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Posted: 2/17/2015 3:29:58 AM EDT
[#1]
We were using it when I started. Must have gotten dropped in the late 90s. I don't remember exactly when.
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Posted: 2/17/2015 11:03:27 AM EDT
[#2]
I am not sure what makes me feel older, hearing the stuff we used to use referred to as old school, or having the children of guys I ran with way back when working for me now. When the first kid started It was like a kick in the gut. When the second one started I joked about needing a Jazzy, lol.
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Posted: 2/17/2015 1:21:08 PM EDT
[#3]
I feel your pain. Bretyllium, Isuprel, Datascopes and Lifepack 5s, bicarb for everyone, EOAs.....
And how many times have we seen MAST pants go in and out of fashion??? |
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Posted: 2/17/2015 9:42:32 PM EDT
[#4]
Epi>Shock (200)>Lido>Shock (300)>Bretylium>Shock (360)...
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Posted: 2/18/2015 12:33:50 AM EDT
[#5]
Quote HistoryQuoted:
Epi>Shock (200)>Lido>Shock (300)>Bretylium>Shock (360)... Wasn't it still shock, shock, shock back then? You go through so many guideline revisions and they all start to blend together. Levophed, leave 'em dead! |
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Posted: 2/18/2015 5:50:36 PM EDT
[#6]
Quote HistoryQuoted:
Wasn't it still shock, shock, shock back then? You go through so many guideline revisions and they all start to blend together. Levophed, leave 'em dead! Quote HistoryQuoted:
Quoted:
Epi>Shock (200)>Lido>Shock (300)>Bretylium>Shock (360)... Wasn't it still shock, shock, shock back then? You go through so many guideline revisions and they all start to blend together. Levophed, leave 'em dead! Shock, shock, shock, everybody (epi) shock, little (lido) shock, big (bretyllium) shock bicarb |
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Posted: 2/18/2015 10:00:44 PM EDT
[#7]
Every little boy must pee sometime.
That brings back memories. |
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Posted: 2/18/2015 10:18:40 PM EDT
[#8]
Have no fear, rotating tourniquets for CHF ought to be coming back in vogue any day now...
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Posted: 2/18/2015 11:00:33 PM EDT
[#9]
I think it was mentioned when I was in medic school by our instructor.
You old fogies. |
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Posted: 2/18/2015 11:25:38 PM EDT
[#10]
Quote HistoryQuoted:
I think it was mentioned when I was in medic school by our instructor. You old fogies.  I'm not that old (I don't think).
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Posted: 2/19/2015 2:02:04 PM EDT
[#11]
I just liked saying 'Bretylium', cuz it sounded cool.
. I gave it a few times.
My instructors called it the death drug, because if you got far enough down the algorithm to use it, they probably weren't gonna make it. The timing of your post is funny. I actually just googled it last week to find out why it wasn't used anymore. Been away from EMS for a while, but was looking through the current ACLS guidelines. (getting back in at the EMT level, and looking at maybe getting paramedic certified again.) |
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Posted: 2/19/2015 8:11:29 PM EDT
[#12]
Quote HistoryQuoted:
Shock, shock, shock, everybody (epi) shock, little (lido) shock, big (bretyllium) shock bicarb Quote HistoryQuoted:
Quoted:
Quoted:
Epi>Shock (200)>Lido>Shock (300)>Bretylium>Shock (360)... Wasn't it still shock, shock, shock back then? You go through so many guideline revisions and they all start to blend together. Levophed, leave 'em dead! Shock, shock, shock, everybody (epi) shock, little (lido) shock, big (bretyllium) shock bicarb You are correct.  Stacked shocks were in front of the meds, and after the stacks they were all @ 360.
No bicarb in our system when I first certified though.
While normally I'd be upset at having forgotten that, I'm actually kind of glad, as hopefully I'm less likely to do what a senior officer on our department did once and tell the junior medic to give the arrested baby call 1:100 Epi IVP - a technique that vanished about the same time Bretylium did. Yeah, said senior officer is still a Medic on paper, but hasn't ridden a rig in probably 10 years. One of the good things about actively teaching outside the department as well - forces me to stay current in our protocols. |
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Posted: 2/19/2015 11:23:43 PM EDT
[#13]
I think they stopped producing it back in 98 or 99 because the raw ingredients ran out.
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Posted: 2/19/2015 11:27:18 PM EDT
[#14]
Quote HistoryQuoted:
I think they stopped producing it back in 98 or 99 because the raw ingredients ran out. That is the reason I remember for it being discontinued. |
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Posted: 2/20/2015 1:54:27 PM EDT
[#15]
haha just a few months ago we were dealing with a normal saline shortage. That's right, we were running short on salt water.
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Posted: 2/20/2015 5:36:59 PM EDT
[#16]
Don't forget the precordial thump for a witnessed arrest......
I started in 1995 
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Posted: 2/20/2015 5:44:13 PM EDT
[#17]
Quote HistoryQuoted:
haha just a few months ago we were dealing with a normal saline shortage. That's right, we were running short on salt water. Yeah, I've heard the "shortage" excuse for all kinds of stuff. I had just recertified - and thus was considered a "senior paramedic" when the ConEd guy came in an told us that the system was changing from preloads of Narcan to ampules, because the manufacturer was ceasing production. Our shift:   
So yours truly, being the self-designated toastmaster, bullsh*tter and general PITA calls him on it 
So you're telling me if I call the company, ask for the domestic sales division and ask them if they are stopping production of one of the two most popular medications administered in the pre-hospital arena they're going to tell me yes? And that company isn't the only one. There are at least four sources for naloxone as a generic. What if I call them, and see what they say, especially if the main supplier is getting out of the business? Or are they going to say they have no idea what I'm talking about, because in reality this is the decision of a bean counter in hospital administration who can't justify spending $25.00 for preloads of a drug that they can get in an ampule form for $2.50? Much "uhh", "well" and "ummm" followed before he finally admitted it wasn't the manufacturer, it was the bookkeepers. He's out of EMS now and doing something in management in another state. I wish him nothing but luck, as long as he stays there and off the rig. 
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Posted: 2/21/2015 4:32:14 PM EDT
[#18]
So what was bretylium made from, that they somehow ran out of after almost 40 years of production...???
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Posted: 2/21/2015 5:18:13 PM EDT
[#19]
Quote HistoryQuoted:
So what was bretylium made from, that they somehow ran out of after almost 40 years of production...??? Many of the sources simply echo the vague "lack of raw materials" in Wiki. I did find this: o-Toluidine Methyl bromide N,N-Dimethylbenzylamine 2-Bromotoluene 2-Bromobenzyl bromide Ethyl p-toluenesulfonate: Used as ethylation reagent organic synthesis. Raw material for bretylium tosylate, intermediate of sensitive material, malleableize reagent for acetic acid fibre. ETA2 - it was Toluene. Interestingly enough, it appears they were worried about a shortage before.... like in 1918 |
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Posted: 2/22/2015 4:59:26 PM EDT
[#20]
Quote HistoryQuoted:
Don't forget the precordial thump for a witnessed arrest...... I started in 1995 rookie |
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Posted: 2/22/2015 7:58:32 PM EDT
[#21]
They were building some super lightweight mountain bikes out of that toxic shit about 20 years ago.
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Posted: 2/22/2015 8:41:36 PM EDT
[#22]
Quote HistoryQuoted:
They were building some super lightweight mountain bikes out of that toxic shit about 20 years ago. Methinks you're confusing Bretylium Tosylate the medicine and Beryllium the element with the symbol B and the Atomic Number 4. 
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Posted: 2/22/2015 10:20:53 PM EDT
[#23]
Quote HistoryQuoted:
Methinks you're confusing Bretylium Tosylate the medicine and Beryllium the element with the symbol B and the Atomic Number 4. Quote HistoryQuoted:
Quoted:
They were building some super lightweight mountain bikes out of that toxic shit about 20 years ago. Methinks you're confusing Bretylium Tosylate the medicine and Beryllium the element with the symbol B and the Atomic Number 4. Just testing. Cabernet got the better of me. |
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Posted: 2/23/2015 9:03:43 PM EDT
[#24]
Quote HistoryQuoted:
Just testing. Cabernet got the better of me. Quote HistoryQuoted:
Quoted:
Quoted:
They were building some super lightweight mountain bikes out of that toxic shit about 20 years ago. Methinks you're confusing Bretylium Tosylate the medicine and Beryllium the element with the symbol B and the Atomic Number 4. Just testing. Cabernet got the better of me. While beryllium was quite handy for making strong, non-sparking tools, don't get a sliver of it inside you, or breathe the dust. It'll kill ya. |
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Posted: 2/23/2015 9:06:19 PM EDT
[#25]
Quote HistoryQuoted:
We were using it when I started. Must have gotten dropped in the late 90s. I don't remember exactly when. IIRC MD quit using it sometime around then as well. |
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Posted: 5/8/2015 2:03:18 PM EDT
[#26]
Isuprel (isoproteranol) was my favorite. My instructor described it as "will give hamburger a heatbeat long enough to kill them in the ER..." It increased the O2 demand so much on the heart, even normal hearts couldnt tolerate it for too long before it started to kill cardiac muscle... And that it did, I ran it a few times on borderline pronouncements after the "epi-lido-bretyllium shocktail" and got a beat back, but the heart was completely dead by the time were came through the doors of the ER.
Having been in the game since 1993 I have seen all the protocols change about 9 or 10 times. new drugs in, old drugs out, sometimes the old drugs back in, sometimes the old drugs back in for other reasons... Some were good changes, some were bad. But the 12-leads in the field, (and diverson to STEMI hospitals) I think were the best thing to happen to EMS and patient surviveability in my 20+ years of service. And using I/O drills on adults are pretty frickin cool too.... |
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Posted: 5/13/2015 6:20:57 PM EDT
[#27]
Quote HistoryQuoted:
Don't forget the precordial thump for a witnessed arrest...... I started in 1995 I've had it straight up work. Had a guy on the monitor. He went unresponsive, vfib was immediately converted with precordial thump. |
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Posted: 5/13/2015 6:37:49 PM EDT
[#28]
Quote HistoryQuoted:
Shock, shock, shock, everybody (epi) shock, little (lido) shock, big (bretyllium) shock bicarb Quote HistoryQuoted:
Quoted:
Quoted:
Epi>Shock (200)>Lido>Shock (300)>Bretylium>Shock (360)... Wasn't it still shock, shock, shock back then? You go through so many guideline revisions and they all start to blend together. Levophed, leave 'em dead! Shock, shock, shock, everybody (epi) shock, little (lido) shock, big (bretyllium) shock bicarb That's the one I remember. L.A. County PM #3271. April 1984. We used 4 contolled drugs, MS, Valium, Phenobarb and Demerol. Theodur, Atropine, Isuprel, Ipecac. We certed for intubation on freshly dead people. Our base station used to notify us when a potential dead one came in. It was kinda morbid to see a bunch of PM squads and ambulances hanging out to see if the pt. would die and we could get out 5 tubes done to get certified. |
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Posted: 5/14/2015 9:32:45 PM EDT
[#29]
I remember that and a few others. I remember when my dept. carried Mazicon/Flumazenil. I could never think of a good time to use it. If you need to use valium,versed,etc. for a certain reason , why would you want to reverse the effects? I know they told us it was for od's, but you could not be 100% sure that is what the person did od on.
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Posted: 5/15/2015 6:49:54 PM EDT
[#30]
Quote HistoryQuoted:
I remember that and a few others. I remember when my dept. carried Mazicon/Flumazenil. I could never think of a good time to use it. If you need to use valium,versed,etc. for a certain reason , why would you want to reverse the effects? I know they told us it was for od's, but you could not be 100% sure that is what the person did od on. I used Romazicon once on a vet who got his 3 month worth of pills at the local VA and washed most of them down at a local bar during a self pity party. |
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Posted: 5/15/2015 8:14:47 PM EDT
[#31]
Quote HistoryQuoted:
I feel your pain. Bretyllium, Isuprel, Datascopes and Lifepack 5s, bicarb for everyone, EOAs..... And how many times have we seen MAST pants go in and out of fashion??? i trained on a life pack 3. i still have a pair of mast trouser that cameoff a rig when a company i worked for went tits up. that was my last check
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Posted: 5/15/2015 10:37:37 PM EDT
[#32]
Quote HistoryQuoted:
I've had it straight up work. Had a guy on the monitor. He went unresponsive, vfib was immediately converted with precordial thump. Quote HistoryQuoted:
Quoted:
Don't forget the precordial thump for a witnessed arrest...... I started in 1995 I've had it straight up work. Had a guy on the monitor. He went unresponsive, vfib was immediately converted with precordial thump. Yep, had it work several times. My favorite was when the elevator doors open as I did it in a nursing home; the RN freaked and started accusing me of abusing the pt while she tried to stop me from leaving, told me show was going to call the police, etc. I just said I'd recommend you ask your supervisor what a precordial thump is before you make yourself look stupid.
Nobody has mentioned variable dosing on epi yet either.
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Posted: 5/16/2015 6:12:05 PM EDT
[#33]
Quote HistoryQuoted:
Don't forget the precordial thump for a witnessed arrest...... I started in 1995 emt basic in 1985.. medic in 1987 |
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Posted: 5/18/2015 12:28:14 PM EDT
[#34]
Quote HistoryQuoted: Yep, had it work several times. My favorite was when the elevator doors open as I did it in a nursing home; the RN freaked and started accusing me of abusing the pt while she tried to stop me from leaving, told me show was going to call the police, etc. I just said I'd recommend you ask your supervisor what a precordial thump is before you make yourself look stupid. Nobody has mentioned variable dosing on epi yet either. Quote HistoryQuoted: Quoted: Quoted: Don't forget the precordial thump for a witnessed arrest...... I started in 1995 I've had it straight up work. Had a guy on the monitor. He went unresponsive, vfib was immediately converted with precordial thump. Yep, had it work several times. My favorite was when the elevator doors open as I did it in a nursing home; the RN freaked and started accusing me of abusing the pt while she tried to stop me from leaving, told me show was going to call the police, etc. I just said I'd recommend you ask your supervisor what a precordial thump is before you make yourself look stupid. Nobody has mentioned variable dosing on epi yet either. "5mg didn't work... let's try 10!" |
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Posted: 5/18/2015 2:58:58 PM EDT
[#35]
Come on Escalating Epi, High Dose Epi, IC Epi, etc. Now it might be not as useful as thought. Procainamide works, Bretylium didn't seem to.
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Posted: 5/20/2015 12:05:18 AM EDT
[#36]
Quote HistoryQuoted:
Come on Escalating Epi, High Dose Epi, IC Epi, etc. Now it might be not as useful as thought. Procainamide works, Bretylium didn't seem to. None of our docs will run procainamide during an arrest. Lido is making a comeback in the literature and our cardiac docs are using it more than amio. |
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Posted: 5/27/2015 10:26:18 AM EDT
[#37]
In the short lived era of high done epi, I had an arrest of a 20 year old who drowned in a drunken pool party. Someone before me didnt restock the 10mg/ml multidose vial of epi... So here I am in the back of the bus enroute to the ER drawing up 15mg of epi from 15 glass ampules of 1:1,000.... Later followed by 20mg. By time we got to the ER, we had emptied the drug box in the bus and the jump bag of all the epi we had in every form...
We had a good solid heart rate and a clean strip on the monitor when we pulled in, but I later found out the kid was a vegtable and the family donated his organs. |
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Posted: 5/28/2015 2:32:25 PM EDT
[#38]
Quote HistoryQuoted:
None of our docs will run procainamide during an arrest. Lido is making a comeback in the literature and our cardiac docs are using it more than amio. Quote HistoryQuoted:
Quoted:
Come on Escalating Epi, High Dose Epi, IC Epi, etc. Now it might be not as useful as thought. Procainamide works, Bretylium didn't seem to. None of our docs will run procainamide during an arrest. Lido is making a comeback in the literature and our cardiac docs are using it more than amio. After hearing the last few years of "Lido ain't sh*t" why am I not surprised?
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