Jeremy,
> I am trying to come up with a comprehensive "red box" in conjunction with
> our local hospital pharmacy for use by GPs and Community Hospitals.
Like ET tubes, the drugs-issue can put a lot of GPs off managing a cardiac
arrest, which is a shame because of course it's the electricity that matters
and if they are scared off by drugs that they have no experience of then
they may take the "hope it never happens' approach and be inhibited from
carrying an AED.
So there are 2 points I would make:
1. keep things simple
2. avoid expensive minijets that are not going to get used before they date
expire (I see one arrest a year as a GP).
I agree adrenaline/epi and atropine are the standard drugs that I would
recommend.
Calcium is only useful for known ca channel blocker ODs so may be included,
but is probably too rare to justify a minijet.
Sodabic is unlikely to be of use prehospital.
I think most GPs would be uncomfortable using amiodarone prehospital if they
are not familiar with it. It is also pretty expensive to keep replacing.
You can see a list of the drugs that I carry at
http://www.coull.net/adultbag.html.
> It also makes me realise that there is a gap in the Resus Council's
> guidelines in addressing specifically out of hospital cardiac arrest, by
> GPs, community hospitals and even to some degree ambulance services.
This is a common GP/DN complaint on ALS courses (particularly from remote
GPs who manage arrests alone).
Although the course is generic, it tends to be taught by hospital providers
who may not be aware of the problems encountered in prehospital arrests.
On the courses that I teach on I ensure that there is always at least one
prehospital scenario to show the differences and problems associated with
the prehospital management.
Robbie Coull
email: [log in to unmask] website: http://www.coull.net
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