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blunt traumatic arrest pharmacotherapy

htaed_rd at 123mail.org htaed_rd at 123mail.org
Fri Dec 11 06:54:42 GMT 2009


There is not even good evidence that medical arrests have a good outcome
with ACLS drugs. In certain specific indications, such as calcium for
hyperkalemia, there are drugs that work. 

The "everybody dead gets epinephrine" approach has no evidence to
support it in medical cardiac arrest, so it is unlikely that this
decades old hunch improves outcomes in traumatic arrest.

The question is, will epinephrine be removed in the next revision of the
guidelines, or will it be the revision after?

For all of you, who throw hissy fits, when non-trauma treatment is
mentioned - stop reading here, or you will be scarred for life.Another
way of looking at epinephrine is to look at the treatment of ventricular
tachycardia.

Imagine a medical patient, who is hypotensive, unconscious, and
unresponsive. The rhythm is ventricular tachycardia. The treatment
algorithm is ventricular tachycardia with a pulse and an ACLS student
suggested that epinephrine be given after defibrillation/cardioversion
(ACLS now recommends defibrillation, not cardioversion for unstable VT).

How many of you ACLS instructors would claim that the student just
killed the patient? Perhaps some of you would suggest this in a less
than subtle fashion. I like to describe epinephrine as a heart attack in
a syringe. 

On the other hand, If the fingers of the person assessing the same
patient are just a little less sensitive, they might not feel a pulse.
This very same patient is pulseless according to their assessment.
According to ACLS, that means that the patient should be treated with
the full 1,000 mcg of epinephrine after defibrillation. The only
difference is the ability to palpate a pulse by the person treating the
patient.

This is the difference between -

You can't give them that dangerous drug - You'll kill the patient!

and

It would be unethical to not give this drug - You'll kill the patient!

The same patient, just with different people palpating the pulse, but
the treatments are diametrically opposed.


Tim Noonan.

  

On Thu, 10 Dec 2009 19:08 -1000, "caesar ursic" <cmursic at gmail.com>
wrote:
> Who among you treats victims of blunt traumatic cardiac arrest with "ACLS
> protocol" drugs?  I'm referring to the blunt trauma patient brought in to
> ER
> with closed chest compressions in progress and no palpable pulses with
> wide-complex bradycardia.  Who gives boluses of
> epinephrine/atropine/sodium
> bicarbonate to these patients?  What is the role for these drugs in the
> treatment of obvious blunt traumatic arrest?
> 
> CM Ursic, MD
> g. surg.
> --
> trauma-list : TRAUMA.ORG
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