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Adrenaline for stab heart

Miranda Voss mvossak at yahoo.co.uk
Tue Dec 15 12:26:48 GMT 2009


I realise it is useless, but I would like to know whether it actually causes harm. I wouldn't give it myself, but there are casualty officers who see the patient before I do and anesthetists who look after them intra-op. I am wondering if we should stop them giving epi/ardenaline. 

Thanks,

Miranda.

Simply put, epi is going to be absolutely useless if the heart is empty..........You must fuel the engine before turning the key.

Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Miranda Voss
Sent: Monday, December 14, 2009 10:20 AM
To: trauma-list at trauma.org
Subject: Adrenaline for stab heart

Interested to read this. Have I understood correctly that adrenaline should not be given in penetrating cardiac trauma because the sutures tear out? Had exactly that scenario a few weeks ago and it sounds as though this is the explanation. 

Apologies if this is common knowledge that I have missed, but pls could I get some clarity on the use of adrenaline in cardiopulmonary arrest after penetrating trauma in the "cardiac box"? I realise that it doesn't make sense physiologically, but is adrenaline contraindicated? Intra-operative adrenaline infusions are a common anaesthesiology reaction to patients with a poor output and I had never felt the need to discourage them.

Thanks,

Miranda
Worcester, W Cape. SA.


The problem with any traumatic cardiac arrest is that you need to consider the cause. Cardiac laceration is up there in the differential. Suture the laceration and if you've got inotropes in the system it will pull itself apart.


Matt Dunn
EP
Warwick




      


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