Crash box and how to chart

Re: Crash box and how to chart

Michael Woodhouse — Thu, 22 Jan 2015 23:30:41 GMT

[quote user="John Flynn"]

NB: the atropine doses in your chart for 40kg don't seem to be what would be calculated for the dose and conc you list unless I'm missing something or is based on BSA and dose doesn't go up proportionally with weight? 45kg would be 3ml based on the 1ml/15kg I've always worked with.

[/quote]

You are quite right.

Re: Crash box and how to chart

John Flynn — Thu, 22 Jan 2015 23:22:22 GMT

Re: Crash box and how to chart

John Flynn — Thu, 22 Jan 2015 23:14:34 GMT

[quote user="Michael Woodhouse"] I've used atropine once in my career[/quote]

I suspect I'm a bit outdated in this, but still use it with reasonably regular frequency as part of a premed (especially if planning on high-dose opioids or a dog with mitral regurg murmur or something), or shortly after induction if heart rate hasn't kept up with my expectations.

I know there are undesirable side effects, but I find slow-ish heart rates disconcerting (one of the reasons I don't get on great with medetomidine...) - may be more my problem than the patient's!

I've never used dopram in emergency situation in smallies (other than drop sublingual in pups post-caesarean in days gone by) and looks as if my adrenaline dose might be lower than current recommendations also then, so I'll look into both of these.

If I was going for an "emergency drug chart" (I'm yet to be convinced, but it might not take long once I start to think about it), then I reckon less numbers (and possibly drugs) would be simpler, for example should I decide to give atropine to a dog weighing approximately 40 kg in a panic, I supsect a single decimal place (or even a single dose rate of 2ml rather than split high/low doses) may suffice? My lack of knowledge as to when a high and when a low dose were indicated in an emergency setting would probably be a greater barrier to me though (guess I would need to read up on that one in advance )

Re: Crash box and how to chart

Michael Woodhouse — Thu, 22 Jan 2015 22:47:16 GMT

John, I've used atropine once in my career and adrenalin twice - both were basically DOA but we went through the motions. I think our crash box only gets opened a couple of times per year when a dog comes in fitting. I usually throw the full box of 10 vials of adrenaline away OOD.

I'm not going to calculate the rate for a 22.7kg lab 0 I will use the 25kg dose. The huge lack of familiarity with these drugs means I don't want to be working anything out.

Using those doses is at your own risk - check them first

Re: Crash box and how to chart

John Flynn — Thu, 22 Jan 2015 22:05:40 GMT

[quote user="bob lehner"]

[quote user="Michael Woodhouse"]We have a table on the inside of the lid with drug dosages on [/quote]

This is really essential and I am surprised that many practices I visit on my travels don't do it. Who, in the heat of the moment, is going to remember doses of drugs which one does not use that often (or at least hopefully not)?

You can't wander off to get the formulary whilst Fido is rapidly heading towards the pearly gates.

[/quote]

[quote user="bob lehner"]Who, in the heat of the moment, is going to remember doses of drugs which one does not use that often (or at least hopefully not)? [/quote]

I'm not sure I see the necessity of a dose chart and wonder if it would only complicate matters and slow down in an emergency setting?

I've always had a 0.5ml syringe of adrenaline (1mg/ml I think) taped to the anaesthetic machine that I change monthly.

For a dog I'd give the whole lot.

For a cat (or cat-sized dog), I'd give 0.1ml of it.

In the rare event that I thought it would be a good idea I've been grateful not to have to start cracking open vials and drawing it up and checking charts.

For atropine, I give 1ml/15kg and keep the bottle with the anaesthetic machine (along with a couple of syringes and needles), I think a rough estimation of dose based on that is fine and don't think you need to calculate / look-it-up to the nearest decimal point? I use atropine often enough to remember this [await the embarrassment that I actually using the wrong dose!!!]

Atipamezole is the other one I find useful to have to hand - if using medetomidine, I usually draw up an appropriate dose after administering the medetomidine and keep it with the dog/cat(/occasional rabbit) - it goes back in the bottle if I don't use it.

I don't use naloxone often, but do keep it - I do have the dose stuck written on the front of the box of that one I guess. Last time I actually used it was a comatose puppy that had eaten the owner's fentanyl patch. It was rather out-of-date, but worked very well.

Re: Crash box and how to chart

Yantha Smyth — Thu, 22 Jan 2015 19:21:59 GMT

I just came across this the other day http://www.veteccsmalltalk.com/ecc-resources/ Has downloads for crash box, chart, and also links to CPR and post revival care

Re: Crash box and how to chart

bob lehner — Thu, 22 Jan 2015 17:28:44 GMT

[quote user="Michael Woodhouse"]We have a table on the inside of the lid with drug dosages on [/quote]

You can't wander off to get the formulary whilst Fido is rapidly heading towards the pearly gates.

Re: Crash box and how to chart

Michael Woodhouse — Thu, 22 Jan 2015 16:08:39 GMT

Louise - whilst that would be excellent, I'd say it was typical American over-reaction!

We have a bright orange toolbox

http://medtree.co.uk/medical-bags-and-kits/hard-cases/flambeau-hard-first-aid-case-model-1872

It contains adrenaline, atropine, diazepam and sometimes Dopram injection. We have a selection of 1 and 2ml syringes with needles already attached. A couple of each size IV cannula. Curved scissors, artery forceps and elastic band (make shift vein raising). There is an adult and paediatric BVM

http://medtree.co.uk/vinyl-disposable-bvm-with-pop-off-valve-adult?keyword=BVM&category_id=0

http://medtree.co.uk/vinyl-disposable-bvm-paediatric?keyword=BVM&category_id=0

A WOW bandage (for tying in tubes or opening mouths. There is also a pair of intubation forceps - they are useful at removing things stuck at the back of the throat and we thought that was a good place to keep them.

http://medtree.co.uk/airway-and-oxygen/intubation/intubation-forceps/magill-intubation-forceps

If we have a case that we would use this gear on it would be in theatre and we have ET tubes on the wall and all the monitoring, O2, fluids, chest drains etc etc etc. We tried putting some cheap plastic ET tubes in but they just take up space and didn't add anything.

We have a table on the inside of the lid with drug dosages on (taken from BSAVA formulary). If I can find the file I will attach it.

Re: Crash box and how to chart

Louise6732 — Thu, 22 Jan 2015 15:06:23 GMT

Hi Glenn, this website is good, I can see the whole pdf but I think you might need to register to access it, it's free and has some good articles.

http://www.veterinaryteambrief.com/sites/default/files/sites/cliniciansbrief.com/files/procedures_pro2_july06.pdf

It is an American website so be prepared to 'translate' some things eg epinephrine!

Louise