
The most recent FDA (Food and Drug Administration) listing of drug shortages, editing out the many cancer drugs, and other non-EMS drugs, includes the following:
Generic Name or Active Ingredient Status
Albuterol Sulfate Inhalation Solution (0.5%) Resolved
This is important, but one way of dealing with a nebulized albuterol shortage is to alternate albuterol with nebulized saline. this prevents giving too much albuterol to the patient who is maintaining a reasonable oxygen saturation and keeping the airway humidified.
Atropine Sulfate Injection Currently in Shortage
We should be accumulating atropine, since we no longer use atropine for asystole. Atropine maintains its strength, even when stored for extended periods, so we should only discard atropine when there is contamination.
Calcium Chloride Injection, USP Currently in Shortage
Calcium (chloride or gluconate) appears to be the best drug for hyperkalemia. We are fortunate in EMS to not have to deal with sodium polystyrene (Kayexalate), which is just a means of creating the appearance of clostridium difficlie. Senna glycoside (ex-lax) can be just as effective at causing diarrhea and anything that causes diarrhea will cause some removal of potassium.
Calcium Gluconate Injection Currently in Shortage
See above.
Cromolyn Sodium Inhalation Solution, USP Currently in Shortage
Dexamethasone Sodium Phosphate Injection Resolved
Dextrose 50% Injection Currently in Shortage
We should be using 10% dextrose, rather than 50%, but we are slow to learn from our mistakes.
Comment on 10% Dextrose vs 50% Dextrose.
Epinephrine Injection, 0.1 mg/mL Currently in Shortage
Maybe we will be using less epinephrine after the results of the Paramedic2 trial are published. I expect that some patients will be shown to benefit from epinephrine in cardiac arrest. I hope that the results will help us to identify which patients benefit from epinephrine in cardiac arrest and which patients have worse outcomes because of receiving epinephrine in cardiac arrest. I don’t really expect these answers, because we seem to be trying to avoid asking appropriate questions about drug treatment.
Epinephrine Injection, 1 mg/mL Resolved
Fentanyl Citrate (Sublimaze) Injection Currently in Shortage
There are other drugs that are effective for pain management. Hydromorphone (Dilaudid) can be used safely by EMS.
Labetalol Hydrochloride Injection Currently in Shortage
Lidocaine Hydrochloride (Xylocaine) Injection Currently in Shortage
EMS should have disposed of our supplies of lidocaine and amiodarone following the ALPS and PROCAMIO.
Dr. Kudenchuk is Misrepresenting ALPS as ‘Significant’
Lidocaine Hydrochloride (Xylocaine) Injection with Epinephrine Currently in Shortage
This is more for wilderness EMS, than urban.
Methylprednisolone Sodium Succinate for Injection, USP Currently in Shortage
This is an important drug for reactive airway conditions.
Nitrous Oxide, Gas Currently in Shortage
A lot of people are uncomfortable with the idea of using nitrous oxide, but it is safe – as long as there is good circulation of fresh air.
Pantoprazole (Protonix) Powder for Injection Currently in Shortage
This is usually not the part of allergic reaction that EMS treats, but it can be helpful.
Potassium Chloride Injection Currently in Shortage
Not generally prehospital EMS, but interfacility.
Procainamide Hydrochloride Injection, USP Currently in Shortage
This is an antiarrhythmic drug that actually works, but we tend to avoid it out of a lack of understanding and a lack of familiarity with the evidence.
Promethazine (Phenergan) Injection Currently in Shortage
Ranitidine Injection, USP Currently in Shortage
Rocuronium Bromide Injection Currently in Shortage
Succinylcholine may end up as a shortage because of the rocuronium shortage.
Sodium Bicarbonate Injection, USP Currently in Shortage
After calcium, sodium bicarbonate can be effective for hyperkalemia. Flush the line. Even better, use a different line for these incompatible medications.
We should not be wasting sodium bicarbonate in cardiac arrest patients, since it is not going to do anything to make things better, but it will make it more difficult to get sodium bicarbonate for the patients who can actually benefit.
Sodium Chloride 0.9% Injection Bags Currently in Shortage
Do we really need to start as many IV (IntraVenous) lines with a drip?
Sodium Chloride 23.4% Injection Currently in Shortage
Also effective for hyperkalemia, since it is the sodium that moves the potassium, not any myth of alkalinizing the patient.
.
Thanks, as always.
Thank you.
.