Jump to content


Photo

H2 Blockers?


  • Please log in to reply
11 replies to this topic

#1 croaker260

croaker260

    Member

  • Members
  • PipPip
  • 17 posts

Posted 04 May 2011 - 11:57 PM

OK, for the record I did a search of the forums for this and didnt tearn up anything, but perhaps I missed it.

Anyway, I am curious how many programs are using H2 blockers in addition to H1 blockers in the treatment of anaphylaxis? If so, if you could comment on any preference for one over the other, your service protocols, etc, it would be most helpful.

We are adding H2 blockers, and are probably adding Zantac, but I like to be complete in my research.

Thanks.

Steve
  • 0
"Boldness is like a condom. If you depend on it all the time, no matter how good it is, and no matter how good you are, eventually it will break. " -- Walter SLovotsky

"In crisis we do not rise to the occasion, but sink to the level of our training" -- Lt. Col (ret) Grossman

"Personally, I believe that if we write our CE, text books, and curricula at the physician level instead of the kindergarten level, our medics and EMTs will rise to the occasion and meet the higher standard, maybe with some bitching but they will do it. There are plenty of precedents in every day life and other professions for this. The patients will only benefit, as will our own professions and the level of respect I believe we need and want, but maybe don't yet deserve." Steve Cole

#2 croaker260

croaker260

    Member

  • Members
  • PipPip
  • 17 posts

Posted 05 May 2011 - 12:02 AM

We are adding H2 blockers, and are probably adding Zantac, but I like to be complete in my research.

Thanks.

Steve



Just as a follow up, we are possibly considering Pepcid but are waiting on costs comparison to come in. I dont expect it will be a huge difference.
  • 0
"Boldness is like a condom. If you depend on it all the time, no matter how good it is, and no matter how good you are, eventually it will break. " -- Walter SLovotsky

"In crisis we do not rise to the occasion, but sink to the level of our training" -- Lt. Col (ret) Grossman

"Personally, I believe that if we write our CE, text books, and curricula at the physician level instead of the kindergarten level, our medics and EMTs will rise to the occasion and meet the higher standard, maybe with some bitching but they will do it. There are plenty of precedents in every day life and other professions for this. The patients will only benefit, as will our own professions and the level of respect I believe we need and want, but maybe don't yet deserve." Steve Cole

#3 Mike Mims

Mike Mims

    Advanced Member

  • Moderators
  • PipPipPip
  • 1668 posts

Posted 05 May 2011 - 02:31 AM

Just as a follow up, we are possibly considering Pepcid but are waiting on costs comparison to come in. I dont expect it will be a huge difference.

We don't particularly use H2 blockers on the Aircraft, but we will request some if needed. Here in the ED Pepsid, Zantac, Protonix or Tagamet is used.

Couldn't tell you why one is used over the other.....


  • 0

Mike Mims

Aircare

University of Mississippi Medical Center


#4 SerendepitySaki

SerendepitySaki

    Advanced Member

  • Members
  • PipPipPip
  • 1176 posts

Posted 05 May 2011 - 03:18 AM

Protonix for anaphylaxis? what am i missing mike? it's not a histamine antagonist....
  • 0
LET THE WILD RUMPUS BEGIN !!!!!!
Sean G. Smith, RN-Alphabet Soup

#5 TexRNmedic

TexRNmedic

    Advanced Member

  • Members
  • PipPipPip
  • 257 posts

Posted 05 May 2011 - 04:43 AM

Just as a follow up, we are possibly considering Pepcid but are waiting on costs comparison to come in. I don't expect it will be a huge difference.

Benadryl and pepcid on a 911 rig and in the ED. Famotidine is cheap and effective. Only thing is, our stuff requires cool storage. It lives in our drug cooler. Sean the PPI for anaphylaxis is for the stress ulcer they get when they see the bill!
  • 0
Wes Seale
Houston , TX

#6 Mike Mims

Mike Mims

    Advanced Member

  • Moderators
  • PipPipPip
  • 1668 posts

Posted 05 May 2011 - 06:05 AM

We don't particularly use H2 blockers on the Aircraft, but we will request some if needed. Here in the ED Pepsid, Zantac, Protonix or Tagamet is used.

Couldn't tell you why one is used over the other.....


Yes no H2 I guess I was stuck with acid refluxPosted Image
  • 0

Mike Mims

Aircare

University of Mississippi Medical Center


#7 SerendepitySaki

SerendepitySaki

    Advanced Member

  • Members
  • PipPipPip
  • 1176 posts

Posted 05 May 2011 - 11:55 AM

Yes no H2 I guess I was stuck with acid refluxPosted Image


no worries sir. i am ALWAYS open to anything i might have missed*....

process improvement, by definition, never ends....ego and complacency kill patients... i try very hard to personally avoid both...

like the old thing about the shark...stop swimming and die...


*good one, wes! :lol:
  • 0
LET THE WILD RUMPUS BEGIN !!!!!!
Sean G. Smith, RN-Alphabet Soup

#8 JLP

JLP

    Advanced Member

  • Members
  • PipPipPip
  • 493 posts

Posted 05 May 2011 - 03:10 PM

I have used H2 inhibitors as an adjunct to Benadryl, steroids, etc, for refractory anaphylaxis; we also routinely used Pantoloc (PPI) when transporting ICU patients, with the rationale being, these folks are usually completely NPO and under great physiological stress, a recipe for stress ulcers, and esophageal erosion considering that they are supine and usually have an NG poking through the esophageal sphincter. I've read literature suggesting that ICU patient should be given at least some nutrients as early as possible in their care, even down the NG, to prevent GI tract breakdown. Can anyone with more expertise comment on that?
  • 0

#9 Gila

Gila

    Advanced Member

  • Members
  • PipPipPip
  • 588 posts

Posted 05 May 2011 - 03:20 PM

Much of the rationale behind nutritional support is due to the fact that many critically Ill patients are hypermetabolic and essentially being starved. Of course you should have feeding criteria and also be aware that enteral feeding may increase the risk of VAP. However, it seems that in many cases enteral feeding is preferred. Also, we need to be aware of refeeding syndrome, electrolyte imbalance and so on.
  • 0
Christopher Bare
"Non fui, fui, non sum, non curo "

#10 SerendepitySaki

SerendepitySaki

    Advanced Member

  • Members
  • PipPipPip
  • 1176 posts

Posted 05 May 2011 - 10:09 PM

wealth of literature out there, JLP...

for real fun, explore the TPN/HAL* vs Enteral feeds/ feeding the gut/preserving form and fx argument and the dynamic spectrum in between....

*(and that's HAL as in Hyper ALimentation not 2001 Space Odyssey HAL..even if he WAS Canadian...eh! B))

and H2s or PPIs are pretty SOP across the board in ICU care...someone has already pointed out the cost differential ... generally PPIs are used primarily for active GI bleeds and if H2 antagonists aren't getting the job done....

I have used H2 inhibitors as an adjunct to Benadryl, steroids, etc, for refractory anaphylaxis; we also routinely used Pantoloc (PPI) when transporting ICU patients, with the rationale being, these folks are usually completely NPO and under great physiological stress, a recipe for stress ulcers, and esophageal erosion considering that they are supine and usually have an NG poking through the esophageal sphincter. I've read literature suggesting that ICU patient should be given at least some nutrients as early as possible in their care, even down the NG, to prevent GI tract breakdown. Can anyone with more expertise comment on that?


  • 0
LET THE WILD RUMPUS BEGIN !!!!!!
Sean G. Smith, RN-Alphabet Soup

#11 old school

old school

    Advanced Member

  • Members
  • PipPipPip
  • 1121 posts

Posted 07 May 2011 - 12:02 PM

Not on the aircraft (I don't recall personally ever treating anaphylaxis in transport), but I've used both pepcid and zantac in the ED.
  • 0
bring it in for the real thing

#12 croaker260

croaker260

    Member

  • Members
  • PipPip
  • 17 posts

Posted 10 May 2011 - 06:45 PM

Thanks for the replies guys....

As a follow up question. One of the previous posters mentioned refrigerating PEPCID, is that a requirement? I didnt find any information on refrigeration required for either pepcid nor zantac. Any input would be divine. Thanks.

Steve
  • 0
"Boldness is like a condom. If you depend on it all the time, no matter how good it is, and no matter how good you are, eventually it will break. " -- Walter SLovotsky

"In crisis we do not rise to the occasion, but sink to the level of our training" -- Lt. Col (ret) Grossman

"Personally, I believe that if we write our CE, text books, and curricula at the physician level instead of the kindergarten level, our medics and EMTs will rise to the occasion and meet the higher standard, maybe with some bitching but they will do it. There are plenty of precedents in every day life and other professions for this. The patients will only benefit, as will our own professions and the level of respect I believe we need and want, but maybe don't yet deserve." Steve Cole