# Hextend question!!!



## amlove21 (Apr 23, 2009)

Hey all- I know there are some pretty smart people out there, and I need help on this one. 

The question arose today "Are there any drugs you can not give with Hextend (fluid volume expander)?" I immediately said, "Well, as far as I know, "they" thought that there might be a problem with sodium bicarb and valium initially- but there isnt anything on the fact sheets that prohibits it's use, and all drugs are approved to be administered with hextend." 

One of my VERY smart colleagues disagreed, and said that hospira, at one point or another, had said that yes, certain drugs will precipitate. 

HOWEVER, since I am extremely um, lets say THOROUGH, and since his contention was in front of a group of people, i have now completed a lot of reading up on fact sheets, product inserts, etc, and can find NOWHERE that the use of valium, sodium bicarb, calcium gluconate et al is prohibited or even advised against. 

Any input from those in the know?


----------



## austin (Apr 23, 2009)

Although no experience on this matter yet...did some research...

"Hextend®:

Y-site administration: *Compatible*: Alatrofloxacin, alfentanil, amikacin, aminophylline, amiodarone, ampicillin, ampicillin-sulbactam, atracurium, azithromycin, bumetanide, butorphanol, *calcium gluconate*, cefazolin, cefepime, cefoperazone, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftizoxime, ceftriaxone, cefuroxime, chlorpromazine, cimetidine, ciprofloxacin, cisatracurium, clindamycin, dexamethasone, digoxin, diltiazem, diphenhydramine, dobutamine, dolasetron, dopamine, doxycycline, droperidol, enalaprilat, ephedrine, epinephrine, erythromycin, esmolol, famotidine, fentanyl, fluconazole, furosemide, gentamicin, granisetron, haloperidol, heparin, hydrocortisone, hydromorphone, hydroxyzine, inamrinone, isoproterenol, ketorolac, labetalol, levofloxacin, lidocaine, lorazepam, magnesium, mannitol, meperidine, methylprednisolone, metoclopramide, metronidazole, midazolam, milrinone, mivacurium, morphine, nalbuphine, nitroglycerin, norepinephrine, ofloxacin, ondansetron, pancuronium, phenylephrine, piperacillin, piperacillin-tazobactam, potassium chloride, procainamide, prochlorperazine, promethazine, ranitidine, rocuronium, sodium nitroprusside, succinylcholine, sufentanil, theophylline, thiopental, ticarcillin, ticarcillin-clavulanate, tobramycin, trimethoprim-sulfamethoxazole, vancomycin, vecuronium, verapamil. *Incompatible*: Amphotericin B, *diazepam*, *sodium bicarbonate*"

Heres the link:

http://www.umm.edu/altmed/drugs/hetastarch-061100.htm

Once again I have no experience in this, this is just what I came across...


----------



## amlove21 (Apr 23, 2009)

Sure did. Wrong again! Thanks for the assist. Off to own up.


----------



## austin (Apr 23, 2009)

No problem bro...stay safe


----------



## Muppet (Apr 24, 2009)

A.M. You have to remember all of those meds. and you will be tested in 1 week.:)
On another note, have you used it on patients and does it really last in the vascular system for a long time? I know the mechanism behind it but am wondering if it really works. We (the county) were using Polyheme on trials and as we all know, that failed really bad. Be safe out there.

F.M.


----------



## 8'Duece (Apr 24, 2009)

Would that also include other Benzo's ??  Xanax, Ativan ect ?


----------



## Muppet (Apr 24, 2009)

Good question. I know that Valium is not fat solouble but I am not sure about the others. I am sure you can give Versed (another benzo. we give in the field/EMS).

F.M.


----------



## amlove21 (Apr 24, 2009)

Upon further resarch, the other benzos are fine. Midozolam et al all are Y site compatible, just not Valium. I have NO FREAKING CLUE as to why that is, but there you have it.

And FM, its great. hemodynamically unstable patients get a 250 cc bolus, reasses. you can expect immediate returns- keep in mind, its much the same as saline in the fact that it still doesnt carry o2, so it doesnt really matter if you get their BP back up to 90-120, if that stuff circulating is clear. 

Yea, it does stay in the vasculature, because of the complex structure of the ethylstarch. It takes the bodies enzymes 6-8 hours to get rid of the stuff, making it MUCH better and longer lasting than a regular colloid, which just pulls water into the vasculature thanks to a little oncotic force. But short answer, yes, it is in fact bad ass. and yes, in clinical trials it outperforms saline. However, it does take a little more energy (i.e., on the heart, to process, because its a heavier fluid) so there is a though out there that borderline-irreversible shock patients shouldnt receive it. No way to actually test that though, so plug away. 

p.s.- polyheme is crap compared to hextend, just my two cents.


----------



## Muppet (Apr 25, 2009)

A.M.: I agree on Polyheme. I don't think the state will change our S.O.P.'s to add Hextend because of the permissive hypotension thing. We are now leaving b/p's around the 90's as long as they are mentating, especially if there is still an uncontroled bleeder. Fortunatlly between our medical director, me (with military experience) and some smart people in the state, the S.O.P.'s allow for us to use SOFT-T's and Quick-Clot tea bags IF needed. I just have to train our medics (at out squad) on the proper usage of t-q's and clot stuff. It's amazing hoe the Paramedic, let alone the EMT ciriculium does not teach t-q's, let alone pressure dressings and packing wounds. Problem with the state is that it is so big so it has to dummy down to the lowest retard regarding new procedures. As you know, change does not go well with some people. I miss the Army sometimes.

F.M.


----------



## HeloMedic1171 (May 17, 2009)

hextend works well, but even in the army, we follow a similar method as you do, FM.  bolus of up to 500 cc of hextend, or until radial pulses return, and then TKO.  if nothing, wait 30 minutes, if nothing, bolus 500cc hextend until radials return, if nothing, pray.  that's what they're teaching now at the BCT3 course.  thought process being to preserve the fresh clots at the expense of mild-moderate hypotension.  anyone got another insight?


----------



## Muppet (May 17, 2009)

HeloMedic1171 said:


> hextend works well, but even in the army, we follow a similar method as you do, FM.  bolus of up to 500 cc of hextend, or until radial pulses return, and then TKO.  if nothing, wait 30 minutes, if nothing, bolus 500cc hextend until radials return, if nothing, pray.  that's what they're teaching now at the BCT3 course.  thought process being to preserve the fresh clots at the expense of mild-moderate hypotension.  anyone got another insight?






I think this is one of the best things to come out since the new C.P.R. issues. You know every 5 years or so, somebody comes down with some breaking news on how something does not work. Who knows, maybe MAST trousers may come back into play 5 years down the road. I have had a few permissive hypotension cases and the trauma docs were glad to see we did not flood the poor sould with saline.

F.M.


----------



## Muppet (May 17, 2009)

Oh, yea. I known what TC3 is but what is BTC3? basic TC3?

F.M.


----------



## HeloMedic1171 (May 17, 2009)

neg.

Brigade Combat Team Trauma Training.

they go through some lanes and some lab stuff to show you the newest products in theater, and keep you up to standard on the preferred methods of Trauma medicine as it relates to the Medic.

aka

badass high-speed conventional army class, with some good lanes and lots of cool toys to practice with.  it gets all the medics on the same page and gives good, needed practice to guys like us who don't put a TQ on a bleeding body everyday all day, insert a chest tube often, or practice a Veinous Cutdown.   it also reinforces the basics in the knuckleheads we get from the repo depot prior to wheels up.  good training.


----------



## surgicalcric (May 17, 2009)

HeloMedic1171 said:


> ...I wish I could share pics, I wasn't allowed to take any.  goddamn PETA.



And for that reason you should keep your posting about it to ZERO.  Even though they know we do it we dont need to be advertising it to those who might not be sure nor should we divulge procedures on the 'net.  ;)

Crip


----------



## HeloMedic1171 (May 17, 2009)

point taken, I edited my post a bit.  I can edit further if need be.  thanks for the spot check, Crip. :)


----------



## Muppet (May 19, 2009)

Cool. Thanks. Wish they had that when I was in.

F.M.


----------

