IO adenosine

[sadface]

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Curious to get some input from you all. Has anyone seen IO adenosine work for tachyarrithmias? Do you think it’s worth trying if the team can’t get other access?

 

[AC3_PharmD]

I personally have never seen it attempted and to be honest I don't think it would be worth it. Technically it is an option, but most of the providers I've worked with head straight to the amiodarone OR will get ready to head to the other side of the algorithm to cardiovert.

 

[Rockinacoustic]

Curious to get some input from you all. Has anyone seen IO adenosine work for tachyarrithmias? Do you think it’s worth trying if the team can’t get other access?

Assuming the patient is conscious I'm sure they'd prefer electricity to the IO. Heck, the IO placement itself may terminate the SVT...

 

[sadface]

Assuming the patient is conscious I'm sure they'd prefer electricity to the IO. Heck, the IO placement itself may terminate the SVT...

Unfortunately I don’t have unilateral decision making regarding access 😛

 

[storyhill2]

From my experience and what doctors have told me is that patients don't feel pain from starting IO access. I think if no other access is possible IO is the next best solution. I haven't tried this med via this route.

 

[AC3_PharmD]

From my experience and what doctors have told me is that patients don't feel pain from starting IO access. I think if no other access is possible IO is the next best solution. I haven't tried this med via this route.

They probably don't feel any pain but they definitely feel pressure and hear the sound of that drill 😵 That would knock me out of an arrhythmia too!

 

[Dred Pirate]

We did it on an 8 day old neonate that we couldn't get IV access in - termianted the SVT (>300 BPM to 100 BPM). Worked like a charm, never seen it done in adults thou - generally we have been able to IV access via ultrasound.

Slightly unrelated, a month ago we had a guy sneeze and terminate his SVT after blowing on the syringe failed.

 

[Rockinacoustic]

From my experience and what doctors have told me is that patients don't feel pain from starting IO access. I think if no other access is possible IO is the next best solution. I haven't tried this med via this route.

Awake patients certainly do feel pain from IO access...

Placing an IO just to give adenosine sounds backwards in my mind, and makes an already finicky treatment likely to fail. Proper ACLS mandates you establish IV access and chemically cardiovert if the patient is hemodynamically stable and vagal manuvers fail for SVT. Your provider can always drop a central line if their access is really that bad.

 

[Dred Pirate]

Awake patients certainly do feel pain from IO access...

Placing an IO just to give adenosine sounds backwards in my mind, and makes an already finicky treatment likely to fail. Proper ACLS mandates you establish IV access and chemically cardiovert if the patient is hemodynamically stable and vagal manuvers fail for SVT. Your provider can always drop a central line if their access is really that bad.

There are some great you tube videos on Awake people. They flinch Like an iv being placed, but don’t scream Like you would think of somebody drilled into your bone like something from a saw movie. Sometimes you just don’t have a choice. If you have that bad of access and often don’t have time to place a central line.

 

[sadface]

I think the bone drilling part doesn’t cause pain but getting through the skin/muscle does hurt. Unfortunately most the docs I work with can’t place a central line….

It seems experience is variable but it seems reasonable to try if backed into a corner access-wise. Thanks!

 

[njac]

I think the bone drilling part doesn’t cause pain but getting through the skin/muscle does hurt. Unfortunately most the docs I work with can’t place a central line….

It seems experience is variable but it seems reasonable to try if backed into a corner access-wise. Thanks!

My understanding is that it isn’t the placement of the IO that hurts - it’s that first flush through the bone marrow. And why we should theoretically flush with lido, but I feel like it almost never happens (most of my IO patients are obtunded or already dead)

 

[Rockinacoustic]

Funny enough, I had this exact scenario occur last week:

60 year old with comes in with respiratory distress, EMS couldn't get a line so they placed an IO. Patient is tachy in the 180s, narrow complex. Cardioversion by EMS didn't work. Intubated for airway protection and the HR is still 180s-190s.

Doc asks if we should do adenosine through IO- i recommend Dilt instead as they have a good pressure. Dilt does squat. We finally get a peripheral and try adenosine 6 mg, then 12 mg, which also does nothing. Finally, a dilt drip brings them down to the 120s. It probably wasn't SVT, but sinus tach. Labs come back and the patient is floridly septic.

Just a reminder that tachyarrhythmias are often the sequela of something, and not the problem in itself.

 

[sadface]

Funny enough, I had this exact scenario occur last week:

60 year old with comes in with respiratory distress, EMS couldn't get a line so they placed an IO. Patient is tachy in the 180s, narrow complex. Cardioversion by EMS didn't work. Intubated for airway protection and the HR is still 180s-190s.

Doc asks if we should do adenosine through IO- i recommend Dilt instead as they have a good pressure. Dilt does squat. We finally get a peripheral and try adenosine 6 mg, then 12 mg, which also does nothing. Finally, a dilt drip brings them down to the 120s. It probably wasn't SVT, but sinus tach. Labs come back and the patient is floridly septic.

Just a reminder that tachyarrhythmias are often the sequela of something, and not the problem in itself.

For some reason I keep having to argue with attendings to not add/titrate metoprolol for sinus tach in the 110s lately 😬