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EPI works through alpha receptors to have what effect in cardiac arrest?
Increases SVR, SBP and DBP, myocardial electrical activity, coronary and cerebral blood flow, myocardial contractility, automaticity
What is the acute treatment for Ventricular fibrillation or Pulseless ventricular tyachycardia?
- Step 1- Primary CAB, defibrillation
- Step 2- Epinephrine 1 mg, Q 3-5min no max or Vasopressin 40 IU x1, Continue CPR 2 min
- Step 3 - Defibrillation
- Step 4 - Amiodarone 300 mg IV/IO x 1 if refractory VF or Vtach (all subsequent doses 150 mg 15 min infusion)
- Continue CPR 2 min, defibrillate
- Step 5 - Can resume EPI and defibrillation and 2 min CPR
What is the acute treatment for Asystole and PEA?
- Step 1 - Primary ABCD, CANNOT DEFIBRILLATE
- Step 2- Epinephrine 1 mg IV/IO, repeat Q 3-5 min no max or Vasopressin 40 IU IV/IO single dose
- Continue CPR
- Step 3 –Look for reversible causes
What are the indications for ICD?
- First line therapy for secondary prevention of Sudden Cardiac Death (SCD)
- Primary Prevention of SCD in Patients with prior myocardial infarction, LV dysfunction (low EF), and non-sustained VT
What are the indications for Therapeutic Hypothermia?
- Cardiac Arrest – pts not showing purposeful movements or following commands
- Traumatic Brain Injury
- Second tier therapy for refractory raised ICP
- Neonates with hypoxic-ischemic encephalopathy (HIE)
- Embolic Stroke
What is the temp range for therapeutic hypothermia?
- Typically 32-34˚C
- Recent TTM Trial 33˚C versus 36 ˚C – equally good
How long is Therapeutic Hypothermia induced for?
Applied for 12-24 hours
What is the goal of Therapeutic hypothermia?
Goal: reduce risk of ischemic injury to tissue
What are the CIs for Therapeutic Hypothermia?
- Recent major surgery within 14 days (risk of infection and bleeding)
- Systemic infection/sepsis
- Known bleeding abnormality or ongoing bleeding
- Ideally should be initiated within 6 hrs of ROSC
How can you determine if a patient is bleeding prior to Therapeutic Hypothermia?
Check PT/PTT, fibrinogen and d-dimer at admit
What are the drug types needed for Therapeutic Hypothermia?
What type of drugs would have lower clearance rate in Therapeutic Hypothermia?
What effect does Therapeutic Hypothermia have on drug potency?
Decreased potency of some drugs
What sedative might you use for Therapeutic Hypothermia?
- A common approach is continuous infusion of propofol or fentanyl +/- midazolam