Full Arrest

avdrummerboy said:
Alright, here we go...

Question one, in my area, you go local as the next nearest is 35+ min away even code 3!

Question two, big whoop, haul ***, by the time you intercept, drop a line, administer fluids and push atropine, you could have been at the hospital and had them doing it (again that is where the ALS unit would be taking them anyway!) In terms of BLS, monitor vitals and keep a good airway!

Question three, even at the ALS level you're merely guessing at how off K+ levels are anyway, unless of course in that 10 minutes the ALS unit is running blood tests and getting those results. That being said, BLS airway and vitals monitoring and know that the chances of a reoccurring arrest are fairly high.

As was mentioned above, VERY few cardiac arrests waltz out of the hospital later on, regardless of how many ALS providers were on scene initially. The vast majority of them don't make it, or get to live life as a vegetable until the family or legal guardian cannot bear to see it anymore.
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Haven't read a single thing in this thread, but why the heck would you push atropine on a 'severely hypotensive, bradycardic' ROSC pt? That's silly.
 
teedubbyaw said:
Haven't read a single thing in this thread, but why the heck would you push atropine on a 'severely hypotensive, bradycardic' ROSC pt? That's silly.
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Looks like he was replying to a symptomatic brady patient post rosc. usaf gave him that scenario in the post or two before.
 
Let's keep it civil and polite. I had to start swinging the ban stick on Halloween.
 
Chimpie said:
Let's keep it civil and polite. I had to start swinging the ban stick on Halloween.
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I had made an attempt to edit my post but was on a call and hit the 10-minute edit wall. Is there a thought to allow edits beyond the 10-minute window to account for "repliers remorse"?
 
I am old enough, and I am an ambulance DRIVER lol. PA? Naw, I like the field too much for that!!
 
teedubbyaw said:
Haven't read a single thing in this thread, but why the heck would you push atropine on a 'severely hypotensive, bradycardic' ROSC pt? That's silly.
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What's silly about treating severe bradycardia?
 
Algorithm-Bradycardia.png


The fact that it's ROSC doesn't change the current condition!
 
teedubbyaw said:
Giving atropine to an unstable pt who has ROSC after a presumed STEMI is silly.

Deja vu, I already said that.
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WHY is it silly?

Do you dislike coronary perfusion?
 
I would personally pace a bradycardic unstable rosc patient... but thats just me
 
avdrummerboy said:
The fact that it's ROSC doesn't change the current condition!
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Using an algorithm to make decisions for you isn't the best practice. Please do tell me how administering a drug that causes increased myocardial oxygen demand/workload is beneficial in a patient that just experienced ROSC after a complete occlusion?
 
Any pt. with symptomatic brady can be considered unstable. If that's the case, you should never give atropine.

teedubbyaw said:
Using an algorithm to make decisions for you isn't the best practice. Please do tell me how administering a drug that causes increased myocardial oxygen demand/workload is beneficial in a patient that just experienced ROSC after a complete occlusion?
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If it's a complete occlusion, noting you do in the field will help either way, it's a lost cause, nothing short of PCI is going to be of any help, so the question is pointless. If it's not a complete occlusion, then it's dealers choice I guess, atropine/ pacing, diesel bolus to the hospital!
 
You still seem to be missing critical points. Atropine and TCP are completely different methods of treating bradycardia. To say that ROSC doesn't matter, that bradycardia is bradycardia, and nothing you do in the field matters is completely ignorant.
 
I guess it depends on area, our protocols call for atropine before pacing unless atropine is contraindicated. I didn't say that nothing that you do is pointless, but since you said that it was a complete occlusion, then only PCI will help it, pacing, atropine, dopamine, none of that will clear the blockage and get or keep the heart going.
 
So you won't go out of your protocols if it means the patients best interests are in mind?
 
teedubbyaw said:
Please do tell me how administering a drug that causes increased myocardial oxygen demand/workload is beneficial in a patient that just experienced ROSC after a complete occlusion?
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No one is talking about slamming a mg of atropine and rocketing the HR up to 120. That would be bad. I'd start with 0.2 mg and try to increase the HR by 20-30.

"Severe hypotension" will do far more to compromise MV02 balance than increasing the HR from the 30's to 60's....not to mention the brain and kidneys. You can debate pacing vs. atropine, but the fact is you need to increase MAP, and atropine is simply easier and may do the trick just fine.

There may be a better therapy than atropine, but without seeing an EKG and an echo, I think the safe bet is increasing the HR and if that doesn't increase MAP, then try something else. Once you get the HR up, you can give neo or vaso to increase DBP, if it's low. Or if CO is the problem, you can try something that gives some squeeze.

Bottom line is, you can't ignore "severe hypotension".
 
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