Tue, 6 Nov 2012|
Mike McEvoy reviews tips for mixing the cyanide antidote and administering it to a smoke-inhalation victim in the field.
Automatically Generated Transcript (may not be 100% accurate)
Welcome to training minutes today I'm gonna talk about how to set up and administer a site and a look at -- -- antidote -- -- but firefighters and -- providers who treat. Victims pulled from structure fire with smoke inhalation -- and -- France or as we would say serious condition. People who have suffered the effects of smoke inhalation probably -- -- not only with carbon monoxide but with cyanide as you've seen. And then fire engineering literature in a fire magazines and in medical literature for the last several years. -- kit is an antidote that's a precursor to vitamin B twelve. Only antidote -- safe to administer to a patient who has smoke inhalation. And cyanide poisoning as a consequence of smoke inhalation while there are other -- on the market. None of those are appropriate to get to that smoke inhalation victim. So you're gonna end up -- this kid. In an LS setting to a patient probably who's in cardiac arrest and not the best of circumstances to have to work. So I thought today we'll go through how to mix the drugs together how to setup the -- and get ready for administration. When seconds count which is the situation you're going to find yourself -- giving it. So the -- itself. Is not enough to have the supplies they need to administer it in addition to the kit which contains the medication. And the mixing spikes. You'll also need. Two bags. Hundred CC banks -- hundred and all -- abnormal sailing. You'll need. A syringe. In order to pull some of the medication from a -- And administered into the port -- have connected to an intravenous line in the patient. And more than likely a stop cock to connect that syringe to welcome back in the stop -- later. So inside. Of the -- -- it. Are currently two. Bottles. Which are glass bottles that contain. The -- -- actual powder. That need to be mixed with a 1000000100. CC bags of normal saline that we have looked at earlier. Each bottle. Mixes with a hundred CC's ability and one and then gets administered to the patient over the course of seven and a half minutes so you'd give. Two bottles or a total of five grams of -- okay. To an adult patient. Over the course of fifteen minutes. The mixing. Is -- little bit tricky for an individual who's not used to mixing medications in the field which is most of Austin -- environment. Kit comes with a spike. And only used the spike to connect the bag until you went to this Diana can bottle itself so to open a hundred CC bag. -- -- -- Will pop the top off the -- And then we'll use this spike. To connect to do you went to the bottle itself. The spike is basically. Any medication mixing spike which contains. A sharp and on both sides of the -- To allow the medication to -- from the bag. Into the bottle so -- spike the bag. -- spike the bottle. Similar to how we would spike -- -- solution. Put the bag back up words squeeze. The hundred CC's of -- -- into the bottle. And you probably have to release it once or twice and hard to get air out of the bottle itself. And you'll notice that the -- that's coming back into the bag is reddish colored. The powder inside the bottle is actually read. And one of the side effects of the medication give -- to a patient is to turn their skin red to turn their urine -- Turn most of the patient. Which lasts for five to seven days after the medication is administered. So now we have all of the duly went into the bottle we're going to pull with spike. Out of the bottle. And we're ready now. To mix the medication inside of the bottle. To mix it you need to be cautious because it tends to bubble if -- shake the bottle. So instead will invert the bottle several times and continue to convert -- back -- four. For about thirty seconds to completely mix up the medication. Later on we'll take the bottle out of the box and take a look at what the bottle actually looks like. The next thing that we need to do this too attached the intravenous that. Inside of this thing and -- it is -- -- that can be used with a bottle. We'll open -- fifth set. -- spike the bottle just as we would any -- solution. Notice that the bottle has -- an event. And then actually allows. Air to move into the bottle so that fluid will flow -- spike -- -- with a solution. Hanging on -- IV pole. And will run the solution through the -- and get ready to administer to the patient. Notice the dark red color of the mixture. So we've -- not. Medication through the tubing of the first bottle of. Aside and yet. We haven't atrocities line and the patient many patients during resuscitation like this going to end up with a fifteen -- -- line. And that is the reason why we need to stop cock for the setup in order to get this medication Iran. Into the patient and seven and a half minutes we're gonna have to syringe some medication and ourselves manually. So we were to connect this bottle. To the atrocities line. -- would not be able to squeeze the bottle get the medication to move into the patient faster because the glass bottle. So we've already flushed the atrocities line with a powerful Russian tendency ceased to clear -- debris inside of the bone cavity. We'll take the stop cock that we carry with this -- -- -- and we added that the supplies that we -- that's not something that comes with the kids stuff. And we'll connect the stop cock. To a thirty CC syringe could use a thirty CC -- -- CC a sixty CC he just need the big syringe. Or connecting that to the stop cock. We're now gonna connect the medication. To one piece of the stuff cock. And then we'll connect the other end to the Entrust his line once we pulled some of the medication into the -- so we'll pull some of the medication into the syringe. Loaded up. So now we have the medication to the tip of the stop cock were ready to attach the stop cock to Entrust his line. We moved concerns that we had there will connect stop practice in trust he has line. And we're now in a position where they connected. To be able to. Pull medication. Into the syringe. From. The bottle of medication we have hanging. -- -- -- -- -- -- -- -- -- The stop -- towards the patient and pushed the medication. Through the atrocities line into the patient. And you can continually turn back -- medication from the bottle. Turn back to the patient -- medication into the patient and deliver it over seven and a half minutes using the same to me now despite the second. Bottle of I got to -- bong. Very shortly. The company that manufactures this will release a single -- model which we'll have. Two and a half grams plus two and a half grounds for a total by programs in one single bottle so won't be necessary. Actually spiked two bottles. You will still need to use a hundred annals of -- -- In each two and a half grams for a total of two bags of -- -- into the new container. But most of us who are carrying the site and market now have the two -- to bottle two and a half gram to bottle doses. Of the medication. In our trucks. That's the system that we -- to deliver to and atrocities line. Regardless of whether you have a peripheral -- -- -- -- line the stop cock is a Smart idea so that. He can pull medication Apollo it's not flowing as quickly as she needed to flow. As I mentioned previously some of the side effects you'd expect to see from -- in your patient are turning the color of the skin red. Which will happen very shortly after -- administer the first bottle. He -- will turn red immediately. All of those things we'll stay right on the patient for about five to seven days. And also interfere with some callow metric tests so if you draw labs on the patient prior to administering and -- So that they can run tests like glucose view and creatine and some of those labs will be interfered with after -- I -- it is administered. You'll see some change in your readings for car -- hemoglobin if he used to pulls outs and -- -- that's able to measure that. Those from the red coloring of the blood will actually be interfered with. For about five to ten minutes after the initial -- of medications given to the patient. And if you're doing CPR on the patient which is going to be the case with many of these individuals who get this -- You'll find that the patients will experience to return a spontaneous circulation. If cyanide is what's killed that patient and kept the patient dead. Happens at some point in the first ten minutes after administration of the -- In the study in Paris France the largest study done. On administration of this and -- hydroxy cabala mean brand name's -- -- it. About 50% of patients who are in cardiac arrest following a structure fire. There were grabbed out of a fire had reversal of cardiac arrest -- -- return of vital signs on scene. For administering the senate bill Connolly in the United States without the senate though. Our efficiency yet rescuing those patients and seeing them return to life is less than one person so -- go from -- and 1%. Over 50%. Means that giving cyanide and -- critical. Only cyanide -- -- though it's safe to give to a smoke inhalation patient. Is the sand -- because it doesn't interfere with oxygen carrying capacity like every other cyanide -- -- -- that's on the market. Let me take apart the box that's holding -- -- -- -- that you can see the actual medication. Inside of this cardboard box. -- the glass bottle. Glass bottles actually holds. The hydroxy -- -- and you can see the red color of the medication dark red color the glass bottles labeled. With the name of the medication. So and a kid I got to -- -- -- and this is a two and a half gram -- so again for an adult. Two bottles of this proposal by programs is the normal -- For a child if pediatric dose and he would follow based on your local protocols. Some systems in the -- standing orders some of them acquire physician order again in local protocols dictate. How this would be given to a patient clearly this is -- and serious circumstances and often -- not an environment where you have a lot of time. To make medical control contact. Thanks for watching training minutes I'm Mike -- in mass there are -- engineering night.