rcpals

Second degree type II. Fixed p-r, then drops a beat.

Several recent studies, document rates between 150 and 200 chest compressions. Survival starts to drop as compression rates get greater than 120. So 100-120 is optimal.

According to multiple studies, there is no improvement in neurologically intact survival to hospital discharge, if you intubate during a code. Many hospitals no longer routinely intubate until the patient gets ROSC or they are having difficulty ventilating the pt or it's a primary respiratory issue. Chest rise is chest rise. Intubation is the number one thing that pulls us off the chest during CPR. It seems hard to justify routine intubation during CPR.

Hi Brama, One of the reasons we don't like to push amiodarone, if the patient is alive, is the high rate of hypotension and bradycardia. Generally this is an infusion related issue occuring in up to 25% of patients. Per your scenario, it doesnt seem like that would be such an issue. The community standard of care is Amio 150mg over 10 minutes followed by a 1mg a minute for six hours... Per the manufacture website... "Infusion: Amiodarone: I.V. DOSE RECOMMENDATIONS -- FIRST 24 HOURS -- Loading infusions. The recommended starting dose of Cordarone I.V. is about 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen: [COLOR=#3366ff]First Rapid: 150 mg over the FIRST - 10 minutes (15 mg/min). Add 3 mL of Cordarone I.V. (150 mg) to 100 mL D5W. Infuse 100 mL over 10 minutes. [COLOR=#3366ff]Followed by Slow: 360 mg over the NEXT 6 hours (1 mg/min). Add 18 mL of Cordarone I.V. (900 mg) to 500 mL D5W (conc = 1.8 mg/mL). [COLOR=#3366ff]Maintenance infusion: 540 mg over the REMAINING 18 hours (0.5 mg/min)." The problem with going outside the standard of care is legal risk. It would be appropriate to question an order that is outside the norm and document your concern to cover yourself. What if the doctor said lets give 600 mg of AMIO. Would you give it because he said to? That went out along time ago. Not a critique of you at any means. Just saying. @ESME. Adenosine is not a preferred drug for VT. It's in the AHA VT algorithm as a diagnostic technique, to be used only in the rare instance you can't tell if its SVT w/ abberancy or VT. Vagals and Adenosine only work on areas of the heart that are inervated by the vagus nerve. Thats the SA and AV node. Since V tach is below that level, adenosine or vagals will not work for true V-tach. @[COLOR=#003366]midinphx Your statement is thoughtful, accurate and the best so far. We call that constructive intervention. @[COLOR=#003366]8jimi8ICURN. Stable relates to perfusion not conciousness.

Hey all, Atropine works by blocking areas of the heart that are innervated by the vagus nerve. We know the vagus nerve only connects to the SA and AV node directly. The reason atropine is contraindicated in High level blocks (2nd type II and 3rd/CHB) is these blocks are below the level of the AV node. 2nd degree type 1 is usually at the level of the AV node and might benefit from atropine/vagal blockade. 2nd degree type II and 3rd degree/CHB originate below the AV node. Imagine we give atropine and it blocks the parasympathetic system/Vagus nerve (which is the brake pedal for the heart). It should increase SA to AV rate. Since 2nd degree type II and 3rd degree originate below the AV node, we run the risk of increasing the disassociation between the atria and ventricles. In 2nd degree type II and CHB/3rd degree all or most of the impulses from from the atria are not getting to the ventricles. That’s why we we have P waves that are not causing contractions in 2nd degree II and 3rd degree. If we just increase atrial rate that will not help our patient. We need to increase the ventricular rate to increase blood pressure. The atrial impulses can’t get to the ventricles so we run the risk of increasing the atrial rate with out concurrently increasing the ventricular rate. You can make 2nd degree type II in to 3rd degree or 3rd degree into ventricular aystole. So you might be able to increase SA-AV rate, but since 2nd degree II and 3rd degree is beneath the AV you would not concurrently increase the ventricular rate therefore increasing the dissociation. Pacing is the treatment of choice for the high level blocks. Unfortunately your instructor was wrong. We are not supposed to give atropine to 3rd degree as a primary intervention. The guidelines state “prepare for immediately pacing for higher level blocks”. I hope this helps Jeff Laabs RCP