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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Recent Posts
Ebola October 2, 2014
Breaker of Men September 25, 2014
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Patient Handover May 13, 2014
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  • Comments
    Survivor
    Streamline
    Well said. Given your attention to work/life balance mixed with genuine passion for the profession, it is no surprise that you have had such longevity in this career. I look forward to more posts in the future, whenever you get to them ;) Keep on keepin' on!
    2014-09-24 18:01:15
    McGee
    Solu-Medrol
    TOTWTYTR: How can you say that ED staff are lazy or inefficient? You don't know what are you talking about mate!!! Big difference between EMT/Paramedics and ED staff...is you can give medication when you want and you don't need to wait for a medic to prescribe that drug.
    2014-09-23 08:52:46
    Vanessa
    PSVT-Adenosine
    I have PSVT and have been converted twice with Adenosine and it feels horrible, like an elephant sitting on our chest, I once went to the ER after 30 in V-tach, and a doctor said he learned this maneuver that usually works 90% of the time. Have the patient lay down and push down just…
    2014-08-27 21:08:20
    Jon Kavanagh
    Patient Handover
    Handover needs to be handover. The physical transfer of the patient needs to be a separate step. Introduce the nurse/team to the patient, give the relevant stuff, then move the patient over; even in a high acuity patient, unless he is ready to die without an immediate intervention by the physician, the 15-30 seconds spent…
    2014-08-13 19:19:31
    Lisa Aulbert
    Precepting
    I hate to break this to you, but you are a part of the problem. Having an easy day is not dependent on if a student "talks a good game" and being a good preceptor does not mean that you give a student that has CLEARLY demonstrated deficiencies during several calls during the shift, the…
    2014-08-01 15:01:15

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