In this weeks podcast release we discuss the new concept being looked at in the HEMS industry of push dose pressors in the RSI procedure. For years, anesthesiology has been giving push dose pressors, primarily (Phenylephrine) Neo-synephrine in the operating room during surgery and the RSI procedure to combat the loss of vascular tone secondary to giving a paralytic such as Succinylcholine or Rocuronium.
As such, many large air medical providers are looking at the data surrounding cardiac arrest secondary to a successful, uneventful RSI procedure in conjunction with a hemodynamically compromised trauma or vasogenic shock patient needing advanced airway management and RSI.
Come join us in this case study demonstration and discussion on the concept, preparing, mixing and overall administration techniques.
Phenylephrine – (Neo-synephrine) – This pressors is a potent alpha-receptor agonist
Neo-synephrine is a potent alpha agonist that has great affects on both systolic and diastolic blood pressures. Due to the dominant alpha properties the drug has minimal affects on beta stimulation. As such myocardial oxygen consumption is low. In the shock state, Neo-synephrine is good for vasogenic shock such as neurogenic shock states. However, caution should be taken for patients with renal disease or decreased renal function due to the decreased organ perfusion seen with the medication.
Supplied concentration: 10mg/ml
Onset: 1 minute
Half-life: 5 mins
Draw up 1ml of Neo-synephrine out of vial. That will give you 10 mg. Add that 1 ml to a 100ml bag on NS and mix. That gives you a concentration now of 100mcg/ml.
Now draw up 5-10 ml from bag. This gives you multiple doses. Every 1 ml = 100mcg.
Dosing will be dependent on protocol. However normal range is going to be 0.5-2 ml q 1-5 minutes. That = 50mcg-200mcg per dose.
Here’s a link to the EMcrit podcast that looked at this subject from the emergency department perspective. Scott Weingart has exstensive experience with the technique and is much more abreast on the clincal application.
Here’s a link to the EMcrit & Scott Weingart’s great mixing and prepartion sheet.