Megacode question

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bill williams

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Being tested out on megacode tomorrow. I'm a little confused about something.
When your patient regains a sinus rhythm, when should you hang an amiodarone drip/dopamine drip?
 
When they need one.

Think about the reasons you would use a antiarrhythmic like Amiodarone or a pressor like Dopamine.
 
Don't start amio after ROSC c NSR. If they were on an amio drip and converted to sinus, keep the amio.

Dopamine, along with norepi, are the ACLS pressor options to consider if your patient is hypotensive after ROSC and adding volume is contraindicated or patient is refractory to a bolus.
 
Summit said:
Don't start amio after ROSC c NSR. If they were on an amio drip and converted to sinus, keep the amio.

Dopamine, along with norepi, are the ACLS pressor options to consider if your patient is hypotensive after ROSC and adding volume is contraindicated or patient is refractory to a bolus.
Click to expand...

Ok, so if the patient is hypotensive w pulmonary edema, Dopamine is the way to go
 
Yes, and hypotension without pulmonary edema, after a fluid bolus has failed to adequately raise bp.
 
Took the test today, I failed it. The patient had no pulse with junctional brady on the monitor.
So I treated for bradycardia. Stupid mistake on my part. I leaned towards treating the monitor instead of the patient. Lesson learned.
 
bill williams said:
Took the test today, I failed it. The patient had no pulse with junctional brady on the monitor.
So I treated for bradycardia. Stupid mistake on my part. I leaned towards treating the monitor instead of the patient. Lesson learned.
Click to expand...

Don't fall down that rabbit hole of saying, "treat the patient, not the monitor"...it is bad medicine to say that.

Rhythm is immensely important when treating the patient, especially those without palpable pulses.

Supraventricular rhythm? That's less dead than idioventricular, and less dead than ventricular fibrillation (arguably more or less dead than VT). In all likelihood that rhythm would respond to fluid, chronotropes, and pressors. Perhaps pacing as well.

Should you have started CPR? Yep.

Should you have ignored the monitor? Nope.
 
Christopher said:
Don't fall down that rabbit hole of saying, "treat the patient, not the monitor"...it is bad medicine to say that.

Rhythm is immensely important when treating the patient, especially those without palpable pulses.
Click to expand...

Thank you.

I am so sick of hearing that BS.

"Rhythm doesn't matter". "Spo2 doesn't matter". "BP doesn't matter".

Yeah, OK. Why do we even use monitors, then?
 
I've certainly amended that staying to "Treat the entire patient, not just the patient or just the monitor."

Why that way? The patient's signs and symptoms are important... and so is the monitor.

In this case, you have the monitor showing an organized electrical rhythm. Patient is pulseless... that combo should spark off a certain treatment path, should it not? Ignoring either would potentially lead you to follow an improper protocol or treatment plan.
 
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