Guidelines recommend prompt defibrillation for treatment of in-hospital cardiac arrest due to an initial rhythm of ventricular fibrillation (or pulseless ventricular tachycardia) Epinephrine (adrenaline) is recommended only when patients remain in refractory ventricular fibrillation or pulseless ventricular tachycardia after many defibrillation attempts. Use of epinephrine before defibrillation is associated with lower odds of survival to discharge and of favourable neurological survival, probably due to lower odds of achieving return of spontaneous circulation
Approach to Chest Pain
Clinical factors that INCREASE likelihood of ACS/AMI:
- CP radiating bilaterally > right > left
- Diaphoresis associated with CP
- N/V associated with CP
- Pain with exertion
Clinical factors that DECREASE likelihood of ACS/AMI:
Chest pain that is:
- Sharp, stabbing
- Reproducible with palpation
ACLS REVISION: Post ROSC Care
Once we’ve achieved ROSC our job is not over. Good post-arrest care involves maintaining blood pressure and cerebral perfusion, adequate sedation, cooling and preventing hyperthermia, considering antiarrhythmic medications, optimization of tissue oxygen delivery while avoiding hyperoxia, getting patients to PCI who need it, and looking for and treating the underlying cause.
Giving adenosine for SVT
Giving adenosine 6mg in 20mL of saline as a single syringe push vs the usual 6mg push and rapid flush with 20mL saline is non-inferior for the treatment of SVT.