I just did my clinicals in ICU this past week and have a question regarding the use of acetaminophen. One of my patients was a post v-fib cardiac arrest, intubated, RASS -5, on fentanyl and propofol. Downtime before they got ROSC was 38 min, so he was on hypothermic protocols. Entire situation was most likely due to abrupt EtOH w/d as he had a history of alcoholism; bystander reported seizure before he went into cardiac arrest. Liver enzymes are through the roof. No fever, and we were cooling him down to 33 degrees.
Can someone tell me the rationale behind an order for acetaminophen? Was this strictly a secondary pain medication? There were obviously bleeding concerns since we had him hypothermic, so is this a better choice than an NSAID or something?
I meant to discuss this with my preceptor but it got crazy insane on the floor and I never got a chance. I don't think either one of us even took a bathroom break until at least 7 hours into the shift, lol.
At this point in the game, you have to prioritize. Like some previous posters have stated tylenol is protocol for many places when using post-code hypothermia. IMO i would 100% give the tylenol to help achieve appropriate hypothermia status in hopes that we are able to regain neurological status. Although the liver is very important, i would call it secondary in this situation.
Finishing of the liver with Tylenol when muscle paralysis will achieve the same end doesn't seem to be in the best interests of the patient. Restoring neuro function just to have the patient bleed to death seems counter productive.
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Finishing of the liver with Tylenol when muscle paralysis will achieve the same end doesn't seem to be in the best interests of the patient. Restoring neuro function just to have the patient bleed to death seems counter productive.