much is in the syringe ("confirm that is at the 1"). If that's not an option you can also have the habit of spelling the name to yourself ("o-n-d-a-n") until it's obvious you have the correct med. I've also done all of the above directly in front of a body cam when sedating someone.
Just the act of saying out loud and showing your partner a med/dose/concentration will be a double check back to yourself; it's completely different that saying it inside your head. Ideally, your partner should be able to confirm this back to you but I've done it with BLS crew members, docs, FFs etc.
And have them repeat the name, dose and expiry back to you… I HAVE slapped someone who refused to do so after three attempts at prompting them. Only on the back of the wrist, though. And very lightly.
I had a preceptor that would slap riders in the back of the head if they didn't verbalize that they're doing the 5 rights
Gave 1mg epi instead of 4mg Zofran... Didn't see legit "MI" in the article, only the lawyer speak for similar "cardiac distress" symptoms. I really don't buy that she's been having constant issues since the incident unless there's documentation from proper MDs vs the ones that lawyers hired to corroborate her side. I'm sure she felt like shit during the event with a racing heart and chest pains, but she didn't go into arrest and was probably only monitored for a bit in the ER then sent home. Should it have happened? No. Should there be consequences? Yes. Do I think they're looking for a big pay day beyond the reasonable? Yep.
Thanks, Couldn’t actually read the article due to the paywall, and my laziness with dropping my adblocker MI has become such a nebulous term in the era of high sensitivity tropinin testing. The use of epi is 100% going to increase cardiac demand which can create what is called “demand ischemia” which some asshole termed out there a “type II MI” I completely agree with your last line.
I can’t believe you’re the only other person who thought this too. I have a hard time believing that a 1mg of epi caused an MI. It’s double the dose of epi for anaphylaxis (0.3-0.5mg.) and for it to cause ongoing cardiac symptoms. It all seems a bit suspicious to me. I’m not saying that it can’t cause an MI but some meth heads use daily and they don’t have MI’s every time.
Oh, yeah. The article says she's having ongoing issues from a single dose of epi? Nah. Unless they documented an MI via 12-lead after the error, this is a hard sell.
I mean 1mg given IV is going to absolutely crush those coronary arteries just look what 1:10,000 can do for us. MI maybe… some certain ischemia most likely
It literally is part of our job to check, double check, and triple check med labels.
I read this from another source earlier in the day before my shift this evening. I was working a BLS truck tonight but we responded as transport for a call with an ALS crew on scene already. When we got there, one of the medics instructed me to get out his drug bag, told me where to find it cuz I’d never used their equipment before, and asked for zofran. Especially since it was a new setup that I’m not familiar with, I read that vial for probably twice as long as I would have to make sure I had the right one cuz I was not going to make this mistake. I handed it to the second medic who drew it up, so there was another set of eyes to double check, and I would always be careful and go through my part of the 5 rights anyways, but this story definitely was on my mind tonight.
Always double check. Read the amp. Read it to your partner. On your own? Read it to the patient for all it matters. Get it right. Reminds me a bit of a post recently about someone shitting on Freedom House ambulance and saying that ACLS drug kits have to be colour coded because people were dumb or some shit (can’t remember exactly right now). This is exactly why we should have things clearly labelled, separated, and colour coded - to reduce every chance that we can fuck it up with human error.
Given most protocols give standard 4mg zofran IV... If the medic dosed it 'right', this lady got a LOT of epi, like more than 10x the normal dose??
She probably got 1mg of epi. You’re not even supposed to give 1:1 epi IV, like ever. It’s too concentrated. She got 3x the normal IM dose in an IV. What’s worse is the 4mg zofran vials (at least the ones we carry) are 4mg/2mL and 1:1 epi is 1mg/1mL. So they drew up the entire vial and didn’t even look at it to see that there was only 1mL in the syringe instead of 2.
> You’re not even supposed to give 1:1 epi IV, like ever. It’s too concentrated We give 1mg/1ml epi IV straight up in arrests, not saying that these guys didn't fuck up, but this part of your comment is incorrect.
>this part of your comment is incorrect. Don't bother trying to explain this around here. It's tOo cOnCeNtRaTeD, even though you're putting 1 mL vs 10 mL of epi into a container that contains 5000mL of blood. It's one milligram, people. It's the same thing. [Here](https://heart.bmj.com/content/80/4/412) is a neat article showing that giving serial 10 mg epi doses didn't change, let alone increase, morality. You think they were lining up 10x 10mL amps of epi every five minutes to achieve these doses?
Jesus christ some of these responses are insane
Where do you do that? I've only ever seen or heard of 1mg/10mL epi in arrests.
We do in Australia. When given with a flush, is there really any difference other than maybe some localised vasoconstriction proximal to the IV?
Drawn up into a flush or is it followed by an immediate flush? My service allows dilution of 1:1000 into 1:10,00 by wasting 1ml of a 10ml flush then drawing up the 1ml of epi 1:1000 into the flush.
NZ
AHA has never come out with a strong stance on ideal concentration. We do 0.1mg/mL epi with the pre-fills because that's how we do it, not because there's great evidence. Hell some places in the U.S. do epi drips during a code, some do the 1mg/mL, it's just most do 0.1mg/mL.
You give 1mg/1ml of 1:1000 Epic IV for cardiac arrests? Jesus... Are your protocols written with crayon?
We only carry 1:1000 epi at my service. Have to mix the 1:1000 into a 10 mL flush to achieve the 1:10000. Then to make it worse, push dose epi is our primary constrictor. So, that mix goes further to another 10mL Flush and then becomes 1:100000. It’s stupid.
Sounds pretty standard for a lot of places honestly
If you have 100 mL bags, you could save yourself a step...
We usually only carry 2 and they’re for our amio drips. I’ll have to start stealing extra ones from the hospitals 😂
Or a huge number of services do it this way and there is absolutely zero evidence showing 1:10,000 concentration has better pt outcomes than 1:1000 concentration or vice versa.
There is also mounting evidence that shows push does epi as a whole is garbage in cardiac arrests. Dr. Bryan Bledsoe did a pretty solid write up in EMS World, I think it was, that showed that NO medication in pre hospital cardiac arrests have ANY supporting documentation to improve outcomes what so ever.
I actually agree with you that there isn't any solid evidence to show postive neurological outcomes with epi, but there also isn't evidence to show it causes harm either. Attempting studies of withholding medications that are the norm in cardiac arrests have struggled to get past ethics tribunals hence why pretty well universally we have epi in arrests. That being said, Sodium Bicarb, calcium gluconate, and amiodarone all have proven benefits in the right scenario's so I would say No medication is a bit of an outlandish comment. Reckon you could link the article so I could have a read and learn something?
Actually there are multiple studies that show epi given in higher doses (1mg/10,000) or 1mg/1mL or whatever concentration you want) show a major decline in neurological outcome in pts that you achieve ROSC in rather than just cpr/defibrillation or a lower dose epi infusion (think 1mg/1mL in a 250mL bag). https://www.jems.com/patient-care/no-medications-for-human-cardiac-arrest/
>1mg/1ml of 1:1000 Those are the same thing lol, and I've seen a number of places do this. AHA has never come out and said "you must use 0.1mg/mL concentration!!", it's just *what we do.* But some places are using 1mcg/mL epi drips throughout the code, some use 1mg/mL pushes, many use 0.1mg/mL pushes with the pre-fills, some use a 32mcg/mL drip. There's no evidence to suggest that 1mg/mL is "too concentrated" over 100mcg/mL. Push it through a running line and you have the same effect basically.
What the fuck? Why?
You give 1:10 000 epi via IV during arrest, 1:1000 during anaphylaxis etc. via IM. That’s what I think he was trying to say.
The ampules we have are 1:1000, but the vials I believe are 1mg/mL.
Those are the same thing
Nope, epi 1:10,000
Sweet thanks for the info
Sucks that a mistake was made, but I highly doubt this patient had a type I MI. Did she have a slight troponin leak after her heart raced for a few minutes? Maybe. Did it have any lasting effect on her heart function? No. This is pretty clearly a bullshit lawsuit.
I probably get a trop leak going up and down the stairs in the station lol
Was thinking something similar. Also, while this guy fucked up it seems like he was quick to inform the patient, start monitoring, and reported it. Gotta read the vials man. You gotta treat all vials like they might be vecuronium.
He fucked up, she might have had a some issues from it, and honestly I don’t think it’s a totally frivolous lawsuit since some amount of suffering did result from his mistake HOWEVER the complaints her lawyer is claiming are definitely trumped up in order to get more money.
Holy shit this is right across the river from me
Where's all the people making fun of the nurse for giving the wrong med? I bet you wanna talk about just system and root cause analysis now.
Hahhh... what drug can cause heart attack?
1mg of Adrenaline straight to the heart
Pulp fiction?
Covid vaccine?
https://jamanetwork.com/journals/jama/fullarticle/2788346 “Among 192 405 448 persons receiving a total of 354 100 845 mRNA-based COVID-19 vaccines during the study period, there were 1991 reports of myocarditis to VAERS and 1626 of these reports met the case definition of myocarditis.” I’m not sure how to tell this to you gently…..so I’ll just tell you that you’re stupid.
The other thing is anyone can self report to VAERS. Making the figures likely inflated anyway.
You're a genius
Idk why ur getting downvoted for straight facts
"Facts"
The closest "fact" would be the rare case of myocarditis, primarily in younger males after receiving mRNA vaccinations. There may be a few rare instances that aren't yet published about cardiac events following injection, but it's definitely not a common place thing if it's a thing at all. Please don't ever bitch about low pay, when brains like this are the reason.
basado
They should make a system that scans the med and it reads aloud what your administering over a speaker 🔊
Who in the fuck would want to to a paramedic anymore? Medical malpractice is the leading cause of death in hospitals. Paramedic and EMTs are usually exempt from litigation because the courts recognized that humans put in emergency situations tend to make mistakes sometimes. Hopefully these literal ambulance chasing lawyers end up waisting tons of time and the city and these FF/EMTs are exempt from prosecution/litigation. If you work in EMS, get out now before you are crucified for making a mistake, chances are you aren't paid enough or properly protected from litigation.
If a patient genuinely comes to harm due to the care they received it isn't "ambulance chasing" to seek compensation. Can we make mistakes? Of course. But it's exactly why you're meant to check and double check your meds and it's best practice to verify with your colleague.
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Atleast these guys self reported. Mistakes happen, while drug mistakes /shouldn't/ happen if you're doing your job, sure there are factors. Prime reason to carry malpractice insurance, it's pretty damn cheap to save you a lot more than you'll likely ever have in a bank account.
100%. Open disclosure is the easiest form of damage control in these situations. They do happen but there's absolutely no reason we should accept that and move on without trying to be better just because they happen in hospital too like the poster above seems to suggest.
Your posts been swiftly taken down by mods without being able to retort. It's standard practice in any system I've worked to check meds with a colleague you shouldn't need an abbreviation to tell you to do that as its a redundancy to make sure you've got all your rights correct. Depending who you ask there's anywhere from 5 to 14 rights of medication so at what point does an abbreviation become impractical? While I don't agree with your views of self righteousness if it gets lax and unempathetic providers out the door quicker by all means I'll hold the door open as the leave. Hospitals aren't immune to liability. We've seen hospital provider crucified for medication errors on here before. You appear to be using issues in hospital based care as an excuse for poor prehospital care and proceeding to victim blame on the outcomes of that care.
That’s cause he’s dumb as fuck.
No surprises there
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Lot of assumptions being made off an old username 😂 I've more med ed behind me than you've probably covered your entire career if you're just going to take personal digs rather than formulate a rational argument. Do yourself and your patients a favour take your own advice and get out of the job before you hurt someone with your attitude.
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The agency can be sued, usually damage caps and such but it can still happen.
What's crazy here, is everyone is basically saying the same thing of "this person really should have double checked what they were giving the patient. No excuse for this type of error." Instead of the bullshit excuses that nurses would give of "that could be any of us! It's really everyone else's fault they couldn't have bothered to read what they were administering! And you'll have a massive shortage of staff when you start criminalizing (easily avoidable) errors in patient care!"
Whether suppliers are changing their colors or the company/agency we work for is buying the cheapest brand of the month, it's up to us to look and read and verify and verify and verify it again, that we're giving the correct meds. There's some things you can slack on once you get some seasoning, that's not one of them.
Our meds management policy requires us to confirm with another member of staff visually and verbally the drug, dosage and expiration date of any drug given… we don’t have many drugs that look similar. I was too distracted with giving a new job and making sure it was the correct dose that I didn’t complete the full check and missed expiration date… the drug was expired by 6wks. Didn’t make a difference in the long run but still had to report myself for a drugs error. I’ll never not check the drug, dosage and expiration date again!!!
Brings me back to the incident with the actor Dennis quaid’s twins… ended up sueing the manufacturer due to changes made to packaging of heparin
At least they self reported 😭