Cardio Selective Beta Blockers

[MadMack]

Do you think we're going to be seeing Labetalol in the field anytime in the near future? Does anyone's agency already do this or are they looking into it?

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[snulma1]

I'm not sure of what drug they are using specifically, but I do believe that MD has started using pre-hospital beta-blockers. I know that where I used to fly, we had carte-blanche to use whatever beta-blockers were appropriate if we were able to get them from the sending facility.

 

[polygonal]

Do you think we're going to be seeing Labetalol in the field anytime in the near future? Does anyone's agency already do this or are they looking into it?

Labetalol is not "cardioselective."

 

[MadMack]

Labetalol is not "cardioselective."

You're right its an alpha1 blocker and non-selective beta blocker. We use Labetalol as a secondary drug in the treatment of certain drug induced arrhythmias, we were discussing it in the same context as the selective beta1 antagonists in class the other night so it jumped into my head when I posted. I was thinking more along the lines of acebutol or esmolol for use in treating MI's during long transport time. I only ask if its used because we don't have a transport time of more then 15 - 20 minutes, and even if we did, we'd contact MedCom at get the chopper sent, so Medical Direction generally doesn't have standing orders for them.

 

[polygonal]

I'm not really sure labetalol has a place in the EMS treatment of dysrhythmias. It's main use is to lower BP. Beta blockers in general probably should not be used in the field at all except for a few circumstance. For dysrhythmia management (again probably not a good idea under most circumstances) I would prefer esmolol because of it's short half-life.

Is that what you wanted to know?

 

[JLM]

http://odemsa.vaems.org/index.php?option=com_docman&task=doc_download&gid=15

 

[viostorm]

Do you think we're going to be seeing Labetalol in the field anytime in the near future? Does anyone's agency already do this or are they looking into it?

We use labetalol for hypertensive crisis at my agency.

We used metoprolol for MI at my old agency in Virginia. I've seen ST-seg changes resolve with metoprolol.

Both work very well.

 

[polygonal]

There is not great evidence that beta blockers should be used in the acute management of MIs. There is also evidence that is can be harmful. I don't think you can make a good evidenced-based recommendation that BBs should be used by EMS (or the ED for that matter) for acute MIs.

 

[ER-ER-Oh]

We use labetalol for hypertensive crisis at my agency.

We used metoprolol for MI at my old agency in Virginia. I've seen ST-seg changes resolve with metoprolol.

Both work very well.

No one should be giving B-blockers in the field for MI. I'm an EM physician and I don't give them any longer for MI. New evidence in a recent New England Journal article shows increased morbidity and mortality with the use of B-blockers for acute MI. They only show benefit > 12 hours post MI because of risk of cardiogenic shock during acute MI. It will probably take some time for this practice to change, especially in the ED where we all stick with what we once learned and shy away from the new.

 

[docB]

No one should be giving B-blockers in the field for MI. I'm an EM physician and I don't give them any longer for MI. New evidence in a recent New England Journal article shows increased morbidity and mortality with the use of B-blockers for acute MI. They only show benefit > 12 hours post MI because of risk of cardiogenic shock during acute MI. It will probably take some time for this practice to change, especially in the ED where we all stick with what we once learned and shy away from the new.

It's going to be a big problem and a practice difficult to change in the ED. Everyone had to institute steps to give B-blockers to meet the stupid CMS "Core Measures" so even though it's now on the outs I still get in trouble with the hospital administration if I don't give them.

 

[fiznat]

We just started with Metoprolol for rapid A-Fib, A-Flutter, and other PSVTs. The protocol gives a choice between this drug and cardizem, with a preference for the lopressor if the patient already takes PO beta blockers.

Even though we now carry it, we can't use it for acute coronary syndrome. For that, we're still sticking with MONA and anti-emetics (phenergan/zofran/reglan).