Calcium

calcium

I rank Calcium 23 out of 33 drugs I carry.

I don’t use calcium very much, but there is one situation I always reach for it in — cardiac arrest in a diaylsis patient. While we don’t have labs in the field, a dialysis patient is a possible bet to be hypocalcemic and/or hyperkalemic, and calcium can save lives if they are. We can also consider calcium in the setting of calcium channel blocker overdose.

I can’t claim any arrest saves using it, but I have had quite a number of return of spontaneous circulation and hospital admissions after I have used it.

We can also use calcium for symptomatic bradycardia due to suspected calcium channel blocker overdose with medical control orders. I have never used it for this.

***

Calcium Chloride

Class: Electrolyte

Action: Facilitates the actin/myosin interaction in the heart muscle.

Indication: Hypocalcemia
Hyperkalemia with arrhythmia
Calcium channel blocker intoxication with hypotension or symptomatic bradycardia

Contraindication: Not to be mixed with any other medication – precipitates easily.

Precaution: Patients receiving calcium need cardiac monitoring

Side effect: Cardiac arrhythmias
Precipitation of digitalis toxicity

Dose: Usual dose is 5-10ml of 10% Calcium Chloride in 10ml.

Route: IV

Pedi Dose: 0.2ml/kg of 10% concentration

***

Here’s an excerpt from my novel, Mortal Men, that includes a call where Calcium is used:

“The real rivalry between Troy and Ben started the day Sidney coded,” Joel said. “Sidney Seuss — he’s the guy in the portrait in the front office. He founded the place. A real old time ambulance man. He was just getting ready to start his dialysis treatment – he had his own machine in his office – when he crumpled to the ground. His secretary screams. When Ben gets there, he sees Sidney lying on the carpet. He’s blue. No breathing, no pulse. Ben rips Sidney’s shirt open, puts the paddles on his chest. He’s in v-fib. He shocks him. 200 Joules. No change. Shocks him again. 300 Joules. Nothing. 360. Nothing.

“The secretary starts CPR while Ben goes for the airway. Sidney’s a big broad guy with no neck. A difficult tube. Ben’s looking down into his throat, trying to move his tongue out of the way. He sees the chords for a moment, passes the tube. Puke comes up. He’s in the esophagus.

“That’s when Troy and I come in,” Victor said. “We’d been in the office resupplying. Troy sidesteps the puke, and while Ben tries again, Troy slams an IV in Sidney’s arm. Ben’s still struggling with the tube, Troy says, ‘Let me try.’ He takes the scope from him. Then like that — ‘I’m in,’ he says. Ben pushes epi and lidocaine into the IV line. They shock him again 360 joules. No change.

“’Calcium,’ Troy says.

“‘Calcium?’ Ben says. We carry it, but it’s not in the routine protocol.

“‘Calcium. His kidneys suck.’

“Ben goes ahead and gives it to him. They shock him again.

“Ben looks at the monitor — sees a rhythm. You don’t have to feel a pulse. You can just look at his neck and see it pounding.

“Then Sidney opens his eyes and he’s looking right up at Troy. He looks a little confused like maybe he was expecting to see Satan or St. Peter. Instead Troy Johnson is the one grinning at him.

“‘Afternoon, boss,’ Troy says. ‘I see I’m not the only slacker around this place likes to get in a good snooze.’

“Troy was the golden boy after that. Sidney gave Troy his own dedicated ambulance, his own shift whatever hours he wanted to work, and let him pick whatever partner he wanted. Told the dispatchers no transfers for Troy. They have to leave him free for the big bad ones. The Deputy mayor coded. Troy saved him. One of the high-ranking police brass coded. Troy brought him back to life. Head of the chamber of commerce choked on a piece of meat the size of his fist; Troy yanked it out with a pair of McGill’s. The guy was well enough to give the after dinner speech.

“Every save Troy got, Sidney made a show of visiting the patient in the hospital, and bringing a photographer along. Ben wasn’t happy about it — that and the fact every time Sidney saw Ben and Troy together he ribbed Ben about it. ‘Good, I got my bodyguard here to keep my chief paramedic from killing me.’ The truth is we got some good publicity in those days. We were miracle workers. The pride of the city. Paramedics. We were all like Johnny and Roy on that old Emergency show. You could walk tall.”

“Not any more?”

“No, that’s the past. Sidney’s dead. Things are changing for the worse. They don’t get better, we could be out of business. We could all be looking for jobs. So you can understand why no one’s happy.”

3 Comments

  • I’m really, really enjoying the series you have going on all of these EMS medications. I’ve read every one of them. You’re a great writer and I hope that you combine all of these into a series when you’re done with this. Great stuff.

    You need to add a Tweet Meme button and a Share to Facebook button. I’ve been tweeting your stuff, but one click is easier than 10. Please?

  • medicscribe says:

    Thanks CKemtp-

    I’m not certain I know how to add those buttons. Are they in the widget section?

    Thanks for the help,

    Peter

  • Kel says:

    love this series too ^___^

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Peter Canning

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  • Comments
    Casey
    Intranasal Medication
    Agreed Steve. Love IN Versed for combative/ictal patients. Also IN versed is used in ED for kids. Helps with pain relief and as an amnesic and wears off fairly quick- not sure that directly applies to prehospital but food for thought nonetheless
    2015-05-07 00:36:28
    Chris
    AHA 2015 Guidelines: A Preview
    I am a 25 year veteran firefighter/medic, and 9 year veteran critial care fixed wing medic. I work in Northeast Ohio. In this region, we have all but abandoned endotrachal intubation for the intent of ease of a superglottic airway. AHA de-emphasizing ETI and we have seen this coming for a while. We either bag…
    2015-05-05 20:54:08
    Steve
    Intranasal Medication
    "either because they are seizing or are violent, then the better and quicker route would be IM. " I'm quite hesitant about bring a needle against someone fighting me or shaking... those are the perfect times to be needleless.
    2015-04-27 18:34:14
    bill
    The Ideal Medic
    very well put! aggression can be a good in moderation but over aggression can do harm. 1 year to 30 years no medic will know it all epically with our ever changing job description. thank you for your input!
    2015-04-26 11:46:50
    Ben Leighton
    Adenosine
    Hi. Im a UK Student Paramedic and I have a few questions regarding adenosine (we currently dont carry it) and I was wondering if any of you guys could e-mail me at ben-leighton@hotmail.co.uk and start some correspondance. Im aiming to set a proposal to my service in order to carry this drug and wanted some…
    2015-04-20 13:36:03

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