My choices are getting harder and harder as my drug box shrinks.
Alas, today I rank Adenosine 16 out of the 33 drugs I carry.
I wrote quite a bit about Adenosine a few months ago in a post Adenosine/PSVT that first got me thinking about doing a series on the drugs I carry in my med bag.
While I only give Adenosine a few times a year, it has always been one of my favorite drugs. It is a great paramedic drug because you can fix the problem on the spot and the results are dramatic. Someone calls 911 because they are weak and clammy and they feel this rapid palpitating in their heart. You try to feel a pulse and you can’t. You put them on the monitor and behold they are cranking away at 220. You turn the monitor toward your partner and away from the patient’s view. My hands always used to shake when I’d do the IV for this type of patient (prestage performance anxiety). Fortunately this patient has a nice big fat AC and the catheter easily sinks in.
You carefully explain what you are about to do, how you will inject some medicine in the IV line that will soon fix their problem, while it may make them feel a little strange, but that strange feeling will pass quickly, you add. You slam the drug in, followed by a flush. The person gets a weird expression on their face, while your audience – partner, bystanders gasp as the monitor goes asystole, and then weird funky beat, weird funky beat and then a few more weird beats and the person is back in a regular rhythm at 80, and they feel so much better and you feel so much better and you print out the strips and show the printout to the patient and say this was your heart going 220 and then here’s what happened when I gave you the medicine and you felt all weird, see that flat line — that was you — and then here’s you now, good as new, and you — the paramedic — are everybody’s hero.
So why only 16 out of 32? Well, there are many great drugs still to come, and while great, if I didn’t have Adenosine, I could try Cardizem or Amiodarone, or if I have to, I could shock the person back to a regular rhythm (I’m not a big fan of this).
I have had a few patients who found Adenosine so uncomfortable, that they have asked to be cardioverted (shocked) instead. Once I offered a trial of Cardizem and it worked great. There was no dramatic asystole, just an easy slowing. The other patient I convinced to let me give them Adenosine with success.
Farewell, Adenosine, old friend. (I am glad it is only a mock farewell.)
Class: Endogenous nucleoside
Action: Stimulates adenosine receptors; decreases conduction through the AV node
Contraindication: Patients taking Persantine or Tegretol.
Precaution: Short half-life must administer rapid normal saline bolus immediately after
administration of drug. Use IV port closest to IV site.
Side effect: Arrhythmias, chest pain, dyspnea, bronchospasm (rare)
Dose: Adult – 6mg IV over 1-2 seconds; may repeat 12mg twice at 2 minute
intervals. Pedi – 0.1mg/kg, may repeat twice at 0.2mg/kg
Route: Rapid IV push, followed by a flush