Endotracheal meds?

[WilcoWorld]

I just read an EMed Home blurb stating that endotracheal meds should not be administered via an LMA. That got me thinking, does anyone give meds down the ETT anymore? It would seem that with the wide use of IO's there's no longer a need.

When was the last time you gave a dose of epinephrine or naloxone down an ET tube?

---

Members don't see this ad.

 

[DrDrummer]

The most common scenario for ETT meds I've seen is neonatal resuscitation, giving epi via the ETT until you get an umbilical line.

 

[WilcoWorld]

The most common scenario for ETT meds I've seen is neonatal resuscitation, giving epi via the ETT until you get an umbilical line.

Good thought.

 

[CajunMedic]

I don't think I've given anything down the tube in the field in at least 5 years (maybe more). The EZ-IO and mucosal atomizer have made it pretty much unnecessary.

 

[Arcan57]

My thought when I read the subject of the thread: "That's why God invented the IO".

 

[dchristismi]

When was the last time you gave a dose of epinephrine or naloxone down an ET tube?

Uh, about 4 hours ago.
Which is really crazy because it was the first time I've seen it done or done it in years.

But... 3 mo infant, found down, asystolic in crib, EMS pulls out all the stops, briefly PEA (supposedly,) then back to asystole. EMS inserted 1st IO, which "blew." We inserted second (both anterior tibia as CPR in progress), and I don't know if the IO was too long, or just wasn't perfectly positioned, but the entire calf infiltrated. (And it was the smallest one we had.) No other IV access despite multiple attempts by 2 docs, and a bunch of damn-good ED nurses. And so we ended up dosing at least one epi via ETT.

I've never dealt with an IO that did that. And considering what little we had to work with, in a very small baby, we did it. As noted above, this is about the only time I'd imagine it being used these days. I contemplated a humeral or even sternal IO, but I think we all knew he was gone, in all likelihood before parents even noticed. Still, you work a baby as long as you have to.

 

[WilcoWorld]

Uh, about 4 hours ago.
Which is really crazy because it was the first time I've seen it done or done it in years.

But... 3 mo infant, found down, asystolic in crib, EMS pulls out all the stops, briefly PEA (supposedly,) then back to asystole. EMS inserted 1st IO, which "blew." We inserted second (both anterior tibia as CPR in progress), and I don't know if the IO was too long, or just wasn't perfectly positioned, but the entire calf infiltrated. (And it was the smallest one we had.) No other IV access despite multiple attempts by 2 docs, and a bunch of damn-good ED nurses. And so we ended up dosing at least one epi via ETT.

I've never dealt with an IO that did that. And considering what little we had to work with, in a very small baby, we did it. As noted above, this is about the only time I'd imagine it being used these days. I contemplated a humeral or even sternal IO, but I think we all knew he was gone, in all likelihood before parents even noticed. Still, you work a baby as long as you have to.

Wow. Rough case.

 

[TooMuchResearch]

Wow. Rough case.

Medicine sucks.

 

[diphenyl]

It's a very rare event to have to dump meds down the tube when I always have access to an IO kit. The only time I have had to do it is in the field on a rig during a code when we can't get access. People forget often that in addition to the epi you have to put some NSS down there too.

 

[sakigt]

We did ETT a few months ago. Discharged patient waiting for ride in room goes unresponsive. Probably PE. It was a floor code and they didnt have an IO kit. I (Pharmacist) run to the ER to get one (5 floors) but they did ETT meds in the meantime. Didnt make it.

 

[medicsb]

Probably get the same results with just putting saline down the tube. AHA recommended doubling the dose even though you'd actually have to give 3-10 times the dose to get near blood concentration of IV dosing. Why not go for broke and just give intracardiac epi. At least they might actually get a dose of the drug.