Here’s my first lecture from SMACCgold: The New Intra-Arrest. It generated a bit of controversy amongst my critical care friends, so we’ll be discussing various parts in more detail in the coming weeks.
- Please, please sign up for EMCrit CME
Links and References
- See this EMCrit Podcast on Hemodynamic Dosing of EPI
- The Music to Code By Compilation
- Waveform ETCO2 is the only way to confirm tube placement during a code (Anaesthesia 2011;66:1183)
- Max Harry Weil’s Disease-a-Month on CPR
- Steve Smith has the references for PCI during arrest in this ECG Blog Post
- Vent Settings for Arrest: Volume AC, Vt 500, Peak Flow 30 lpm, RR 10, PEEP 0, FiO2 100%, Pressure limit 100 cm H20
- Eliminate the Peri-Shock Pause–it is crucial (Resuscitation. 2014 Mar;85(3):336-42.)
- See the Slides Below for all the rest of the references
1 mg Epi and 20 IU Vasopressin Q3 minutes for 5 cycles, plus 40mg methylprednisolone for the 1st cycle. Hydrocortisone if in persistent shock
Journal Club Crit Care 2014;18:308
Why Epi and not Phenylephrine
From MH Weil’s Article Above:
Adrenergic agents with predominant a2 effect have been shown to be more effective as vasoconstrictor drugs, presumably because extrajunctional a2-receptors are more accessible to circulating catecholamines than postjunctional a1-receptors. This may explain why adrenergic amines that have predominant a1 actions such as methoxamine (Vasoxyl) and phenylephrine (Neo-Synephrine) are less effective than epinephrine after prolonged cardiac arrest.
LUCAS seems equivalent to excellent manual compressions (from ResusMe)
Cardiac Arrest: To the cath lab with ongoing chest compressions?
Steve Smith has a great post on the topic with a ton of evidence
Consider Dual-Shock for Non-Converting VF/VT
Charles Bruen has a great post with the evidence
Now on to the Podcast…