Podcasts about Cardiopulmonary resuscitation

Play Episode Listen Later Nov 12, 2024 13:20

Hoy abordaremos una actualización esencial en el ámbito de las emergencias: la Actualización 2024 de las Guías de Resucitación tras Ahogamiento de la American Heart Association (AHA) y la American Academy of Pediatrics (AAP). Este tema es fundamental, ya que el ahogamiento sigue siendo una de las principales causas de muerte no intencional en el mundo. El ahogamiento se define como el proceso de experimentar insuficiencia respiratoria por inmersión en agua y, si no se actúa de inmediato, este evento progresa de una parada respiratoria a una parada cardíaca. La resucitación en estos casos requiere intervenciones específicas que consideren la hipoxia severa como causa principal del paro. Hoy discutiremos las recomendaciones clave y los puntos a tener en cuenta al responder a emergencias de ahogamiento, ya sea que seas un rescatista laico o un profesional de la salud. LA CADENA DE SUPERVIVENCIA EN AHOGAMIENTOS Presentador: Comencemos con el concepto de la Cadena de Supervivencia en Ahogamientos. Esta cadena es un enfoque sistemático que establece cinco pasos críticos para aumentar la supervivencia de la persona ahogada. Paso 1 - Prevención del Ahogamiento: La prevención es siempre el primer paso. Las guías indican que más del 90% de los ahogamientos son prevenibles. Entre las medidas de prevención se encuentran: instalar barreras para evitar el acceso a áreas de agua, usar chalecos salvavidas en actividades acuáticas y garantizar la supervisión de niños en áreas cercanas al agua. Paso 2 - Reconocer el Peligro y Activar la Ayuda: Reconocer que alguien está en peligro es crucial para activar la ayuda rápidamente. Es importante recordar que una persona ahogada no siempre puede pedir auxilio, ya que el instinto por respirar es tan fuerte que impide que levante los brazos o grite. Paso 3 - Proporcionar Flotación: Antes de intentar un rescate, las guías recomiendan ofrecer un dispositivo de flotación si está disponible. Esto ayuda a evitar que el rescatador se convierta en una segunda víctima y permite estabilizar a la persona en el agua. Paso 4 - Sacar del Agua de Forma Segura: Si es seguro, el siguiente paso es sacar a la persona del agua. Esto facilita la evaluación y el manejo posterior. Las guías sugieren que si la persona está inconsciente, se realice la extracción en una posición lo más horizontal posible para evitar comprometer aún más la vía aérea. Paso 5 - Iniciar Soporte Vital Básico y Avanzado: Finalmente, se debe iniciar el soporte vital básico (SVB) lo antes posible. Si la parada es confirmada y llega el equipo de emergencia, deben iniciar el soporte vital avanzado (SVA) para mejorar las probabilidades de supervivencia. IMPORTANCIA DE LA VENTILACIÓN Y EL MANEJO DE LA VÍA AÉREA La siguiente recomendación clave en esta actualización se centra en el manejo de la vía aérea y la ventilación. A diferencia de otras paradas cardíacas, el ahogamiento requiere una prioridad en la ventilación debido a la hipoxia severa causada por el agua en los pulmones. Recomendación para Respiración de Rescate en el Agua: Si el rescatador está entrenado y es seguro hacerlo, las guías recomiendan iniciar la respiración de rescate en el agua. Esta intervención temprana ayuda a prevenir que el ahogamiento avance a un paro cardíaco completo. Sin embargo, se debe valorar constantemente la seguridad del rescatador, ya que no se debe comprometer la seguridad personal. Recomendación sobre Administración de Oxígeno: Otra recomendación importante es administrar oxígeno lo antes posible cuando esté disponible, ya que la hipoxia severa es la causa principal de la parada. No obstante, se enfatiza que la administración de oxígeno no debe retrasar el inicio de una RCP de alta calidad si la persona ya está en paro. USO DEL DESFIBRILADOR EXTERNO AUTOMÁTICO (DEA) Y RCP EN AHOGAMIENTO Un aspecto único de la resucitación tras ahogamiento es el orden de prioridad entre RCP y DEA. Debido a que los ritmos desfibrilables son poco comunes en el ahogamiento, las guías enfatizan que es más efectivo iniciar la RCP con ventilación antes de aplicar el DEA. Recomendación sobre el Orden de RCP y DEA: En caso de ahogamiento con paro, la prioridad debe ser la RCP con ventilación antes de aplicar el DEA. Aunque la desfibrilación es útil si se detecta un ritmo desfibrilable, la mayoría de los paros por ahogamiento no tienen este tipo de ritmo, por lo que no debe retrasarse la RCP buscando un DEA. Uso de DEA en Ritmos Desfibrilables: Si se cuenta con un DEA y es seguro usarlo, puede aplicarse en caso de un ritmo desfibrilable. Sin embargo, siempre priorizando la RCP y evitando que la búsqueda de un DEA retrase las compresiones y ventilaciones necesarias para el paciente ahogado. BRECHAS Y NECESIDADES DE INVESTIGACIÓN FUTURA Un aspecto importante que resaltan las guías es la necesidad de continuar investigando la resucitación y prevención del ahogamiento en diferentes contextos y regiones. Se identificaron algunas brechas de conocimiento, como la falta de recursos en áreas remotas o de bajos ingresos y la implementación de programas de desfibrilación pública en áreas acuáticas. Recomendación de Educación y Entrenamiento Comunitario: Las guías sugieren fortalecer la educación comunitaria sobre técnicas de rescate y resucitación, especialmente en áreas con alta incidencia de ahogamientos. También se recomienda promover la formación en soporte vital básico y avanzado en todas las comunidades para mejorar los tiempos de respuesta y la calidad de la resucitación. CONCLUSIÓN Para resumir, hemos cubierto las recomendaciones esenciales de la actualización 2024 de la AHA y la AAP sobre resucitación tras ahogamiento. Como hemos visto, los elementos clave incluyen: Priorizar la ventilación y la vía aérea en el manejo de los ahogamientos, dado que la hipoxia es la causa principal del paro. Iniciar RCP con ventilación sin retraso y solo usar el DEA si está disponible y se detecta un ritmo desfibrilable. Fortalecer la educación y prevención en las comunidades para reducir la incidencia de ahogamientos y mejorar la respuesta en estos eventos. En ECCtrainings, ofrecemos cursos de soporte vital básico y avanzado que cubren estas y otras técnicas críticas para responder a emergencias. Si estás interesado en aprender más, visita nuestra página en ECCtrainings. Gracias por acompañarnos en ECCpodcast, ¡nos vemos en el próximo episodio! Referencias 2024 American Heart Association and American Academy of Pediatrics Focused Update on Special Circumstances: Resuscitation Following Drowning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Cameron Dezfulian, MD, FAHA, FAAPCo-Chair, Tracy E. McCallin, MD, FAAPCo-Chair, Joost Bierens, MD, PhD, MCPM, Cody L. Dunne, MD, Ahamed H. Idris, MD, FAHA, Andrew Kiragu, MD, FAAP, Melissa Mahgoub, PhD, Rohit P. Shenoi, MD, FAAP, David Szpilman, MD, Mark Terry, MPA, NRP, Janice A. Tijssen, MD, MSc, FAHA, Joshua M. Tobin, MD, MSc, Alexis A. Topjian, MD, MSCE, FAHA

SCCM Pod-525 PCCM: Extracorporeal Cardiopulmonary Resuscitation Outcomes in Pediatric Patients

university washington phd seattle md outcomes pediatrics mortality pharmd bcps pediatric patients sccm extracorporeal cardiopulmonary resuscitation

Play Episode Listen Later Sep 19, 2024 21:18

Host Marilyn N. Bulloch, PharmD, BCPS, FCCM, is joined by Catherine Beni, MD, PhD, to discuss a study aimed at determining outcomes of extracorporeal CPR (ECPR) in pediatric patients without congenital cardiac disease and identifying associations with in-hospital mortality of factors such as initial arrest rhythm and patient demographics (Beni CE, et al. Pediatr Crit Care Med. 2023 Nov;24:927-935). Catherine Beni, MD, PhD, is a resident physician in the department of surgery at the University of Washington in Seattle, Washington.

The Poison Letter To The Editor: Listener Critiques and Author Responses for The AHA 2023 Life Threatening Poisoning Guidelines with Dr. Michael Mullins, Dr. Donna Seger, Dr. Leon Gussow, and Dr. Eric Lavonas

The Poison Lab

Play Episode Listen Later Aug 28, 2024 23:47

In this episode the poison lab hosts scientific discourse . Three listeners (Dr. Michael Mullins, Dr. Donna Seger, and Dr. Leon Gussow) write in their critiques surrounding specific recommendations and language used with the AHA 2023 Management of Poisoning Cardiac Arrest or Life-Threatening Toxicity guidelines. Lead author of the guidelines Dr. Eric Lavonas then responds to and addresses their points with counterpoints or appraisals. Tune in and draw your own conclusions!Link to guidelinesLink to high yield review

management guidelines responses aha poisoning critiques life threatening seger letter to the editor cardiopulmonary resuscitation michael mullins

Episode 891: Hypothermia

online trial gm inflation shorts chest controlled ratio cluster sustained compression ventilation pmid newborns schm journal club randomised cardiopulmonary resuscitation

Play Episode Listen Later Feb 19, 2024 4:55

Contributor: Taylor Lynch MD Educational Pearls Hypothermia is defined as a core body temperature less than 35 degrees Celsius or less than 95 degrees Fahrenheit Mild Hypothermia: 32-35 degrees Celsius Presentation: alert, shivering, tachycardic, and cold diuresis Management: Passive rewarming i.e. remove wet clothing and cover the patient with blankets or other insulation Moderate Hypothermia: 28-32 degrees Celsius Presentation: Drowsiness, lack of shivering, bradycardia, hypotension Management: Active external rewarming Severe Hypothermia: 24-28 degrees Celsius Presentation: Heart block, cardiogenic shock, no shivering Management: Active external and internal rewarming Less than 24 degrees Celsius Presentation: Pulseless, ventricular arrhythmia Active External Rewarming Warm fluids are insufficient for warming due to a minimal temperature difference (warmed fluids are maintained at 40 degrees vs. a patient at 30 degrees is not a large enough thermodynamic difference) External: Bear hugger, warm blankets Active Internal Rewarming Thoracic lavage (preferably on the patient's right side) Place 2 chest tubes (anteriorly and posteriorly); infuse warm IVF anteriorly and hook up the posterior tube to a Pleur-evac Warms the patient 3-6 Celsius per hour Bladder lavage Continuous bladder irrigation with 3-way foley or 300 cc warm fluid Less effective than thoracic lavage due to less surface area Pulseless patients ACLS does not work until patients are rewarmed to 30 degrees High-quality CPR until 30 degrees (longest CPR in a hypothermic patient was 6 hours and 30 minutes) Give epinephrine once you reach 35 degrees, spaced out every 6 minutes ECMO is the best way to warm these patients up (10 degrees per hour) Pronouncing death must occur at 32 degrees or must have potassium > 12 References 1. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - Part 1: Introduction. Circulation. 2005;112(24 SUPPL.). doi:10.1161/CIRCULATIONAHA.105.166550 2. Brown DJA, Burgger H, Boyd J, Paal P. Accidental Hypothermia. N Engl J Med. 2012;367:1930-1938. doi:10.1136/bmj.2.5543.51-c 3. Dow J, Giesbrecht GG, Danzl DF, et al. Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update. Wilderness Environ Med. 2019;30(4S):S47-S69. doi:10.1016/j.wem.2019.10.002 4. Kjærgaard B, Bach P. Warming of patients with accidental hypothermia using warm water pleural lavage. Resuscitation. 2006;68(2):203-207. doi:10.1016/j.resuscitation.2005.06.019 5. Lott C, Truhlář A, Alfonzo A, et al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation. 2021;161:152-219. doi:10.1016/j.resuscitation.2021.02.011 6. Plaisier BR. Thoracic lavage in accidental hypothermia with cardiac arrest - Report of a case and review of the literature. Resuscitation. 2005;66(1):99-104. doi:10.1016/j.resuscitation.2004.12.024 Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit, OMSII

#183 - [Journal Club Shorts] -

The Incubator

Play Episode Listen Later Feb 11, 2024 5:45

Sustained inflation and chest compression versus 3:1 chest compression to ventilation ratio during cardiopulmonary resuscitation of asphyxiated newborns (SURV1VE): A cluster randomised controlled trial.Schmölzer GM, Pichler G, Solevåg AL, Law BHY, Mitra S, Wagner M, Pfurtscheller D, Yaskina M, Cheung PY; SURV1VE- Trial Investigators.Arch Dis Child Fetal Neonatal Ed. 2024 Jan 11:fetalneonatal-2023-326383. doi: 10.1136/archdischild-2023-326383. Online ahead of print.PMID: 38212104 As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Podcast 887: Family Presence in Cardiac Resuscitation

family presence ptsd lower references secondary cpr cardiac resuscitation new england journal of medicine cardiopulmonary resuscitation

Play Episode Listen Later Jan 22, 2024 2:46

Contributor: Aaron Lessen MD Educational Pearls: A 2013 study randomized families of those in cardiac arrest into two groups: Actively offered patients' families the opportunity to observe CPR Follow standard practice regarding family presence (control group) Of the 266 relatives that received offers to observe CPR, 211 (79%) accepted vs. 43% in the control group observed CPR The study assessed a primary end-point of PTSD-related symptoms 90 days after the event Secondary end-points included depression, anxiety, medicolegal claims, medical efforts at resuscitation, and the well-being of the healthcare team The frequency of PTSD-related symptoms was significantly higher in the control group Lower rates of anxiety and depression for the families who witnessed CPR There were no effects on resuscitation efforts, patient survival, medicolegal claims, or stress on the healthcare team If families choose to witness CPR, it's beneficial to have someone with the family to explain the process References 1. Jabre P, Belpomme V, Azoulay E, et al. Family Presence during Cardiopulmonary Resuscitation. N Engl J Med. 2013;368(11):1008-1018. doi:10.1056/NEJMoa1203366 Summarized by Jorge Chalit, OMSII | Edited by Jorge Chalit

Cardiopulmonary Resuscitation with Dr. Tarif Choudhury, Part 2

PedsCrit

Play Episode Listen Later Dec 11, 2023 34:35

Dr. Tarif Choudhury is a pediatric cardiac intensivist at Columbia University College of Physicians and Surgeons. After finishing his residency in pediatrics at Cohen Children's Medical Center, he completed his cardiology fellowship at Lurie Children's Hospital in Chicago followed by a pediatric critical care fellowship at Morgan Stanley Children's Hospital at Columbia University School of Medicine. His areas of interest are the impact of clinical simulation to improve team performance, clinical outcomes of PCICU patients and clinical outcomes of patients on mechanical circulatory support in the PCICU.Dr. Gav Apfel is a CICU hospitalist at Columbia University College of Physicians and Surgeons. He completed his residency training at Columbia University College of Physicians and Surgeons and will be joining the Columbia University's critical care fellowship program next year. He is interested in pursuing a career in cardiac intensive care.ObjectivesBy the end of this podcast series, listeners should be able to: Strategize how to approach an arrest as the code leaderRecognize the key elements of high-quality CPR and how to optimize perfusion during an arrest Recall airway management, oxygenation, and ventilation during CPRRecall different approaches to physiological monitoring during an arrest to guide therapy Recognize appropriate resuscitation drug administration and timing during CPRRecall management with manual defibrillation for arrests with a shockable rhythmDevelop approach to determining code duration and when to discontinue CPRHow to support PedsCritPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.To help improve the podcast, please complete our Listener Feedback Survey (< 5 minutes)!Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.Support the show

Cardiopulmonary Resuscitation with Dr. Tarif Choudhury, Part 1

PedsCrit

Play Episode Listen Later Dec 4, 2023 39:34

Dr. Tarif Choudhury is a pediatric cardiac intensivist at Columbia University College of Physicians and Surgeons. After finishing his residency in pediatrics at Cohen Children's Medical Center, he completed his cardiology fellowship at Lurie Children's Hospital in Chicago followed by a pediatric critical care fellowship at Morgan Stanley Children's Hospital at Columbia University School of Medicine. His areas of interest are the impact of clinical simulation to improve team performance, clinical outcomes of PCICU patients and clinical outcomes of patients on mechanical circulatory support in the PCICU.Dr. Gav Apfel is a CICU hospitalist at Columbia University College of Physicians and Surgeons. He completed his residency training at Columbia University College of Physicians and Surgeons and will be joining the Columbia University's critical care fellowship program next year. He is interested in pursuing a career in cardiac intensive care.ObjectivesBy the end of this podcast series, listeners should be able to: Strategize how to approach an arrest as the code leaderRecognize the key elements of high-quality CPR and how to optimize perfusion during an arrest Recall airway management, oxygenation, and ventilation during CPRRecall different approaches to physiological monitoring during an arrest to guide therapy Recognize appropriate resuscitation drug administration and timing during CPRRecall management with manual defibrillation for arrests with a shockable rhythmDevelop approach to determining code duration and when to discontinue CPRHow to support PedsCritPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.To help improve the podcast, please complete our Listener Feedback Survey (< 5 minutes)!Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.Support the show

Bellows, Barrels, and Smoke: The History of CPR (Cardiopulmonary Resuscitation)

Poor Historians: Misadventures in Medical History Podcast

Play Episode Listen Later Nov 23, 2023 59:35

CPR (aka cardiopulmonary resuscitation) is a simple way to save a life. When a heart stops, the modern teaching is to "get on the chest" and start giving compressions. But it may surprise nobody that there were early forms of CPR. There were whole committees devoted to this topic. Some of the first ideas were definitely a rough draft. Others were downright comically bad, though well-meaning. The history of CPR is almost as sexy as Baywatch made it seem.References: available HERE on website in our show notes/blog section for the episode.--------------------- Mike's Trivia Challenge Contest is still in effect through the end of November. Keep those submissions coming for your chance to win a T-shirt and "Show Me Your Guts" coloring book from our sponsor, Artery Ink.For info to participate, details are HERE on our website. ---------------------Support the showSponsor: Artery InkUse promo code HISTORYPOD at Artery Ink's website to save 10%* on your order of $35 or more and show support for our show as well as for a homegrown, wonderful local company. Artery Ink specializes in apparel and decor inspired by anatomy and the human body. Whether you're in the field of healthcare or not, Artery Ink has something that will definitely appeal to you so go and check them out! (*Discount code does not apply to subscription boxes)Submissions for Mike's Trivia Challenge Segment:-We invite our audience to submit medical history trivia questions (with or without a supporting article) to see if Mike happens to know the answer off the top of his head.-If Mike is wrong we'll award you your very own medical eponym so that you can join us in becoming a part of medical history.-Submit through our website, social media DMs, or via e-mail: poorhistorianspod@gmail.comPodcast Links:-Linktree (reviews/ratings/social media links): linktr.ee/poorhistorianspod

history smoke dms discounts references cpr baywatch submissions barrels bellows cardiopulmonary resuscitation

Elvytys vuonna 2024 - terveisiä Barcelonasta!

Laadukasta ensihoitoa

Play Episode Listen Later Nov 23, 2023 58:48

Tänään otetaan selvää mitä uutta taannoinen Resuscitation 2023 -konferenssi Barcelonassa tarjosi elvytykseen liittyvien käytäntöjen ja suositusten osalta, mikä on Double Sequential Defibrillation (DSED) ja mitä tulisi huomioida hukuksissa olleiden elvytyksessä. Pohditaan myös miksi voisi olla tarkoituksenmukaista, että omaiset seuraavat läheisensä elvytystoimia. Lisäksi tutustutaan Suomen elvytysneuvoston toimintaan ja millä tavoin maallikoiden elvytystaitoja pyritään lisäämään myös Suomessa. Jakson vieras, Piritta Setälä, on kokenut ensihoitolääkäri. Hän on työskennellyt Pirkkalan FinnHEMS 30 -lääkärihelikopterissa toiminnan aloittamisesta asti ja toimii tukikohdan vastuulääkärinä sekä Pirkanmaan hyvinvointialueen ensihoitopalveluiden apulaisylilääkärinä. Lisäksi Piritta toimii myös Suomen elvytysneuvoston puheenjohtajana. Hänen muutaman vuoden takainen väitöskirja osatutkimuksineen käsitteli niin ikään sairaalan ulkopuolisia elvytystilanteita eri näkökulmista. Defibrillation Strategies for Refractory Ventricular Fibrillation (N Engl J Med 2022; 387:1947-1956): https://www.nejm.org/doi/full/10.1056/NEJMoa2207304 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: https://www.resuscitationjournal.com/article/S0300-9572(23)00306-4/fulltext #laadukastaensihoitoa #FOAMed #ensihoito #akuuttihoito #lääketiede #elvytys #kaksoisdefibrillaatio #elvytysneuvosto #resuscitation #CPR #DSED #ERC

lis suomen suomessa jakson resuscitation vuonna foamed pohditaan cardiopulmonary resuscitation terveisi barcelonassa

Paro cardiaco por intoxicación con digoxina: Actualización 2023 de guías de ACLS

Play Episode Listen Later Oct 28, 2023 24:44

La American Heart Association publicó un documento con recomendaciones específicas para el manejo del paciente en paro cardiaco por intoxicación. Este artículo repasará las principales recomendaciones. Este es el quinto episodio de una serie de episodios relacionados al manejo del paro cardiaco por envenenamientos. En este episodio discutimos el manejo de la intoxicación por digoxina. Índice terapéutico de la dioxina El índice terapéutico mide la seguridad de un medicamento. Un medicamento con un índice terapéutico reducido significa que es necesario mantener una concentración muy precisa en la sangre. De lo contrario, no es suficiente para ser efectiva, o se vuelve tóxica. Según la farmacocinética y farmacodinamia, para que un medicamento sea efectivo, el cuerpo tiene primero que absorberlo a la circulación. Una vez en la circulación, el cuerpo va a metabolizarlo hasta eliminarlo completamente. Luego de un tiempo determinado, la dosis que queda en el cuerpo ya deja de ser efectiva. Si es necesario mantener una concentración constante en la sangre, entonces es necesario seguir administrando otras dosis a intervalos definidos para asegurar que el cuerpo siga teniendo un suplido constante de la droga para reemplazar lo que se va eliminando. La digoxina tiene un índice terapéutico muy reducido. Quiere decir que es necesario administrar una cantidad precisa del medicamento y medir cuánto es el nivel en la sangre para evitar correr el riesgo de haber administrado demasiado. La digoxina se excreta a través de los riñones. Si un paciente desarrolla fallo renal agudo, pudiera tener un aumento clínicamente significativo de los niveles de digoxina. Medicamentos que alteran la fracción libre de la digoxina Disminución del efecto de la digoxina Carbamazepine, fosfenitoína y fenobarbital Rifampin Aumento del efecto de la digoxina Amiodarona, carvedilol, ranozaline, ticagrelol Verapamil, tacrolimus, cyclosporine Azitromicina, eritromicina y claritromicina Fungicidas azoles Signos y síntomas de la intoxicación por digoxina La intoxicación con digoxina puede producir una amplia gama de signos y síntomas gastrointestinales, neurológicos y cardiacos: Signos cardiacos Cambios en el segmento ST (La descripción clásica del EKG del paciente con intoxicación con digoxina es una depresión del segmento ST con una curva cóncava.) Cambios en el intervalo QTc Taquicardia atrial Taquicardia nodal Taquicardia ventricular (especialmente taquicardia ventricular bidireccional) Bradicardia y bloqueo AV (1er grado y 2ndo grado Tipo 1) Bigeminismo ventricular Fibrilación ventricular o asístole Signos gastrointestinales (intoxicación aguda) Anorexia Náusea Vómitos Diarrea Disturbios visuales (color amarillo o verde) Signos neurológicos (intoxicación crónica) Confusión Debilidad Síncope Convulsiones Hiperkalemia Nota: La hipokalemia (causada, por ejemplo, por el uso de diuréticos) puede causar toxicidad por digoxina. Si el paciente tiene hipokalemia, pudiera ser necesario suplementar con potasio si se va a usar anticuerpos antidigoxina porque estos van a bajar los niveles de potasio aún mas. Si el paciente toma digoxina, es posible que los signos y síntomas que ve sea por la digoxina. La hiperkalemia por digoxina La intoxicación por digoxina puede causar hiperkalemia, pero el mecanismo de la hiperkalemia inducida por digoxina es diferente al mecanismo de la hiperkalemia por otras causas. Por lo tanto, el manejo es diferente. Mecanismo de hiperkamia por digoxina Los glucósidos cardiacos inhiben la bomba de sodio y potasio en las células cardiacas. El movimiento de calcio hacia afuera de la célula depende del movimiento de sodio. Los glucósidos cardiacos inhiben la bomba de sodio y potasio, por lo tanto están inhibiendo el movimiento de sodio. La inhibición de la bomba de sodio y potasio produce que el potasio deje de entrar a la célula, acumulándose afuera (hiperkalemia). La bomba de sodio y potasio no produce un balance eléctrico perfecto, por lo que el cuerpo recurre al movimiento de sodio y calcio para completar la repolarización. Al dejar de funcionar la bomba de sodio y potasio, aumentan los niveles de calcio dentro de la célula. Normalmente, este aumento en la concentración de calcio produce un aumento en la fuerza de contractilidad del músculo cardiaco. En teoría, y una muy limitada evidencia, si se inyecta más calcio para tratar la hiperkalemia, se puede agravar los niveles ya elevados de calcio dentro de la célula y se puede producir una contracción continua (contracción tetánica) que lleva a paro cardiaco. Aunque esto es un riesgo teórico, no hay mucha data que apoye la teoría y tampoco hay mucha data de que el calcio apoye este tipo de hiperkalemia porque el mecanismo es diferente. Manejo de la hiperkalemia por digoxina El manejo de la hiperkalemia por inducida por digoxina consiste primariamente en la administración de anticuerpos antidigoxina. Consulte al Centro de Control de Envenenamientos En los Estados Unidos y Puerto Rico, 1-800-222-1222. Algunos pacientes con ingestas recientes (< 1 hr) pudieran beneficiarse del uso de carbón activado. Pero, en general, el manejo se centra alrededor del uso de los anticuerpos antidigoxina. Recomendaciones de la American Heart Association para paro cardiaco por intoxicación con digoxina Recomendamos la administración de anticuerpos antidigoxina para envenenamientos con digoxina o digitoxina. (Clase de recomendación: 1, Nivel de evidencia: B-NR) Es razonable administrar anticuerpos antidigoxina para envenenamiento por sapo bufo o adelfa amarilla. (Clase de recomendación: 2a, Nivel de evidencia: C-LD) Puede ser razonable administrar anticuerpos antidigoxina para tratar envenenamientos por glicósidos cardiacos que no sean digoxina, digitoxina, sapo bufo, o adelfa amarilla. (Clase de recomendación: 2b, Nivel de evidencia: C-LD) Puede ser razonable administrar atropina para bradidisritmias causadas por digoxina y otros envenenamientos por glicósidos cardiacos. (Clase de recomendación: 2b, Nivel de evidencia: C-LD) Puede ser razonable administrar un marcapasos eléctrico para tratar bradidisritmias debido a envenenamiento por digoxina y otros glicósidos cardiacos. (Clase de recomendación: 2b, Nivel de evidencia: C-LD) Puede ser razonable administrar lidocaína, fenitoína, o bretilio para tratar disritmias ventriculares causadas por digitálicos y otros glicósidos cardiacos hasta que se pueda obtener anticuerpos antidigitálicos. (Clase de recomendación: 2b, Nivel de evidencia: C-LD). No recomendamos el uso de hemodiálisis, hemofiltración, hemoperfusión, o plasmaféresis para tratar envenenamiento por digoxina. (Clase de recomendación: 3: no beneficio, Nivel de evidencia: B-NR) Referencias Lavonas EJ, Akpunonu PD, Arens AM, Babu KM, Cao D, Hoffman RS, Hoyte CO, Mazer-Amirshahi ME, Stolbach A, St-Onge M, Thompson TM, Wang GS, Hoover AV, Drennan IR; on behalf of the American Heart Association. 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2023;148:e•••–e•••. doi: 10.1161/ CIR.0000000000001161 https://litfl.com/digoxin-toxicity-ecg-library/ https://litfl.com/digoxin-effect-ecg-library/ https://litfl.com/calcium-digoxin-toxicity-and-stone-heart-theory/#:~:text=This%20is%20based%20on%20the,by%20causing%20delayed%20after%2Ddepolarisations https://emcrit.org/ibcc/dig/#:~:text=mechanism%20of%20action%20of%20digoxin,in%20patients%20with%20digoxin%20overdose.

Paro cardiaco por intoxicación con cianuro: Actualización 2023 de las guías de ACLS de la American Heart Association

Play Episode Listen Later Oct 24, 2023 8:47

La American Heart Association publicó un documento con recomendaciones específicas para el manejo del paciente en paro cardiaco por intoxicación. Este artículo repasará las principales recomendaciones. Este es el cuarto episodio de una serie de episodios relacionados al manejo del paro cardiaco por envenenamientos. En este episodio discutimos el manejo de la intoxicación por cianuro. En adición a su uso en la limpieza de joyería, laboratorios y en procesos industriales, el cianuro se puede liberar en fuegos estructurales debido a la combustión incompleta de productos que contienen nitrógeno, tales como los plásticos, vinyl, lana y la seda. Mecanismo de toxicidad del cianuro El cianuro afecta la capacidad de la célula para utilizar el oxígeno. En específico, inhibe la respiración celular en la mitocondria. Esto puede llevar rápidamente a signos severos de hipoxia con colapso cardiovascular. Debido a que no es práctico obtener niveles de cianuro en un tiempo razonable, se debe sospechar dentro del contexto de alguien que ha estado potencialmente expuesto y/o esté experimentando signos de hipoxia refractaria. Antídotos: Hidroxocobalamina (Vitamina B-12), nitrito de sodio y tiosulfato de sodio El antídoto preferido es la vitamina B-12 (hidroxocobalamina). En segundo plano, puede considerarse el nitrito de sodio, sin embargo, puede complicar la hipoxia en presencia de intoxicación con monóxido de carbono. El tiosulfato de sodio se puede añadir a cualquiera de las dos intervenciones anteriores. Oxígeno al 100% La guía de la AHA menciona que algunos estudios en animales sugieren un mayor beneficio de los antídotos cuando se combinan con terapia de oxígeno al 100%, pero que no hay estudios hechos en humanos. Aunque esta sección trata específicamente la intoxicación con cianuro, es importante enfatizar que la exposición más común al cianuro es en fuegos estructurales y, por lo tanto, es necesario considerar también el monóxido de carbono. El tratamiento de la intoxicación con monóxido de carbono es oxígeno al 100%. Resumen de recomendaciones de la American Heart Association para intoxicación con cianuro Recomendamos que se administre hidroxocobalamina para la intoxicación con cianuro. (Clase de recomendación: 1, Nivel de evidencia C-LD) Recomendamos que el nitrito de sodio se administre para intoxicación con cianuro cuando no esté disponible la hidroxocobalamina. (Clase de recomendación: 1, Nivel de evidencia: C-LD) En adición a administrar la hidroxocobalamina o el nitrito de sodio, es razonable administrar tiosulfato de sodio para la intoxicación con cianuro. (Clase de recomendación: 2a, Nivel de evidencia: C-LD) Es razonable administrar oxígeno al 100% para intoxicación con cianuro. (Clase de recomendación 2a, Nivel de evidencia: C-EO) Referencias Lavonas EJ, Akpunonu PD, Arens AM, Babu KM, Cao D, Hoffman RS, Hoyte CO, Mazer-Amirshahi ME, Stolbach A, St-Onge M, Thompson TM, Wang GS, Hoover AV, Drennan IR; on behalf of the American Heart Association. 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2023;148:e•••–e•••. doi: 10.1161/ CIR.0000000000001161

Paro cardiaco por sobredosis por cocaína: Actualización 2023 de guías de ACLS

management patients focused toxicity aha american heart association poisoning cardiac arrest high yield life threatening cardiopulmonary resuscitation

Play Episode Listen Later Oct 19, 2023 18:44

La American Heart Association publicó un documento con recomendaciones específicas para el manejo del paciente en paro cardiaco por intoxicación. Este artículo repasará las principales recomendaciones. Este es el tercer episodio de una serie de episodios relacionados al manejo del paro cardiaco por envenenamientos. En este episodio discutimos el manejo de la intoxicación por cocaína. Toxíndrome clásico de intoxicación por cocaína El toxíndome clásico de la intoxicación por cocaína está basado en la sobre-estimulación simpatomimética. A pesar de que la cocaína hace daño aún en dosis bajas, muchas personas usan la cocaína ilegalmente con fines recreaciones debido a su efecto de estimulación alfa y beta. Por lo tanto, hay pacientes que tienen presencia de cocaína pero no necesariamente tienen una queja principal asociada al uso de la cocaína. Para efectos de esta discusión, vamos a dividir los pacientes que usan cocaína en tres escenarios: Los pacientes que tienen signos típicos asociados al consumo de cocaína, con o sin una queja principal que amenaze la vida. Los pacientes con efectos adversos severos Paro cardiaco La cocaína produce signos y síntomas típicos de la estimulación alfa y beta: Taquicardia Hipertermia Hipertensión Diaforesis Agitación Dejando a un lado temporalmente la discusión de los efectos adversos a la salud, dos personas pudieran percibir estos signos de forma diferente: uno pudiera desearlo al punto de que la usa para obtener esta estimulación, y otra persona pudiera percibirlo como efectos no deseados. Es posible que las palpitaciones, sudoración y agitación sean percibidas como un signo desagradable. No obstante, es parte del efecto clásico de la cocaína y pudiera, o no, requerir atención médica de emergencia. En otros pacientes, la estimulación excesiva de los receptores beta y alfa pudiera producir una emergencia hipertensiva, vasoespasmo coronario, disección aórtica, y/o arritmias cardiacas que requieran atención médica de emergencia. Para efectos de esta discusión, voy a considerar el paciente en paro cardiaco como un escenario diferente porque el manejo es diferente. Manejo de emergencias asociadas al uso de cocaína Aunque los efectos anteriores, especialmente el potencial para producir infartos y arritmias, puede ser suficiente para llevar al paciente a un paro cardiaco, existe otro mecanismo por el cual el uso de cocaína está asociado a inestabilidad hemodinámica, arritmias y paro cardiaco: bloqueo de los canales de sodio y potasio. En el episodio anterior del ECCpodcast les mencionaba que el propranolol, a pesar de que puede producir inestabilidad puramente por el bloqueo de los canales beta, también actúa como bloqueador de canal de sodio y es este último mecanismo el que lo hace más peligroso que los demás betabloqueadores. De la misma manera, la cocaína puede producir efectos de bloqueo de canales de sodio y potasio que están asociados a emergencias médicas. Efectos debido al bloqueo de canales de sodio Prolongación del QRS Taquicardia de complejo ancho El manejo del bloqueo de canales de sodio puede incluir el uso de bicarbonato de sodio. Efectos debido al bloqueo de canales de potasio Prolongación del intervalo QTc La prolongación del intervalo QTc puede dar paso a una taquicardia ventricular polimórfica. El manejo de esta puede incluir el uso de magnesio. Otros efectos debido a sobre-estimulación alfa y beta En términos generales, el manejo de la sobre-estimulación por la cocaína está basado en el uso de benzodiazepinas para manejar los síntomas y jarabe de tiempo. Pueden haber algunas recomendaciones adicionales según el contexto clínico. Emergencias hipertensivas y síndrome coronario agudo La cocaína puede producir espasmo de las arterias coronarias, especialmente en personas que usan cocaína por primera vez. Es un mecanismo clásico de dolor de pecho y de síndrome coronario agudo en pacientes jóvenes. No obstante, el uso de cocaína, aún en dosis bajas, está asociado a eventos cardiovasculares mayores. La cocaína puede acelerar la producción de placas ateromatosas en las arterias coronarias, lo que puede inducir a enfermedad coronaria y síndrome coronario agudo. Las guías de la American Heart Association recomiendan que se usen vasodilatadores como los nitratos, la fentolamina y los bloqueadores de canales de calcio para pacientes con vasoespasmo coronario y/o emergencias hipertensivas. Arritmias ventriculares Al igual que con las arritmias ventriculares por propranolol, se recomienda el uso de lidocaína en vez de amiodarona o procainamida en pacientes con arritmias ventriculares, por el hecho del bloqueo de los canales de potasio. Taquicardias atriales La estimulación beta puede producir taquicardias atriales tales como taquicardia sinusal, fibrilación atrial o taquicardias nodales. Los betabloqueadores históricamente han estado prohibidos en los pacientes con taquicardias por cocaína. La estimulación simpática de la cocaína incluye efectos en los receptores alfa y beta (1 y 2). La estimulación alfa provoca vasoconstricción, pero la estimulación B2 provoca vasodilatación arterial. En otras palabras, la vasodilatación por B2 mantiene a raya la vasoconstricción por alfa. Si se elimina el efecto B2 (por el betabloqueador), ocurre una estimulación alfa sin oposición, lo que puede llevar a una crisis hipertensiva. Podemos argumentar que esto no se ve frecuentemente, y que algunos pacientes que son admitidos con síndrome coronario agudo y que han sido administrados betabloqueadores luego dan positivo a cocaína y nunca experimentaron una crisis hipertensiva. Aunque esto no ocurre en todos los pacientes, es una complicación potencial que puede ser evitada usando otro medicamento que no sea un betabloqueador. Paro cardiaco por intoxicación con cocaína Posiblemente lo único antes mencionado que aplique durante el manejo del paro cardiaco es la consideración del uso de bicarbonato y lidocaína. Resumen: Recomendaciones de la AHA para el manejo de pacientes con intoxicación por cocaína Recomendamos el enfriamiento rápido externo para pacientes con hipertermia que amenaza la vida por envenenamiento por cocaína. (Clase de recomendación 1, Nivel de evidencia: C-LD) Es razonable administrar bicarbonato de sodio para taquicardias de complejo ancho o paro cardiaco por envenenamiento por cocaína. (Clase de recomendación: 2a, Nivel de evidencia: C-LD) Es razonable administrar lidocaína para taquicardias de complejo ancho por envenenamiento por cocaína. (Clase de recomendación: 2a, Nivel de evidencia: C-LD) Es razonable administrar vasodilatadores (ej. nitratos, fentolamina, bloqueador de canal de calcio) para pacientes con vasoespasmo coronario o emergencias hipertensivas inducidas por cocaína. (Clase de recomendación: 2a, Nivel de evidencia: C-LD) Referencias Lavonas EJ, Akpunonu PD, Arens AM, Babu KM, Cao D, Hoffman RS, Hoyte CO, Mazer-Amirshahi ME, Stolbach A, St-Onge M, Thompson TM, Wang GS, Hoover AV, Drennan IR; on behalf of the American Heart Association. 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2023;148:e•••–e•••. doi: 10.1161/ CIR.0000000000001161

High Yield Highlight- 2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning

The Poison Lab

Play Episode Listen Later Oct 15, 2023 15:30

In this episode Ryan does a high yield "just the facts" break down of the recently released "2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Tune in to learn about the most recent treatment recommendations made by AHA via a panel of toxicology experts. This was released alongside a full interview with the lead author Dr. Eric Lavonas MD. Be sure to check out the full interview to hear it straight from the source! (link in show notes).Link to guidelinesLink to full in depth interview

Episode #25-AHA 2023 Management of Poisoning Cardiac Arrest or Life-Threatening Toxicity Guidelines with Co-Author Dr. Eric Lavonas MD

The Poison Lab

Play Episode Listen Later Oct 15, 2023 50:38

In this episode, Ryan sits down with Dr. Eric Lavonas MD, a seasoned EM resuscitation guideline writer, emergency medicine physician, medical toxicologist, and lead author of the latest update to the American Heart Association's guidelines for the management of cardiac arrest and life-threatening toxicity due to poisoning. They have an in-depth discussion as they explore the key aspects of the 2023 AHA treatment recommendations and the rationale behind each decision point. A great review to discover how to effectively apply these guidelines in real-world scenarios and find out what knowledge gaps exist in the realm of toxin resuscitation. Be sure to also check out the accompanying mini-episode for a high-yield review of the major treatment recommendations. Link to guidelinesLink to high yield review Cyanide paper mentioned in the showAdult calcium channel blocker toxicity guidelines

management guidelines toxicity aha co authors american heart association poisoning author dr cardiac arrest life threatening cardiopulmonary resuscitation

Paro cardiaco por sobredosis por betabloqueadores y bloqueadores de canales de calcio: Actualización 2023 de guías de ACLS

Play Episode Listen Later Oct 12, 2023 20:03

La American Heart Association publicó un documento con recomendaciones específicas para el manejo del paciente en paro cardiaco por intoxicación. Este artículo repasará las principales recomendaciones. Este es el segundo episodio de una serie de episodios relacionados al manejo del paro cardiaco por envenenamientos. A pesar del efecto de bloqueo de los receptores beta 1 y beta 2, el propranlol y el sotalol pueden causar inestabilidad cardiaca por bloqueo de canales de sodio y bloqueo de canales de potasio, respectivamente. Por lo tanto, el manejo de estos dos β-bloqueadores requiere una discusión adicional. Bloqueadores de canales beta La presentación del paciente con intoxicación con betabloqueadores incluye: Hipotensión Bradicardia Hipoglicemia Hiperkalemia Coma, convulsiones Manejo de sobredosis con betabloqueadores Atropina Glucagón Calcio (debido a hiperkalemia por intoxicación) Vasopresores Insulina en altas dosis Dextrosa (hipoglucemia debido a intoxicación, y debido a la insulina) ILE Therapy Resumen de las recomendaciones de la AHA para intoxicaciones con betabloqueadores Recomendamos la administración de insulina en altas dosis para la hipotensión debido a envenenamiento con betabloqueadores refractario a, o en conjunto con, terapia con vasopresores. Clase de recomendación: 1, Nivel de evidencia: B, NR Recomendamos que se administren vasopresores para la hipotensión debido a envenenamiento con betabloqueadores. Clase de recomendación: 1, Nivel de evidencia: C-LD) Es razonable usar un bolo de glucagón, seguido de una infusión continua, para la bradicardia o hipotensión debido a envenenamiento por betabloqueadores. Clase de recomendación: 2a, Nivel de evidencia: C-LD Es razonable utilizar técnicas de soporte vital extracorpóreo como VA-ECMO para amenaza a la vida por sobredosis de betabloqueadores con shock cardiogénico refractario a intervenciones farmacológicas. Clase de recomendación: 2a, Nivel de evidencia: C-LD Puede ser razonable administrar atropina para bradicardia inducida por betabloqueadores. Nivel de recomendación: 2b, Clase de evidencia: C-LD Puede ser razonable intentar el uso de marcapasos eléctrico para bradicardia inducida por betabloqueadores. Nivel de recomendación: 2b, Clase de evidencia: C-LD Puede ser razonable usar hemodiálisis para amenazas a la vida por sobredosis con atenolol o sotalol. Clase de recomendación: 2b, Nivel de evidencia: C-LD La terapia de emulsión de lípidos intravenosos no es de beneficio para envenenamientos que amenazan la vida con betabloqueadores. Clase de recomendación: 3 no hay beneficio. Nivel de evidencia: C-LD Notas adicionales sobre el propranolol La sobredosis con propranolol puede producir un bloqueo en los canales de sodio. Los bloqueos de canales de sodio se manifiestan prolongación del complejo QRS y un complejo QRS predominantemente positivo en aVR. El manejo de los pacientes con intoxicaciones con bloqueadores de canales de sodio requiere la administración de bicarbonato de sodio. La amiodarona y la procainamida están contraindicadas en el manejo de los pacientes con intoxicación con bloqueadores de canales de sodio. Esta Guía de la AHA discute el tema de las intoxicaciones con bloqueadores de canales de sodio en otra sección, por lo que este tema no se expandió en esta sección de intoxicaciones con betabloqueadores. Notas adicionales sobre sotalol La sobredosis con sotalol puede producir prolongación del completo QTc, y como resultado el paciente puede tener torsada de punto. Bloqueadores de canales de calcio Dos tipos de bloqueadores de canales de calcio: Dihidropiridinos (frecuencia) Nifedipina Amlodipina No-dihidropiridinos (vasodilatación) Diltiazem Verapamil Resumen de recomendaciones de la AHA para intoxicaciones con bloqueadores de canales de calcio Recomendamos la administración de vasopresores para la hipotensión por envenenamiento con bloqueadores de canales de calcio. (Clase de recomendación: 1, Nivel de evidencia: B-NR) Recomendamos la administración de insulina en dosis alta para hipotenso debido a envenenamiento con bloqueadores de canales de calcio. (Clase de recomendación: 1, Nivel de evidencia: B-NR) Es razonable administrar calcio para envenenamiento por bloqueadores de canales de calcio. (Clase de recomendación: 2a, Nivel de evidencia: C-LD) Es razonable administrar atropina para bradicardias hemodinámicamente significativas debido a envenenamiento por bloqueadores de canales de calcio. (Clase de recomendación: 2a, Nivel de evidencia: C-LD) Es razonable utilizar técnicas de soporte vital extracorpóreo tales como VA-ECMO para shock cardiogénico debido a envenenamiento por bloqueadores de canales de calcio que sea refractario a intervenciones farmacológicas. (Clase de recomendación: 2a, Nivel de evidencia: C-LD) Puede ser razonable tratar con marcapasos eléctrico para envenenamientos con bloqueadores de canales de calcio con bradicardia refractaria. (Clase de recomendación: 2b, Nivel de evidencia: C-LD). La utilidad de los bolos e infusión de glucagón para envenenamientos por bloqueadores de canales de calcio es incierta. (Clase de recomendación: 2b, Nivel de evidencia: C-LD) La utilidad de administrar azul de metileno para shock vasodilatorio refractario debido a envenenamiento por bloqueadores de canales de calcio es incierta. (Clase de recomendación: 2b, Nivel de evidencia: C-LD) El uso rutinario de terapia con emulsión de lípidos intravenosos para envenenamiento por bloqueadores de canales de calcio no está recomendado. (Clase de recomendación: 3, no hay beneficio, Nivel de evidencia: C-LD) Referencias Lavonas EJ, Akpunonu PD, Arens AM, Babu KM, Cao D, Hoffman RS, Hoyte CO, Mazer-Amirshahi ME, Stolbach A, St-Onge M, Thompson TM, Wang GS, Hoover AV, Drennan IR; on behalf of the American Heart Association. 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2023;148:e•••–e•••. doi: 10.1161/ CIR.0000000000001161 https://litfl.com/beta-blocker-toxicity/ https://litfl.com/glucagon-as-an-antidote/ https://litfl.com/high-dose-insulin-euglycaemic-therapy/

Paro cardiaco por sobredosis de benzodiazepinas: Actualización 2023 de guías de ACLS

GeriPal - A Geriatrics and Palliative Care Podcast

Play Episode Listen Later Oct 9, 2023 28:31

La American Heart Association publicó un documento con recomendaciones específicas para el manejo del paciente en paro cardiaco por intoxicación. Este artículo repasará las principales recomendaciones. Este es el segundo episodio de una serie de episodios relacionados al manejo del paro cardiaco por envenenamientos. A pesar del efecto de bloqueo de los receptores beta 1 y beta 2, el propranlol y el sotalol pueden causar inestabilidad cardiaca por bloqueo de canales de sodio y bloqueo de canales de potasio, respectivamente. Por lo tanto, el manejo de estos dos β-bloqueadores requiere una discusión adicional. Bloqueadores de canales beta La presentación del paciente con intoxicación con betabloqueadores incluye: Hipotensión Bradicardia Hipoglicemia Hiperkalemia Coma, convulsiones Manejo de sobredosis con betabloqueadores Atropina Glucagón Calcio (debido a hiperkalemia por intoxicación) Vasopresores Insulina en altas dosis Dextrosa (hipoglucemia debido a intoxicación, y debido a la insulina) ILE Therapy Resumen de las recomendaciones de la AHA para intoxicaciones con betabloqueadores Recomendamos la administración de insulina en altas dosis para la hipotensión debido a envenenamiento con betabloqueadores refractario a, o en conjunto con, terapia con vasopresores. Clase de recomendación: 1, Nivel de evidencia: B, NR Recomendamos que se administren vasopresores para la hipotensión debido a envenenamiento con betabloqueadores. Clase de recomendación: 1, Nivel de evidencia: C-LD) Es razonable usar un bolo de glucagón, seguido de una infusión continua, para la bradicardia o hipotensión debido a envenenamiento por betabloqueadores. Clase de recomendación: 2a, Nivel de evidencia: C-LD Es razonable utilizar técnicas de soporte vital extracorpóreo como VA-ECMO para amenaza a la vida por sobredosis de betabloqueadores con shock cardiogénico refractario a intervenciones farmacológicas. Clase de recomendación: 2a, Nivel de evidencia: C-LD Puede ser razonable administrar atropina para bradicardia inducida por betabloqueadores. Nivel de recomendación: 2b, Clase de evidencia: C-LD Puede ser razonable intentar el uso de marcapasos eléctrico para bradicardia inducida por betabloqueadores. Nivel de recomendación: 2b, Clase de evidencia: C-LD Puede ser razonable usar hemodiálisis para amenazas a la vida por sobredosis con atenolol o sotalol. Clase de recomendación: 2b, Nivel de evidencia: C-LD La terapia de emulsión de lípidos intravenosos no es de beneficio para envenenamientos que amenazan la vida con betabloqueadores. Clase de recomendación: 3 no hay beneficio. Nivel de evidencia: C-LD Notas adicionales sobre el propranolol La sobredosis con propranolol puede producir un bloqueo en los canales de sodio. Los bloqueos de canales de sodio se manifiestan prolongación del complejo QRS y un complejo QRS predominantemente positivo en aVR. El manejo de los pacientes con intoxicaciones con bloqueadores de canales de sodio requiere la administración de bicarbonato de sodio. La amiodarona y la procainamida están contraindicadas en el manejo de los pacientes con intoxicación con bloqueadores de canales de sodio. Esta Guía de la AHA discute el tema de las intoxicaciones con bloqueadores de canales de sodio en otra sección, por lo que este tema no se expandió en esta sección de intoxicaciones con betabloqueadores. Notas adicionales sobre sotalol La sobredosis con sotalol puede producir prolongación del completo QTc, y como resultado el paciente puede tener torsada de punto. Bloqueadores de canales de calcio Dos tipos de bloqueadores de canales de calcio: Dihidropiridinos (frecuencia) Nifedipina Amlodipina No-dihidropiridinos (vasodilatación) Diltiazem Verapamil Resumen de recomendaciones de la AHA para intoxicaciones con bloqueadores de canales de calcio Recomendamos la administración de vasopresores para la hipotensión por envenenamiento con bloqueadores de canales de calcio. (Clase de recomendación: 1, Nivel de evidencia: B-NR) Recomendamos la administración de insulina en dosis alta para hipotenso debido a envenenamiento con bloqueadores de canales de calcio. (Clase de recomendación: 1, Nivel de evidencia: B-NR) Es razonable administrar calcio para envenenamiento por bloqueadores de canales de calcio. (Clase de recomendación: 2a, Nivel de evidencia: C-LD) Es razonable administrar atropina para bradicardias hemodinámicamente significativas debido a envenenamiento por bloqueadores de canales de calcio. (Clase de recomendación: 2a, Nivel de evidencia: C-LD) Es razonable utilizar técnicas de soporte vital extracorpóreo tales como VA-ECMO para shock cardiogénico debido a envenenamiento por bloqueadores de canales de calcio que sea refractario a intervenciones farmacológicas. (Clase de recomendación: 2a, Nivel de evidencia: C-LD) Puede ser razonable tratar con marcapasos eléctrico para envenenamientos con bloqueadores de canales de calcio con bradicardia refractaria. (Clase de recomendación: 2b, Nivel de evidencia: C-LD). La utilidad de los bolos e infusión de glucagón para envenenamientos por bloqueadores de canales de calcio es incierta. (Clase de recomendación: 2b, Nivel de evidencia: C-LD) La utilidad de administrar azul de metileno para shock vasodilatorio refractario debido a envenenamiento por bloqueadores de canales de calcio es incierta. (Clase de recomendación: 2b, Nivel de evidencia: C-LD) El uso rutinario de terapia con emulsión de lípidos intravenosos para envenenamiento por bloqueadores de canales de calcio no está recomendado. (Clase de recomendación: 3, no hay beneficio, Nivel de evidencia: C-LD) Referencias Lavonas EJ, Akpunonu PD, Arens AM, Babu KM, Cao D, Hoffman RS, Hoyte CO, Mazer-Amirshahi ME, Stolbach A, St-Onge M, Thompson TM, Wang GS, Hoover AV, Drennan IR; on behalf of the American Heart Association. 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2023;148:e•••–e•••. doi: 10.1161/ CIR.0000000000001161 https://litfl.com/beta-blocker-toxicity/ https://litfl.com/glucagon-as-an-antidote/ https://litfl.com/high-dose-insulin-euglycaemic-therapy/

The Language of Serious Illness: A Podcast with Sunita Puri, Bob Arnold, and Jacqueline Kruser

Play Episode Listen Later Oct 5, 2023 46:12

Communicating about a serious illness is hard. Last week's podcast we talked about the challenge around miscommunication in serious illness. This week we dive into the challenges with communication when it comes to life sustaining treatments and CPR. Take for example the simple question: “If her breathing gets any worse, she will need to be intubated.” This seems like an innocuous statement of fact, but does she really “need” to be intubated if, for example, her primary goals are to be comfortable and die at home? Of course not. We've invited Jacqueline Kruser and Bob Arnold on this week's podcast to talk about their recently published JAMA Viewpoint article titled “Reconsidering the Language of Serious Illness.” I love this article as it specifically discusses what's wrong with “need” statements and how we can shift our communication and thinking to create space for deliberation about patients' priorities and the best course of action. We've also invited Sunita Puri to talk about the language of life sustaining treatments, in particular CPR. Sunita recently published a wonderful New Yorker article titled The Hidden Harms of CPR arguing among other things that these conversations “are procedures, demanding the same precision of everything else in medicine.” So take a listen and check out some of these other links to dive deeper: Our first podcast in the series of 3 podcasts “Miscommunication” A great article on why you shouldn't ask what patients “want” Sunita's book That Good Night: Life and Medicine in the Eleventh Hour The paper Jacky talked about regarding the ingrained pattern of focusing on the “need” for specific life-sustaining interventions, typically as the reason to admit a patient to the ICU Changes in End-of-Life Practices in European Intensive Care Units From 1999 to 2016 Cardiopulmonary Resuscitation on Television — Miracles and Misinformation Code Status Discussions Between Attending Hospitalist Physicians and Medical Patients at Hospital Admission

medicine language new yorker communicating cpr puri reconsidering sunita serious illness cardiopulmonary resuscitation that good night life bob arnold kruser

On Shift Review: "The Hidden Harms of CPR"

EMSconnect On Shift

Play Episode Listen Later Sep 25, 2023 50:21

Well, this one sure caught our attention. Shaun Pitts and Dr. Travis Dierks dive into the recent article published in The New Yorker: "The Hidden Harms of CPR" by Sunita Puri.This raises the ethical question, should EMS be doing CPR on patients that are VERY unlikely to survive? We know that all patients have the right to refuse care, and on the flip side, have the right to demand care, and EMS is caught right in the middle of a legal and more often ethical grey area. Link to article: https://www.newyorker.com/news/the-weekend-essay/the-hidden-harms-of-cpr?fbclid=IwAR2EoZ1S4DNbDk5xXILzC4PThVo_LyUH51mEVUEC-CRXf0sWXRySkpCcaAILink to Dr Dierks reference: https://www.bmj.com/company/newsroom/patients-overestimate-the-success-of-cpr/#:~:text=Patients%20and%20the%20general%20public,online%20in%20Emergency%20Medicine%20Journal.Links to studies found on damage from CPR: Ouellette l, Puro A, Weatherhead j, Chassee T, Whalen D, Jones J. Public knowledge and perceptions about cardiopulmonary resuscitation (CPR): Results of a multicenter survey. American Journal of Emergency Medicine 2018;36(10): P1900-1901. Available at: https://www.ajemjournal.com/article/S0735-6757(18)30117-7/fulltext.Peberdy MA, Kaye W, Ornato JP, Larkin GL, Nadkarni V, Mancini ME, et al. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation. Resuscitation 2003;58;297-308. Available at: https://www.ncbi.nlm.nih.gov/pubmed/12969608. Girotra S, Nallamothu BK, Spertus JA, Li Y, Krumholz. Trends in survival after in-hospital cardiac arrest. New England Journal of Medicine 2012 Nov 15;367(20):1912-20. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3517894/van Gijn MS, Frijns D, van de Glind EMM, van Munster BC, Hamaker ME. The chance of survival and the functional outcome after in-hospital cardiopulmonary resuscitation in older people: a systematic review. Age and Ageing 2014;43(4): 456-463. Available at: https://academic.oup.com/ageing/article/43/4/456/2812217. Sehatzadeh S. Cardiopulmonary Resuscitation in Patients With Terminal Illness: An Evidence-Based Analysis.Ontario Health Technology Assessment Series 2014; 14(15): 1–38. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4552960/. Scholz KH, Tebbe U, Herrmann C, Wojcik J, Lingen R, Chemnitius JM, et al. Frequency of complications of cardiopulmonary resuscitation after thrombolysis during acute myocardial infarction [see comments]. Am J Cardiol.1992; 69:724–728.Available at: https://www.ajconline.org/article/0002-9149(92)90494-J/pdf. Kralja E, Podbregarb M, Kejžarc N, Balažica J. Frequency and number of resuscitation related rib and sternum fractures are higher than generally considered. Resuscitation. Aug 2015. 93:136-141. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404201/.Support the showhttps://www.facebook.com/EMSconnectonline https://www.youtube.com/@EMSconnect

Cardiopulmonary Resuscitation Free NCLEX Review

ReMar Nurse Radio

Play Episode Listen Later Jul 27, 2023 55:13

Live Nursing Review with Regina MSN, RN! Every Monday & Wednesday we are live. LIKE, FOLLOW, & SUB @ReMarNurse for more. Sign up for the NCLEX 30-Day Challenge Review now at http://www.ReMarNurse.com/30Days Quick Facts for NCLEX Next Gen Study Guide here - https://bit.ly/QF-NGN Study with Professor Regina MSN, RN every Monday as you prepare for NCLEX Next Gen. ► Create Free V2 Account - http://www.ReMarNurse.com ► Get Quick Facts Next Gen - https://bit.ly/QF-NGN ► Subscribe Now - http://bit.ly/ReMar-Subscription ► GET THE PODCAST: https://remarnurse.podbean.com/ ► WATCH LESSONS: http://bit.ly/ReMarNCLEXLectures/ ► FOLLOW ReMar on Instagram: https://www.instagram.com/ReMarNurse/ ► LIKE ReMar on Facebook: https://www.facebook.com/ReMarReview/ ReMar Review features weekly NCLEX review questions and lectures from Regina M. Callion MSN, RN. ReMar is the #1 content-based NCLEX review and has helped thousands of repeat testers pass NCLEX with a 99.2% student success rate! ReMar focuses on 100% core nursing content and as a result, has the best review to help nursing students to pass boards - fast!

rn nclex remar cardiopulmonary resuscitation

Podcast 850: Cardiac Arrest - Entertainment vs. Reality

MedLink Neurology Podcast

Play Episode Listen Later May 8, 2023 2:11

Contributor: Travis Barlock, MD Educational Pearls: Sudden Cardiac Arrest (SCA) is defined as when the heart suddenly stops beating. Immediate treatment for SCA includes Cardiopulmonary Resuscitation (CPR) and defibrillation. This event is commonly depicted in medical dramas as an intense moment but often with the patient surviving and making a full recovery (67-75%). This depiction has likely led the general population astray when it comes to the true survivability of SCA. When surveyed, the general population tends to believe that in excess of 50% of patients requiring CPR survive and return to daily life with no long-term consequences. What percent of patients actually survive cardiac arrest? SCA due to Ventricular Fibrillation (VF): 25-40% SCA due to Pulseless Electrical Activity (PEA): 11% SCA due to noncardiac causes (trauma ect.): 11% SCA when the initially observed rhythm is Asystole: Less than 5%, by some measures as low as 2%. References Diem SJ, Lantos JD, Tulsky JA. Cardiopulmonary resuscitation on television. Miracles and misinformation. N Engl J Med. 1996 Jun 13;334(24):1578-82. doi: 10.1056/NEJM199606133342406. PMID: 8628340. Bitter CC, Patel N, Hinyard L. Depiction of Resuscitation on Medical Dramas: Proposed Effect on Patient Expectations. Cureus. 2021 Apr 11;13(4):e14419. doi: 10.7759/cureus.14419. PMID: 33987068; PMCID: PMC8112599. Engdahl J, Bång A, Lindqvist J, Herlitz J. Can we define patients with no and those with some chance of survival when found in asystole out of hospital? Am J Cardiol. 2000 Sep 15;86(6):610-4. doi: 10.1016/s0002-9149(00)01037-7. PMID: 10980209. Cobb LA, Fahrenbruch CE, Walsh TR, Copass MK, Olsufka M, Breskin M, Hallstrom AP. Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillation. JAMA. 1999 Apr 7;281(13):1182-8. doi: 10.1001/jama.281.13.1182. PMID: 10199427. Rea TD, Eisenberg MS, Becker LJ, Murray JA, Hearne T. Temporal trends in sudden cardiac arrest: a 25-year emergency medical services perspective. Circulation. 2003 Jun 10;107(22):2780-5. doi: 10.1161/01.CIR.0000070950.17208.2A. Epub 2003 May 19. PMID: 12756155. Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, Kudenchuk PJ, Kurz MC, Lavonas EJ, Morley PT, O'Neil BJ, Peberdy MA, Rittenberger JC, Rodriguez AJ, Sawyer KN, Berg KM; Adult Basic and Advanced Life Support Writing Group. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020 Oct 20;142(16_suppl_2):S366-S468. doi: 10.1161/CIR.0000000000000916. Epub 2020 Oct 21. PMID: 33081529. Summarized by Jeffrey Olson, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS1

BrainWaves #137 Neurologists as medical actuaries

Play Episode Listen Later Feb 16, 2023 25:11

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021.Originally released: April 25, 2019 For patients who survive cardiopulmonary arrest but do not wake up, neurologists are called to the bedside to prognosticate. And the question of “How much will this patient recover?” is not unlike “What is the benefit of aggressive therapy to await possible recovery?” In that way, you might consider neurologists to be the actuaries of hospital medicine. In this week's program, we review the clinical and diagnostic data that neurologists incorporate into their model for outcome prediction following anoxic brain injury. Produced by James E Siegler. Music courtesy of Swelling, Soft and Furious, Rafael Archangel, Lovira, and Dark Room. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES Booth CM, Boone RH, Tomlinson G, Detsky AS. Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest. JAMA 2004;291(7):870-9. PMID 390099PMID: 14970067 Callaway CW, Donnino MW, Fink EL, et al. Part 8: Post-Cardiac Arrest Care: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132(18 Suppl 2):S465-82. Erratum in: Circulation 2017;136(10 ):e197. PMID 390099PMID: 26472996 Jorgensen EO, Holm S. The natural course of neurological recovery following cardiopulmonary resuscitation. Resuscitation 1998;36(2):111-22. PMID 9571727 Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med 2013;369(23):2197-206. PMID 24237006 Sandroni C, D'Arrigo S. Neurologic prognostication: neurologic examination and current guidelines. Semin Neurol 2017;37(1):40-7. PMID 28147417 Sandroni C, Cariou A, Cavallaro F, et al. Prognostication in comatose survivors of cardiac arrest: an advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine. Resuscitation 2014;85(12):1779-89. PMID 25438253 Seder DB. Management of comatose survivors of cardiac arrest. Continuum (Minneap Minn) 2018;24(6):1732-52. PMID 30516603 Seder DB, Sunde K, Rubertsson S, et al. Neurologic outcomes and postresuscitation care of patients with myoclonus following cardiac arrest. Crit Care Med 2015;43(5):965-72. PMID 25654176 Young GB. Clinical practice. Neurologic prognosis after cardiac arrest. N Engl J Med 2009;361(6):605-11. PMID 19657124We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

ILCOR 2022 - Consenso sobre la ciencia y recomendaciones de tratamiento de paro cardiaco y primeros auxilios

Play Episode Listen Later Dec 30, 2022 29:05

El International Liaison Committee on Resuscitation (ILCOR) es el organismo internacional que evalúa la ciencia disponible y emite recomendaciones sobre la resucitación de pacientes en paro cardiaco. Los integrantes de ILCOR representan los diferentes concilios de resucitación en el mundo. Los concilios emiten sus propias guías, basadas en las recomendaciones de ILCOR. La revisión anual de la ciencia no es una revisión de todos los temas, sino solamente de aquellas preguntas clínicas que necesitan revisión y/o hay alguna evidencia nueva que justifique un cambio en la recomendación, o simplemente un cambio en el nivel de la recomendación. A veces un tema se vuelve a verificar cuando es prudente incluir los resultados de algún estudio importante reciente. Los estudios no tienen que sugerir un cambio para ser importantes. Usted puede (y debe) leer el documento completo aquí. El documento completo explica el análisis detrás de las recomendaciones y los estudios que fueron considerados en la discusión. Dependiendo de los hallazgos, los diferentes concilios (ej. la American Heart Association) pueden entonces emitir actualizaciones a sus respectivas guías de acuerdo con las recomendaciones de ILCOR. Tratamiento en escena versus RCP durante transporte Sugerimos que los proveedores realicen la resucitación en la escena en vez de realizar el transporte mientras se resucita, a menos que haya una indicación apropiada para justificar el transporte (ej. oxigenación a través de membrana extracorpórea). (Recomendación débil, evidencia de muy baja certeza). Aumento en riesgo de lesiones para los rescatadores. Ahogamiento Las ventilaciones son importantes. Público general: comiencen con compresiones. Profesionales de la salud: comiencen con ventilaciones. Comenzar con las compresiones primero NO supone un retraso significativo. Temperatura pos-paro cardiaco Sugerimos activamente prevenir la fiebre mediante establecer una meta de temperatura igual o menor a 37.5 grados centígrados para pacientes comatosos luego del retorno de circulación espontánea. (Recomendación débil, baja certeza de evidencia) Se sugiere estandarizar la nomenclatura para evitar usar un término que esté vinculado directamente con un protocolo en específico (TTM/MET): Control de temperatura con hipotermia: control activo de temperatura con una meta de temperatura por debajo del parámetro normal. Control de temperatura con normotermia: control activo de temperatura con una meta de temperatura en el rango normal. Control de temperatura con prevención de fiebre: monitoreo de la temperatura y activamente prevenir y tratar la temperatura que esté por encima del rango normal. Ningún control de temperatura: ninguna estrategia de control activo de la temperatura. Sonografía durante el paro cardiaco Sugerimos en contra del uso rutinario de sonografía (POCUS) durante la RCP para diagnosticar causas reversibles del paro cardiaco (recomendación débil, nivel de evidencia muy bajo). Sugerimos que, si la sonografía puede ser realizada por personal experimentado sin interrumpir la RCP, pueda ser considerada como una herramienta diagnóstica adicional cuando hay sospecha clínica presente para una causa reversible (recomendación débil, nivel de evidencia muy bajo). Cualquier uso de sonografía diagnóstica durante RCP debe ser cuidadosamente considerada y sopesada ante el riesgo de interrumpir las compresiones torácicas y malinterpretar los hallazgos sonográficos (declaración de mejores prácticas). En un estudio del 2017, el uso de sonografía durante el paro cardiaco estaba asociado a interrupciones de 21 segundos en promedio. DEA en los niños e infantes. No significa que no se usen. Hay pocos estudios que documentan que un DEA se haya colocado y/o descargado en niños. Los diferentes concilios pueden tomar decisiones sobre sus respectivas guías. Posición de recuperación Colocar al paciente en posición de recuperación. La posición de recuperación no debe afectar la habilidad de verificar la vía aérea, respiración y circulación. Si se dificulta evaluar al paciente, es mejor colocarlo en posición supina. Referencias 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces Myra H. Wyckoff, MD, Robert Greif, MD, MME, Peter T. Morley, MBBS, Kee-Chong Ng, MBBS, Mmed(Peds), Theresa M. Olasveengen, MD, PhD, Eunice M. Singletary, MD, Jasmeet Soar, MA, MB, BChir, Adam Cheng, MD, Ian R. Drennan, ACP, PhD, Helen G. Liley, MBChB, Barnaby R. Scholefield, MBBS, MRCPCH, PhD, Michael A. Smyth, BSc(Hons), MSc, PhD, Michelle Welsford, MD, BSc, David A. Zideman, LVO, QHP(C), MBBS, Jason Acworth, MBBS, FRACP(PEM), Richard Aickin, MBChB, Lars W. Andersen, MD, MPH, PhD, DMSc, Diane Atkins, MD, David C. Berry, PhD, MHA, Farhan Bhanji, MD, MSc(Ed), Joost Bierens, MD, PhD, MCDM, MCPM, Vere Borra, PhD, Bernd W. Böttiger, MD, ML, DEAA, Richard N. Bradley, MD, Janet E. Bray, RN, PhD, Jan Breckwoldt, MD, MME, Clifton W. Callaway, MD, PhD, Jestin N. Carlson, MD, MS, Pascal Cassan, MD, Maaret Castrén, MD, PhD, Wei-Tien Chang, MD, PhD, Nathan P. Charlton, MD, Sung Phil Chung, MD, PhD, Julie Considine, RN, PhD, Daniela T. Costa-Nobre, MD, MHS, PhD, Keith Couper, RN, PhD, Thomaz Bittencourt Couto, MD, PhD, Katie N. Dainty, MSc, PhD, Peter G. Davis, MBBS, MD, Maria Fernanda de Almeida, MD, PhD, Allan R. de Caen, MD, Charles D. Deakin, MA, MD, Therese Djärv, MD, PhD, Michael W. Donnino, MD, Matthew J. Douma, PhD(c), MN, RN, Jonathan P. Duff, MD, Cody L. Dunne, MD, Kathryn Eastwood, PhD, BParamedicStud, BNurse, Walid El-Naggar, MD, Jorge G. Fabres, MD, MSPH, Joe Fawke, MBChB, Judith Finn, PhD, RN, Elizabeth E. Foglia, MD, MA, MSCE, Fredrik Folke, MD, PhD, Elaine Gilfoyle, MD, MMEd, Craig A. Goolsby, MD, MEd, Asger Granfeldt, MD, PhD, DMSc, Anne-Marie Guerguerian, MD, PhD, Ruth Guinsburg, MD, PhD, Karen G. Hirsch, MD, Mathias J. Holmberg, MD, MPH, PhD, Shigeharu Hosono, MD, PhD, Ming-Ju Hsieh, MD, MSc, PhD, Cindy H. Hsu, MD, PhD, Takanari Ikeyama, MD, Tetsuya Isayama, MD, MSc, PhD, Nicholas J. Johnson, MD, Vishal S. Kapadia, MD, MSCS, Mandira Daripa Kawakami, MD, PhD, Han-Suk Kim, MD, PhD, Monica Kleinman, MD, David A. Kloeck, MBBCh, FCPaed, Crit Care (SA), Peter J. Kudenchuk, MD, Anthony T. Lagina, MD, Kasper G. Lauridsen, MD, PhD, Eric J. Lavonas, MD, MS, Henry C. Lee, MD, MS, Yiqun (Jeffrey) Lin, MD, MHSc, PhD, Andrew S. Lockey, MBChB, PhD, Ian K. Maconochie, MBBS, LMSSA, PhD, R. John Madar, MBBS, Carolina Malta Hansen, MD, PhD, Siobhan Masterson, PhD, Tasuku Matsuyama, MD, PhD, Christopher J.D. McKinlay, MBChB, PhD, DipProfEthics, Daniel Meyran, MD, Patrick Morgan, MBChB, DipIMC, RCSEd, Laurie J. Morrison, MD, MSc, Vinay Nadkarni, MD, Firdose L. Nakwa, MBBCh, MMed (Paeds), Kevin J. Nation, NZRN, Ziad Nehme, , PhD, Michael Nemeth, MA, Robert W. Neumar, MD, PhD, Tonia Nicholson, MBBS, BScPsych, Nikolaos Nikolaou, MD, Chika Nishiyama, RN, DrPH, Tatsuya Norii, MD, Gabrielle A. Nuthall, MBChB, Brian J. O'Neill, MD, Yong-Kwang Gene Ong, MBBS, MRCPCH, Aaron M. Orkin, MD, MSc, PHH, PhD, Edison F. Paiva, MD, PhD, Michael J. Parr, MBBS, Catherine Patocka, MDCM, MHPE, Jeffrey L. Pellegrino, PhD, MPH, Gavin D. Perkins, MBChB, MMEd, MD, Jeffrey M. Perlman, MBChB, Yacov Rabi, MD, Amelia G. Reis, MD, PhD, Joshua C. Reynolds, MD, MS, Giuseppe Ristagno, MD, PhD, Antonio Rodriguez-Nunez, MD, PhD, Charles C. Roehr, MD, PhD, Mario Rüdiger, MD, PhD, Tetsuya Sakamoto, MD, PhD, Claudio Sandroni, MD, Taylor L. Sawyer, DO, Med, Steve M. Schexnayder, MD, Georg M. Schmölzer, MD, PhD, Sebastian Schnaubelt, MD, Federico Semeraro, MD, Markus B. Skrifvars, MD, PhD, Christopher M. Smith, MD, MSc, Takahiro Sugiura, MD, PhD, Janice A. Tijssen, MD, MSc, Daniele Trevisanuto, MD, Patrick Van de Voorde, MD, PhD, Tzong-Luen Wang, MD, PhD, JM, Gary M. Weiner, MD, Jonathan P. Wyllie, MBChB, Chih-Wei Yang, MD, PhD, Joyce Yeung, PhD, MBChB, Jerry P. Nolan, MBChB, Katherine M. Berg, MD In't Veld, M. A. H., Allison, M. G., Bostick, D. S., Fisher, K. R., Goloubeva, O. G., Witting, M. D., & Winters, M. E. (2017). Ultrasound use during cardiopulmonary resuscitation is associated with delays in chest compressions. Resuscitation, 119, 95-98.

education phd ms md med mn rn mph msc implementation carlson ml dea recomendaciones ning almeida cualquier winters bsc aumento mb american heart association la ciencia usted ultrasounds comenzar profesionales caen paro jm tratamiento mha colocar recomendaci posici temperatura mhs acp consenso referencias mbbs resuscitation dependiendo mme pocus veld bsc hons rcp drph christopher j lvo maria fernanda primeros auxilios mbchb mhsc bostick mckinlay mscs sugerimos lauridsen cardiaco voorde dmsc cardiopulmonary resuscitation mbbch advanced life support witting phh mdcm nicholas j johnson henry c lee adam cheng ilcor

SCCM Pod-467 PCCM: AHA Guidelines Address Calcium During Pediatric Cardiopulmonary Arrest

Play Episode Listen Later Dec 21, 2022 27:34

The American Heart Association's (AHA) cardiopulmonary resuscitation guidelines recommend against the routine administration of IV calcium during pediatric cardiopulmonary arrest because of its association with worse outcomes. However, IV calcium is routinely used in children with heart disease who have cardiopulmonary arrest. Maureen A. Madden, DNP, RN, CPNP-AC, CCRN, FCCM, is joined by Gurpreet S. Dhillon, MD, to discuss the article, Calcium Administration During Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest in Children With Heart Disease is Associated With Worse Survival - A Report From the American Heart Association's Get With the Guidelines-Resuscitation (GWTG-R) Registry, published in the November issue of Pediatric Critical Care Medicine (Dhillon G, et al. Pediatr Crit Care Med. 2022;23:860-871). Dr. Dhillon is a pediatric cardiac intensivist at Lucile Packard Children's Hospital at Stanford in Palo Alto, California.

SCCMPod-465 PCCM: Who's Got the Right Dose?

children child ms philadelphia hospitals md survey dose pediatric pals cardiac arrest anesthesiology critical care medicine picu epinephrine cardiopulmonary resuscitation pediatric critical care medicine

Play Episode Listen Later Dec 6, 2022 12:03

Pediatric advanced life support (PALS) guidelines include weight-based epinephrine dosing recommendations of 0.01 mg/kg with a maximum of 1 mg, which corresponds to a weight of 100 kg. But what are the actual practice patterns? Elizabeth H. Mack, MD, MS, FCCM, is joined by Martha Kienzle, MD, to discuss the article: Weight-Based Versus Flat Dosing of Epinephrine During Cardiac Arrest in the PICU: A Multicenter Survey, published in the October 2022 issue of Pediatric Critical Care Medicine. Dr. Kienzle is an attending physician in the Department of Anesthesiology and Critical Care Medicine at Children's Hospital of Philadelphia.

Extracorporeal Cardiopulmonary Resuscitation (ECPR) with Dr. Lakshmi Raman

PedsCrit

Play Episode Listen Later Oct 31, 2022 31:34

Extracorporeal Cardiopulmonary Resuscitation (ECPR) with Dr. Lakshmi RamanObjectives:By the end of listening to this episode, learners should be able to:Define ECPR.Understand the rationale for ECPR in cardiopulmonary arrest in children.Recognize aspects of high-quality ECPR.Understand the patient selection, context and setting that is most appropriate for pediatric ECPR.Recognize when it is appropriate to activate the ECPR team after pediatric cardiac arrest.Understand the rationale of choosing the location of cannulation (i.e., peripheral vs. central).About our guest: Dr. Lakshmi Raman is a Professor of Pediatrics at UT Southwestern and a pediatric intensivist at Children's Medical Center Dallas. She serves as the Medical Director of the Extracorporeal Membrane Oxygenation (ECMO) program at CMC. She is active in ELSO and serves as the Chair of Publications. She also co-authored the 2021 ELSO Pediatric ECPR guidelines.References:Guerguerian, Anne-Marie; Sano, Minako; Todd, Mark; Honjo, Osami; Alexander, Peta; Raman, Lakshmi. Pediatric Extracorporeal Cardiopulmonary Resuscitation ELSO Guidelines. ASAIO Journal: March 2021 - Volume 67 - Issue 3 - p 229-237doi: 10.1097/MAT.0000000000001345 How to support PedsCrit:Please rate and review on Spotify or Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.Support the show

Scotty & Goss - Professor Michael Henderson (11/10/22)

SEN WA Breakfast

Play Episode Listen Later Oct 10, 2022 9:18

Masters Hockey Player, Professor Michael Henderson, spoke to Scott Cummings & Tim Gossage about performing CPR on field with Dr David Mountain to save their team's captain. Plus what courses and steps we can all take to learn CPR and save someones life in a similar situation.

health professor scotty cpr heart health first aid goss resuscitation michael henderson st john ambulance scott cummings cardiopulmonary resuscitation

Pulse Checks During Cardiopulmonary Resuscitation

FOAMcast - Emergency Medicine Core Content

Play Episode Listen Later Sep 3, 2022 14:48

Since 2010, the American Heart Association guidelines for cardiopulmonary resuscitation (CPR) have de-emphasized pulse checks - such that they recommend against routine pulse checks. Despite this recommendation, may individuals and institutions continue to perform pulse checks. This episode reviews the recommendations and the literature. References/show notes: FOAMcast.org Thanks for listening! Lauren Westafer

pulse references checks cpr american heart association cardiopulmonary resuscitation lauren westafer foamcast

ACEP E-QUAL 51: Stroke Systems of Care

Academic Life in Emergency Medicine (ALiEM) Podcast

Play Episode Listen Later Jun 17, 2022 33:49

Guest: Edward Jauch MD, MS (Chief of System Research, Mission Health System, Asheville, NC) Host: Jason Woods MD References: Jauch EC, Cucchiara B, Adeoye O, Meurer W, Brice J, Chan YY, Gentile N, Hazinski MF. Part 11: adult stroke: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010 Nov 2;122(18 Suppl 3):S818-28. doi: 10.1161/CIRCULATIONAHA.110.971044. Erratum in: Circulation. 2011 Oct 11;124(15):e404. PMID: 20956227. Dall TM, Storm MV, Chakrabarti R, Drogan O, Keran CM, Donofrio PD, Henderson VW, Kaminski HJ, Stevens JC, Vidic TR. Supply and demand analysis of the current and future US neurology workforce. Neurology. 2013 Jul 30;81(5):470-8. doi: 10.1212/WNL.0b013e318294b1cf. Epub 2013 Apr 17. PMID: 23596071; PMCID: PMC3776531. Kronick SL, Kurz MC, Lin S, Edelson DP, Berg RA, Billi JE, Cabanas JG, Cone DC, Diercks DB, Foster JJ, Meeks RA, Travers AH, Welsford M. Part 4: Systems of Care and Continuous Quality Improvement: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015 Nov 3;132(18 Suppl 2):S397-413. doi: 10.1161/CIR.0000000000000258. PMID: 26472992. Adeoye O, Nyström KV, Yavagal DR, Luciano J, Nogueira RG, Zorowitz RD, Khalessi AA, Bushnell C, Barsan WG, Panagos P, Alberts MJ, Tiner AC, Schwamm LH, Jauch EC. Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update. Stroke. 2019 Jul;50(7):e187-e210. doi: 10.1161/STR.0000000000000173. Epub 2019 May 20. Erratum in: Stroke. 2020 Apr;51(4):e70. PMID: 31104615.

POCUS Spotlight: Point-of-Care Ultrasound in Cardiopulmonary Resuscitation

ASRA News

Play Episode Listen Later Jun 1, 2022 12:24

"POCUS Spotlight: Point-of-Care Ultrasound in Cardiopulmonary Resuscitation," by Nibras Bughrara, MD, FCCM, FASA, Associate Professor, Department of Anesthesiology and Critical Medicine, Albany Medical College, Albany, New York; Oliver Panzer, MD, Associate Professor, Department of Anesthesiology and Critical Care Medicine, Columbia University Medical Center, New York, New York; and Aliaksei Pustavoitau, MD, MHS, FCCM, Associate Professor, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland. From ASRA Pain Medicine News, May 2022. See original article at www.asra.com/asra-news for figures and references. This material is copyrighted.

3: Episode 3 - Should family be present during cardiopulmonary resuscitation? with Mitchell Trethowan

The Shift Extension Paramedic Podcast

Play Episode Listen Later Apr 21, 2022 25:37

We recently sat down with Mitchell Trethowan, to have a chat about his recent publication "Good Grief, Bad Grief - Should family be present during cardiopulmonary resuscitation". Can being present benefit the family, or can it hinder clinical interventions? Does being present allow the family to be involved in decision making, or does it hinder communication within the team? Tune in to hear our thoughts! To read the article in full, head to Good Grief Bad Grief - Clinical Education (theshiftextension.org)

family good grief cardiopulmonary resuscitation

Tourniquet use and mass casualty

The CEEP Disaster Preparedness Journal Club

Play Episode Listen Later Jan 13, 2022 32:21

This episode describes the latest research on when, where and how to apply pre-hospital tourniquets as well as guidelines on removal in hospital. Articles reviewed: Levy MJ, Pasley J, Remick KN, Eastman AL, Margolis AM, Tang N, Goolsby CA. Removal of the Prehospital Tourniquet in the Emergency Department. The Journal of Emergency Medicine. 2021 Jan 1;60(1):98-102. Henry R, Matsushima K, Ghafil C, Henry RN, Theeuwen H, Golden AC, Abramson TM, Inaba K. Increased Use of Prehospital Tourniquet and Patient Survival: Los Angeles Countywide Study. Journal of the American College of Surgeons. 2021 Apr 22. Wyckoff MH, et al. 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation. 2021 Nov 11:S0300-9572(21)00448-2. doi: 10.1016/j.resuscitation.2021.10.040. Gattere M, Scaffei N, Gozzetti L, Alessandrini M. Tourniquet Use on a Pediatric Patient. Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals. 2021 Jan 1;21(1):120-3.

journal surgeons american colleges removal emergency medicine emergency departments resuscitation tourniquet mass casualty henry r cardiopulmonary resuscitation

Extracorporeal cardiopulmonary resuscitation in adults: evidence and implications

ESICM Talk

Play Episode Listen Later Jan 12, 2022 16:44

Attempts at improving cardiac arrest outcomes have increasingly included extracorporeal techniques to re-establish circulation. In particular, the application of veno-arterial extracorporeal membrane oxygenation (ECMO) during cardiac arrest is called extracorporeal cardiopulmonary resuscitation (ECPR). However, there is much debate about the impact of ECPR use on survival and neurological and functional recovery in adults suffering cardiac arrest. These issues have been evaluated in a systematic review conducted by Dr Abrams et al. Listen to the following podcast to hear more about which patients are most likely to benefit from EPCR, required resources and relevant ethic issues on using EPCR. Original article: https://pubmed.ncbi.nlm.nih.gov/34505911/ (Extracorporeal cardiopulmonary resuscitation in adults: evidence and implications) Speakers: Darryl ABRAMS. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York (USA). Laura BORGSTEDT. Department of Anesthesiology, Klinikum rechts der Isar, Technical University of Munich, Munich (DE).

Guests and topics that have inspired and educated us

Play Episode Listen Later Jan 4, 2022 51:39

Paula Shaw - featured on 5/7/21 Jordan Colbert - featured on 11/10/21 Barry Shore - featured on 4/7/21 Kathy Murray - featured on 10/12/21 Robb Lucy - featured on 4/27/21 Anne Quinn Young - featured on 5/6/21 Isaac Ford - featured on 5/10/21 Serving Seniors - featured on 7/28/21 Uncle Larry's Restaurant - featured on 10/15/21 Dr. Brady Allen - featured on 2/23/21 Dr. Russell Lebovitz - featured on 9/13/21 Dr. Thomas Carrell - featured on 6/25/21 James Cooley: James Cooley, a motivational speaker, and a retired Navy Officer was born in Chattanooga, Tennessee. He is the Host of The James Cooley Show…IT'S YOUR LIFE. He is the author of “Country Boy, City Boy, A Journey, That Ain't Over Yet” (2020) & Audio-book narrated by James Cooley (2021), "The Book of Knowledge: Your Pathway to Enlightenment" (2015), "My Path" (2014). James is the President and CEO of JC Cooley Innovation Solutions, LLC, and The JC Cooley Foundation Options & Opportunities / The Choice Program. James was presented with the 1992 Senior Enlisted Admirals Gallery and Renken Award of Merit for the development of a Breakfast Tutoring Program for academically at-risk students. He also qualified and re-qualified over 1,000 military and civilian personnel in Cardiopulmonary Resuscitation as well as hosting 47 television shows titled “Cooley's Fitness Tips”. James was selected as one of the first George H. Bush's One-Thousand Points of Light recipients for outstanding community service. He resides in Temecula, California and Fort Worth, Texas with his wife of almost 14 years Michelle. More information here http://www.cooleyfoundation.org/ Michelle Cooley: Michelle is a native of New York City, NY and currently resides in Fort Worth, Texas and Temecula, California. She has been married to James (JC) Cooley for almost 14 years. She spends most of her spare time with her family, friends, and her wonderful dog Bella. Michelle was a Sunday School teacher for children ages 6-10 for the Youth and Teen Ministry during her residence in Atlanta, GA. Her hobbies include walking, running and basically working out at the gym. Michelle has a Bachelor's Degree in Marketing Management, and a Masters Degree in Marketing from Concordia University Nebraska. She has been part of the J.C. Cooley Foundation since its inception in 2014. Her continued focus is on giving back to the community and finding ways to inspire and help those in need. Noah Dingley: Noah Dingley is host of "Across The County" Radio. He interviews guests that impact the San Diego community as a whole; sometimes these issues are local non-profits doing good works throughout the county. Other times these topics are national issues that also directly impact the city of San Diego. Noah is a single father and has a heart and passion for lifting-up kids. He loves to talk about anything that can benefit the life of a child. Book authors fascinate him, and much can be learned from hearing their tales. He often likes to use the phrase, "It's about what matters locally to you." Also, sail aboard "Noah's Ark" on KPRZ M-F; 9pm - midnight as Noah brings you through various national ministry programs. Noah enjoys world history, loves the film industry, and is a podcast aficionado. More information here: https://kprz.com/personality/2275 Brought to you by J.C. Cooley Foundation "Equipping the Youth of Today for the Challenges of Tomorrow". Support the show: http://www.cooleyfoundation.org/ See omnystudio.com/listener for privacy information.

The James Cooley It's Your Life Team discusses Love, Compassion and Friendship

nursing fundamental cpr cardiopulmonary resuscitation

Play Episode Listen Later Dec 23, 2021 51:41

James Cooley: James Cooley, a motivational speaker, and a retired Navy Officer was born in Chattanooga, Tennessee. He is the Host of The James Cooley Show…IT'S YOUR LIFE. He is the author of “Country Boy, City Boy, A Journey, That Ain't Over Yet” (2020) & Audio-book narrated by James Cooley (2021), "The Book of Knowledge: Your Pathway to Enlightenment" (2015), "My Path" (2014). James is the President and CEO of JC Cooley Innovation Solutions, LLC, and The JC Cooley Foundation Options & Opportunities / The Choice Program. James was presented with the 1992 Senior Enlisted Admirals Gallery and Renken Award of Merit for the development of a Breakfast Tutoring Program for academically at-risk students. He also qualified and re-qualified over 1,000 military and civilian personnel in Cardiopulmonary Resuscitation as well as hosting 47 television shows titled “Cooley's Fitness Tips”. James was selected as one of the first George H. Bush's One-Thousand Points of Light recipients for outstanding community service. He resides in Temecula, California and Fort Worth, Texas with his wife of almost 14 years Michelle. More information here http://www.cooleyfoundation.org/ Michelle Cooley: Michelle is a native of New York City, NY and currently resides in Fort Worth, Texas and Temecula, California. She has been married to James (JC) Cooley for almost 14 years. She spends most of her spare time with her family, friends, and her wonderful dog Bella. Michelle was a Sunday School teacher for children ages 6-10 for the Youth and Teen Ministry during her residence in Atlanta, GA. Her hobbies include walking, running and basically working out at the gym. Michelle has a Bachelor's Degree in Marketing Management, and a Masters Degree in Marketing from Concordia University Nebraska. She has been part of the J.C. Cooley Foundation since its inception in 2014. Her continued focus is on giving back to the community and finding ways to inspire and help those in need. Noah Dingley: Noah Dingley is host of "Across The County" Radio. He interviews guests that impact the San Diego community as a whole; sometimes these issues are local non-profits doing good works throughout the county. Other times these topics are national issues that also directly impact the city of San Diego. Noah is a single father and has a heart and passion for lifting-up kids. He loves to talk about anything that can benefit the life of a child. Book authors fascinate him, and much can be learned from hearing their tales. He often likes to use the phrase, "It's about what matters locally to you." Also, sail aboard "Noah's Ark" on KPRZ M-F; 9pm - midnight as Noah brings you through various national ministry programs. Noah enjoys world history, loves the film industry, and is a podcast aficionado. More information here: https://kprz.com/personality/2275 Brought to you by J.C. Cooley Foundation "Equipping the Youth of Today for the Challenges of Tomorrow". Support the show: http://www.cooleyfoundation.org/ See omnystudio.com/listener for privacy information.

Fundamental Nursing: Cardiopulmonary Resuscitation (CPR)

Nclexsuccess

Play Episode Listen Later Dec 22, 2021 15:03

CPR and management for infant, Children & Adults

The True Meaning of Christmas

Sports Medicine Research Podcast

Play Episode Listen Later Dec 16, 2021 51:41

The James Cooley Show…IT'S YOUR LIFE Team's thoughts on the true meaning of Christmas Christmas family traditions past and present People in need during the holiday season Gift giving James Cooley: James Cooley, a motivational speaker, and a retired Navy Officer was born in Chattanooga, Tennessee. He is the Host of The James Cooley Show…IT'S YOUR LIFE. He is the author of “Country Boy, City Boy, A Journey, That Ain't Over Yet” (2020) & Audiobook narrated by James Cooley (2021), "The Book of Knowledge: Your Pathway to Enlightenment" (2015), "My Path" (2014). James is the President and CEO of JC Cooley Innovation Solutions, LLC, and The JC Cooley Foundation Options & Opportunities / The Choice Program. James was presented with the 1992 Senior Enlisted Admirals Gallery and Renken Award of Merit for the development of a Breakfast Tutoring Program for academically at-risk students. He also qualified and re-qualified over 1,000 military and civilian personnel in Cardiopulmonary Resuscitation as well as hosting 47 television shows titled “Cooley's Fitness Tips”. James was selected as one of the first George H. Bush's One-Thousand Points of Light recipients for outstanding community service. He resides in Temecula, California and Fort Worth, Texas with his wife of almost 14 years Michelle. More information here http://www.cooleyfoundation.org/ Michelle Cooley: Michelle is a native of New York City, NY and currently resides in Fort Worth, Texas and Temecula, California. She has been married to James (JC) Cooley for almost 14 years. She spends most of her spare time with her family, friends, and her wonderful dog Bella. Michelle was a Sunday School teacher for children ages 6-10 for the Youth and Teen Ministry during her residence in Atlanta, GA. Her hobbies include walking, running and basically working out at the gym. Michelle has a Bachelor's Degree in Marketing Management, and a Masters Degree in Marketing from Concordia University Nebraska. She has been part of the JC Cooley Foundationsince its inception in 2014. Her continued focus is on giving back to the community and finding ways to inspire and help those in need. Noah Dingley: Noah Dingley is host of "Across The County" Radio. He interviews guests that impact the San Diego community as a whole; sometimes these issues are local non-profits doing good works throughout the county. Other times these topics are national issues that also directly impact the city of San Diego. Noah is a single father and has a heart and passion for lifting-up kids. He loves to talk about anything that can benefit the life of a child. Book authors fascinate him, and much can be learned from hearing their tales. He often likes to use the phrase, "It's about what matters locally to you." Also, sail aboard "Noah's Ark" on KPRZ M-F; 9pm - midnight as Noah brings you through various national ministry programs. Noah enjoys world history, loves the film industry, and is a podcast aficionado. More information here: https://kprz.com/personality/2275 Brought to you by J.C. Cooley Foundation "Equipping the Youth of Today for the Challenges of Tomorrow". Support the show: http://www.cooleyfoundation.org/ See omnystudio.com/listener for privacy information.

Circulation December 14, 2021 Issue

Circulation on the Run

Play Episode Listen Later Dec 13, 2021 25:48

Please join Guest Host Mercedes Carnethon, author Jason Roberts, and Associate Editor Vlad Zaha as they discuss the article "Epigenetic Age and the Risk of Incident Atrial Fibrillation." Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. We're your co-host, I'm Dr. Carolyn Lam, Associate Editor from the National Heart Center in Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley Associate Editor, Director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Well, Carolyn, this week's feature we're going to learn more about the risk of incident atrial fibrillation, but as that pertains to epigenetics. But before we get to that feature, how about we grab a cup of coffee and get started on some of the other articles in the issue. Would you like to go first? Dr. Carolyn Lam: I would love to. And the first paper I want to highlight asks the question, are social economic variables associated with 30 day survival after out of hospital cardiac arrest. And this comes from Dr. Jonsson from Karolinska Institute in Stockholm, Sweden, and colleagues. They linked data from the Swedish Registry of Cardiopulmonary Resuscitation with individual level data on social economic factors. In other words, educational level and disposable income, all from statistics, Sweden. And what they found was that both higher disposable income and higher educational level independently associated with better 30 day survival following out of hospital cardiac arrest. The relationship between disposable income and 30 day survival was more robust for mediating factors compared to educational level. Dr. Greg Hundley: Oh, wow Carolyn. Really interesting in a very, what I would call hot topic these days. So what are the clinical implications of this particular study? Dr. Carolyn Lam: Well, the results really highlight the importance of preventive efforts aimed at patients with lower social economic status. And these preventive actions could include both early recognition and warning signs and for example, CPR and AED training. So very lovely paper there. Dr. Greg Hundley: Absolutely. Very nice Carolyn. Well, my first paper comes to us from Dr. Nan Wang from Columbia University Medical Center. And Carolyn this paper focuses on a common genetic variant called link RS 3184504, and it is associated with increased platelet and neutrophil counts, coronary artery disease, thrombotic stroke, and autoimmune diseases. And so this research group previously has shown that hematopoietic link deficiency synergizes with hyperlipidemia to promote platelet production and activation, neutrophilia, platelet neutrophil aggregates, atherosclerosis and arterial thrombosis, all of those things. So platelet activation and platelet neutrophil interactions have been shown to promote neutrophil extracellular traps or net formations. So nets are formed when neutrophils release their contents leading to the formation web-like structures made of DNA, myeloperoxidase, citrullinated histone and proteases that entrap and kill bacteria. Now, while nets may help to suppress infection, the formation of nets called NETosis in blood vessels can promote atherosclerosis and thrombosis. And so this study was undertaken to investigate the hypothesis that linked deficiency might promote NETosis leading to formation of unstable atherosclerotic plaques, and arterial thrombosis. Dr. Carolyn Lam: Wow. What a really neat hypothesis and NETosis. I learn new things all the time. So what do they find? Dr. Greg Hundley: Right Carolyn. First of all, hypercholesterolemic mice with hematopoietic link deficiency displayed accelerated arterial thrombosis with nets in thrombi and these changes were reversed by PAD4 deficiency or OxPL antibodies. Second, linked deficient platelet from hyperlipidemic mice expose and release increased OxPL when activated promoting NETosis, when incubated with link deficient neutrophils. Third, an AntiOxPL antibody reduced OxPL levels, NETosis and arterial thrombosis specifically in link deficient mice, and finally Carolyn targeting atherothrombotic risk using OxPL antibodies might be particularly effective in genetically defined populations with reduced link function or increased JAK-STAT signaling. Dr. Carolyn Lam: Wow. Okay. So they proved their hypothesis. Could you sum it up for us, Greg? Dr. Greg Hundley: You bet Carolyn. So this foundational work suggests that perhaps future studies targeting NETosis and OxPL in patients carrying the common link loss of function variant, could reduce atherothrombotic risk. Dr. Carolyn Lam: Wow. Thanks, Greg. My next paper is super interesting in its approach. Listen up. Now the assessment of the relationship between myocardial ATP production and cardiac workload. We know is important for better understand disease development and choice of nutritional or pharmacological treatment strategies. So what Dr. Berndt from Charity University and colleagues did, was they developed a comprehensive physiology based mathematical model of cardiac energy metabolism. And this model is called cardiokine one. And what it does is it recapitulates numerous experimental findings on cardiac metabolism obtained with isolated cardiomyocytes, perfused animal hearts and in vivo studies with humans. The model encompassed all pathways along, which the possible energy delivering substrates like glucose, long chain fatty acids, keto bodies, acetate, branch chain, amino acids are utilized. Dr. Carolyn Lam: They use the proteomic space, the abundance of metabolic enzymes and cardiac tissue to generate individualized metabolic models of cardiac energy metabolism. And so to prove their case, they further applied this approach to the left ventricles of controls in patients with mitral insufficiency and aortic stenosis, and showed that despite overall preserved systolic function, the ATP producing capacity of these left ventricles of patients with valvular dysfunction was generally diminished and correlated positively with mechanical energy demand and cardiac output. Dr. Greg Hundley: So Carolyn really interesting findings. Sort of linking metabolism them with ventricular dysfunction in those with valvular heart disease. So what were the clinical implications here? What's the take home? Dr. Carolyn Lam: Well, this methodology is just awesome, but what they also found I think is a very important physiological principle. And that is, while metabolic capacity have a significant correlation with biomechanical properties like myocardial power and cardiac output, they can also vary considerably between individual patients and therefore help us to understand in future perhaps why some patients develop heart failure over time while others with similar hemodynamic conditions do not. So just interesting. I think it just opens the space to a lot more. Dr. Greg Hundley: Absolutely beautiful summary there Carolyn. Well, in the rest of the mailbag for this issue, we have an exchange of letters between Professors Hu and Trifon on the previously published paper, entitled “Short Term Treatment with Aspirin plus Clopidogrel Compared to Monotherapy of Aspirin May Not Significantly Decrease the Risk of Stroke Recurrence.” Also, there's a Research Letter from Professor Catalucci entitled, “Nano miR-133A Replacement Therapy, Blunts Pressure Overloaded Induced Heart Failure.” And then finally Carolyn, there's an In-Depth article from Professor Aengevaeren entitled, “Exercise-Induced Cardiac Troponin Elevations From Underlying Mechanisms to Clinical Science.” Well Carolyn, how about we get onto that feature discussion and learn more about incident atrial fibrillation and the age of epigenetics. Dr. Carolyn Lam: Let's go. Dr. Mercedes Carnethon: Welcome to this episode of Circulation on the Run, where we're going to have a very exciting discussion about a paper on epigenetic age and the risk of incident atrial fibrillation. We're extremely excited to have the lead author here with us, Dr. Jason Roberts from the Population Health Research Institute, McMaster University and Hamilton Health Sciences in Ontario Canada. And I am really excited to host this episode alongside the handling editor. My name is Mercedes Carnethon and I'm the professor and vice chair of Preventive Medicine at the Northwestern University School of Medicine. And I'm pleased to be hosting this with Dr. Vlad Zaha from UT Southwestern Medical School, who was the associate editor who handled the piece. So I'm really excited to jump right into this because I think there's a lot that we can all learn from this. So welcome Jason, and thank you so much, Vlad. Dr. Jason Roberts: Thank you so much for having me, it's a delight to be here. Dr. Mercedes Carnethon: So Jason, tell us a little bit about the rationale for this study, what you found and what it means. Dr. Jason Roberts: Absolutely. So as a cardiac arrhythmia specialist, I see a lot of patients with atrial fibrillation. And in 2021, our understanding of its underlying pathophysiology still remains modest. Our treatment strategies for the condition are also somewhat modest, although catheter ablation and antiarrhythmic drugs can potentially be very effective. In the context of these limitations, they're also exacerbated to some extent by the prevalence of atrial fibrillation, increasing dramatically in developed countries. Part of this is related to the obesity epidemic. Things like hypertension increasing becoming more common, but because atrial fibrillation is age dependent and because of our aging populations in developed countries, this is felt to have a major contribution to the growing prevalence of atrial fibrillation. Unlike obesity and hypertension and other risk factors, which are potentially modifiable, chronological aging is viewed as non-modifiable. It's not something that we can tackle. That said, we know within the population and just from personal experience that people age at different rates. There are some people that are 65 who behave more like they're 50, other people that are 50 who behave more like they're 65. Dr. Jason Roberts: And in that context, biological aging, we wondered whether or not, does biological aging independent of chronological aging potentially impacts the risk of atrial fibrillation. If that was the case, because there are gradually accumulating to suggest that biological aging is potentially modifiable, that could potentially open up the possibility of tackling aging as a respective for atrial fibrillation. So that drove us to ask this question. In terms of what we found in the approach that we used. So we used our biological marker of aging, was something called an epigenetic clock. So it's been found that modifications to DNA, specifically methylation at CpG at dinucleotides, they correlate with aging. This has been appreciated for a few decades. It was initially felt that with aging, methylation levels gradually reduced over time. But with more careful interrogation, it's shown that there's patterns. Some methylation areas increase, other methylation areas there's decreases. Dr. Jason Roberts: And Steve Horvath, who is a scientist at UCLA has found that using mathematical algorithms, you're able to very accurately ascertain chronological age based on the patterns of DNA methylation, he's called these things epigenetic o'clock. That said, even though they very accurately ascertain chronological age, they aren't perfect in each individual in terms of matching up to their chronological age, but that's actually turned out to be a good thing. So when people, their epigenetic age is older than their chronological age, they're said to have positive epigenetic age acceleration. They may be biologically older than their actual chronological age. And then the reverse also holds. So using this concept of epigenetic age acceleration, we ask whether or not do people that are older biologically on the basis of their epigenetic age, do they have an increased risk of atrial fibrillation? And then we tackle that using a few different core works that I'm certainly happy to elaborate on in terms of what we found. Dr. Jason Roberts: So we used three population based cohorts from the United States, the well known Framingham Heart Study, the Cardiovascular Health Study and Eric as well. There were approximately just under 6,000 people from those studies that had undergone genome wide methylation analysis that in the enabled us to calculate their epigenetic ages. The follow period for these people was just under 13 years. And then we look to see whether or not these epigenetic clocks associated with instant atrial fibrillation. In these cohorts, we look at five different clocks. So there's the Horvath Clock and the Hannum clock that were designed to predict chronological aging. The more recent clocks, things like DNAm PhenoAge and DNAm GrimAge are more designed to predict aspects of clinical phenotype and also mortality. We found that in unadjusted analyses, all of these clocks were associated with atrial fibrillation. When we then adjusted for multiple different clinical variables, we found that the DNAm PhenoAge clock and the DNAm GrimAge clock continued to exhibit statistically significant associations with atrial fibrillation. Dr. Jason Roberts: Interestingly, the multi-variable adjustment, one concern is, do these clinical factors, are they confounders where we should be adjusting, or are they potentially mediators. If we adjust for mediators that potentially masks the effect of the clock. But regardless of how we treat them both DNAm PhenoAge and DNAm GrimAge, we're associated with increased risks of incident atrial fibrillation. Alluding to the possibility that biological aging independent of chronological aging is important in terms of determining risk for atrial fibrillation. And it may be that if we're able to modify biological aging, we could potentially reduce the risk of atrial fibrillation. So that's the study in a nutshell. Dr. Mercedes Carnethon: No, that is really exciting. You said something early on about chronological age being immutable. And I would have to say, both Vlad and I are not aging. And in fact, we are going in the opposite direction. If only this were not just an audio podcast, you would see that I steadily gotten younger and younger and I'm suddenly about 25 now. But no, these are really important findings. I really like the innovation of using multiple different strategies to characterize epigenetic age and genetic aging. So tell me Vlad, I want to turn to you. When this came across your desk, what excited you about this particular piece and why did you think that it would be of great interest to our readership? Dr. Vlad Zaha: Good morning Merci and Jason. This is a great question. And as in associate editor at Circulation for the bridging discipline section, it was fascinating to see this topic coming on my desk, thinking about all the genome wide association studies in nature of fibrillation and predisposition to atrial fibrillation, that in that case would not be changed by interventions because of different loci that would be determined. This was coming as a completely new perspective that was opening some new potentials. And it was very interesting to see some of the findings. Dr. Mercedes Carnethon: Certainly. So Jason, I have a question. So what surprised you about the findings of this particular study? Jason Roberts: Yeah, that's a great question. So we had hoped that biological aging would be associated with atrial fibrillation. I think the concept of being able to tackle biological aging is exciting. In terms of what surprised us, I guess we were hoping for these results, I guess. Dr. Mercedes Carnethon: Yeah. Dr. Jason Roberts: But we were…Yeah. So I guess we were pleasantly surprised that our hypothesis was born out. It's important to note that the epigenetic clocks don't tell the full story with chronological aging. So after we insert the clock into the model, chronological age continues to remain associated with instant atrial fibrillation. So this measure biological aging is just part of the story. So I think that's very important. I had wondered whether or not inserting the epigenetic clocks would that potentially eliminate the subsequent association of chronological aging. So that finding suggests it's part of the story. Dr. Jason Roberts: I think that in terms of the overall concept, the idea of this being reversible really excites me. In terms of the approach of how to reverse biological aging. Right now healthy lifestyle seems to be very important. I think it provides more evidence to suggest to patients with atrial fibrillation, living healthy from a diet perspective, from exercise, keeping your weight under control, all of these things that seem to impact epigenetic aging and biological aging can be helpful for preventing atrial fibrillation. So I think that can help reinforce this message to our patients. Dr. Jason Roberts: I think ultimately in terms of where we'll be at in 15 to 20 years, it's possible that new therapies in the future are developed that are able to more powerfully address biological aging. As you alluded to, will it be possible to reverse biological aging as you and Vlad are experiencing that? Dr. Mercedes Carnethon: Most definitely. Yes. Dr. Jason Roberts: I think it may be possible. This is an intense area of investigation that's being pursued and it's still in its relative infancy. But I think that could it be small molecules? Could it be potentially gene editing that can help adjust biological aging and not only increase lifespan, but also health span? I think those concepts are really exciting. Dr. Mercedes Carnethon: I completely agree. There's a lot of richness in this paper and I think our readership is going to really enjoy digging in. Part of the richness is the use of three different cohorts and the use of multiple measures of epigenetic age. And I think you provided a really nice description of the unique information that each of these markers of epigenetic age provide. One thing I note are differences in the strength of association across the different measures of epigenetic age, which I think makes sense, because you said they characterize different aspects of the phenomenon, but I also see what looks like some variability across the cohorts with Framingham in particular seeming to stand out. And that being the only cohort that is 100% one race. It's white. Versus both the cardiovascular health study and the Eric study, which have more diverse study populations. I'm wondering what your hypothesis is about the differential strength of association that it seems Framingham is demonstrating and what you think is possibly the source of those differences. Dr. Jason Roberts: Yeah. I think those are great questions for all of genetics. The question is, does it apply to all races? For example, polygenic risk scores. It seems like when a polygenic risk scores develop for one race, it may not perfectly translate over to other races. So how relevant is that for epigenetic age acceleration. In this study, I think it's difficult to make definitive conclusions about it. We needed the three cohorts to have adequate statistical power in terms of being able to determine a differential effect of race. I think it would really be primarily hypothesis generating. We weren't really powered to look at the different races. So it's difficult for me to comment. Dr. Jason Roberts: I think ultimately and I want to believe anyways, that epigenetic age acceleration is relevant to all races, but in terms of, was it race that drove the differential impacts that we saw to some extent in terms of the magnitude of the hazard ratios, it's difficult to know in terms of tests for interaction and were these actually truly statistically different. We weren't adequately powered to address that hypothesis. So it's difficult for me to comment in a definitive matter I'd say. And sorry to cop out on… Dr. Mercedes Carnethon: No, not at all. I mean, I think there are a lot of things where there is no firm answer and that was just one of my hypotheses when I saw what was going on differently across the cohorts. I think that's a perfectly reasonable answer that sets us on a course for thinking about how we set up future studies. So I wanted to turn to you Vlad for the closing frame around this. As the editor, how do you hope that our readership will use these findings? Dr. Vlad Zaha: That is an excellent question. I was going to follow on this excellent unpacking of the core messages of the manuscript by Jason here to get his perspective as an electrophysiologist into what these type of work may represent for the everyday life of an electrophysiologist in the connecting with the patients and how would this type of approach influence, and maybe now, maybe later when our treatment for atrial fibrillation. Dr. Jason Roberts: Yeah. So that's a great question. I think, as I alluded to some extent before, as far as reinforcing healthy lifestyle, I think this provides more evidence in that respect. So we know that things like excessive alcohol consumption, being excessively obese, poor diets, not engaging in enough exercise, all of those things seem to accelerate your epigenetic age. And those are all things that we think or feel that are important with atrial fibrillation in terms of driving the path of physiology and people progressing. So I think this gives more data to us to reinforce the patients that in addition to the treatments that we're offering in terms of catheter ablation and antiarrhythmic drugs, the concern is that the substrate can continue you to progress. And that's likely driven by to some extent these modifiable risk factors. So keeping all of these under best control as possible, and hence trying to slow your biological aging as much as possible. Dr. Jason Roberts: I think that this will provide us more motivation to push these messages to our patients. A lot of patients can sometimes be like, "Let's just get on with a catheter ablation and I want to get on with my life…" but it really I think, provides more data to suggest that modifying these very important risk factors that can lead to accelerated biological agents, is very important. And in terms of the future as mentioned, so chronological aging, as people get older, people view it as, "Well, there's nothing I can do, and I'm just going to get gradually more and more unhealthy." I think, and this is somewhat futuristic, but to what extent can we slow biological aging? Can we potentially reverse it in the future? There's certainly lots of very compelling and interesting animal work and people are starting to delve into this in a big way. Dr. Jason Roberts: And not only to increase lifespan, will we some day live until we're 200. Who knows? But the concept of prolonging your health span as well. So the number of healthy years that you have before your body starts to gradually give way, I guess to some extent. Hopefully in the future will have therapies that will help keep us healthy. And if we do that increased health span, I think this data suggests that atrial fibrillation will be one thing that benefits from this. So hopefully in the future, maybe in terms of curbing the AFib pandemic, being able to address biological aging will help push things in the right direction. Dr. Mercedes Carnethon: Well, thank you so much Jason. And thank you so much Vlad for your thoughtful questions. I really like that the final bottom line leans towards my area as an epidemiologist, which is maintaining and promoting healthy lifestyles as a way to hopefully help prevent some of the difficulties of atrial fibrillation and its long-term outcomes. Really pleased to have you on this episode of Circulation on the Run, Jason, and thank you again Vlad, and I hope everyone enjoys this episode of the journal and has an opportunity to really dig into this piece. This is Mercedes Carnethon from Northwestern University Feinberg School of Medicine, saying thanks for listening today. Dr. Greg Hundley: This program is copyright of the American Heart Association 2021. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American heart association for more visit ahajournals.org.

Medications May Impact Concussions

Play Episode Listen Later Dec 10, 2021

Welcome to Sports Med Res' this week in review podcast where we highlight the news in sports medicine research from the week ending on December 10, 2021. This week's podcast focused on the relationships between medication to treat attention deficit hyperactivity disorder and concussions. * ADHD Diagnosis May Not Lead To Increased Risk for Concussion: Medication May Stimulate Prevention * 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group * Asian Pacific Society of Cardiology Consensus Recommendations for Pre-participation Screening in Young Competitive Athletes * Anabolic-Androgenic Steroid Use in Sports, Health, and Society * Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group * ACSM Expert Consensus Statement: Injury Prevention and Exercise Performance during Cold-Weather Exercise RSS Feed, Apple Podcasts, or Google Podcast Evidence-Based CEU Courses from Sports Med Res and Human Kinetics (3-10 EBP CEUs/course) The post Medications May Impact Concussions appeared first on Sports Medicine Research.

covid-19 health education sports training research medicine athletic medications screenings implementation concussions week in review human kinetics exercise performance cardiopulmonary resuscitation advanced life support

The J C Cooley Foundation - Options, Opportunities / The Choice Program with James Cooley

Play Episode Listen Later Dec 6, 2021 51:42

Introducing The JC Cooley Foundation: OPTIONS & OPPORTUNITIES/THE CHOICE PROGRAM The mission, core values, and principles of the Foundation The different programs the Foundation is involved in The goals of the Foundation. James Cooley, a devout Christian, and a retired Navy Officer was born in Chattanooga, Tennessee. He is the Host of The James Cooley Show…IT'S YOUR LIFE. He is the author of “Country Boy, City Boy, A Journey, That Ain't Over Yet” (2020) & Audiobook narrated by James Cooley (2021), The Book of Knowledge: “Your Pathway to Enlightenment (2015), My Path (2014). James is the President & CEO of JC Cooley Innovation Solutions, LLC, and The JC Cooley Foundation Options & Opportunities / The Choice Program. James was presented with the 1992 Senior Enlisted Admirals Gallery and Renken Award of Merit for the development of a Breakfast Tutoring Program for academically at-risk students. He also qualified and re-qualified over 1,000 military and civilian personnel in Cardiopulmonary Resuscitation as well as hosting 47 television shows titled “Cooley's Fitness Tips”. James was selected as one of the first George H. Bush's One-Thousand Points of Light recipients for outstanding community service. He resides in Temecula, California and Fort Worth, Texas with his wife of almost 14 years Michelle. More information here : http://cooleyfoundation.org/ James' book: https://amzn.to/3jZAzyr Brought to you by J.C. Cooley Foundation "Equipping the Youth of Today for the Challenges of Tomorrow". Support the show: http://www.cooleyfoundation.org/ See omnystudio.com/listener for privacy information.

The Spirit of Thankfulness

master national rescue degree btech cardiopulmonary resuscitation

Play Episode Listen Later Nov 24, 2021 51:41

The James Cooley Show…IT'S YOUR LIFE TEAM discusses the spirit of thankfulness in their lives. The Thanksgiving holiday and the traditions and memories Trials, tribulations, and lesson learned in which we are thankful James, a motivational speaker, and a retired Navy Officer was born in Chattanooga, Tennessee. He is the Host of The James Cooley Show…IT'S YOUR LIFE. He is the author of “Country Boy, City Boy, A Journey, That Ain't Over Yet” (2020) & Audiobook narrated by James Cooley (2021), The Book of Knowledge: “Your Pathway to Enlightenment (2015), My Path (2014). James is the President & CEO of JC Cooley Innovation Solutions, LLC, and The JC Cooley Foundation Options & Opportunities / The Choice Program. James was presented with the 1992 Senior Enlisted Admirals Gallery and Renken Award of Merit for the development of a Breakfast Tutoring Program for academically at-risk students. He also qualified and re-qualified over 1,000 military and civilian personnel in Cardiopulmonary Resuscitation as well as hosting 47 television shows titled “Cooley's Fitness Tips”. James was selected as one of the first George H. Bush's One-Thousand Points of Light recipients for outstanding community service. He resides in Temecula, California and Fort Worth, Texas with his wife of almost 14 years Michelle. More information here : http://cooleyfoundation.org/ James' book: https://amzn.to/3jZAzyr Michelle is a native of New York City, NY and currently resides in Fort Worth, Texas and Temecula, California. She has been married to James (JC) Cooley for almost 14 years. Her hobbies include walking, running and basically working out at the gym. Michelle has a Bachelor's Degree in Marketing Management, and a Masters Degree in Marketing from Concordia University Nebraska. She has been part of the JC Cooley Foundation since its inception in 2014. Her continued focus is on giving back to the community and finding ways to inspire and help those in need. Noah interviews guests that impact the San Diego community as a whole; sometimes these issues are local non-profits doing good throughout the county and other times they are national issues that also can directly impact our fine city. Noah has a passion for kids, being a father himself. He loves to talk about anything that can benefit the life of a child. He often likes to use the phrase, “It's about what matters locally to you”. Also, sail aboard "Noah's Ark" on KPRZ M-F; 9pm - midnight as Noah brings you through various national ministry programs. Noah enjoys world history, loves the film industry, and is a podcast aficionado. More information here : https://kprz.com/personality/2275 Brought to you by J.C. Cooley Foundation "Equipping the Youth of Today for the Challenges of Tomorrow". Support the show: http://www.cooleyfoundation.org/ See omnystudio.com/listener for privacy information.

EP34: 4th November - National Cardiopulmonary Resuscitation Week

Society's Super Heroes

Play Episode Listen Later Nov 3, 2021 27:18

The 4th November is the start of National Cardiopulmonary Week, we are in conversation with Kaleb Lachenicht. Kaleb is an advanced Life Support Paramedic who manages a private medical training company. Kaleb is passionate about teaching emergency medicine and has a BTech in Emergency Medical Care and Rescue and a Master's Degree in Health Science Education.

Getting to know the James Cooley... It's Your Life Team

Play Episode Listen Later Nov 2, 2021 51:43

Introducing The James Cooley Show…IT'S YOUR LIFE Team: James Cooley, Michelle Cooley, and Noah Dingley James, Michelle, and Noah discuss basic LIFE topics that deal with their personal and professional lives. James, a motivational speaker, and a retired Navy Officer was born in Chattanooga, Tennessee. He is the Host of The James Cooley Show…IT'S YOUR LIFE. He is the author of “Country Boy, City Boy, A Journey, That Ain't Over Yet” (2020) & Audiobook narrated by James Cooley (2021), The Book of Knowledge: “Your Pathway to Enlightenment (2015), My Path (2014). James is the President & CEO of JC Cooley Innovation Solutions, LLC, and The JC Cooley Foundation Options & Opportunities / The Choice Program. James was presented with the 1992 Senior Enlisted Admirals Gallery and Renken Award of Merit for the development of a Breakfast Tutoring Program for academically at-risk students. He also qualified and re-qualified over 1,000 military and civilian personnel in Cardiopulmonary Resuscitation as well as hosting 47 television shows titled “Cooley's Fitness Tips”. James was selected as one of the first George H. Bush's One-Thousand Points of Light recipients for outstanding community service. He resides in Temecula, California and Fort Worth, Texas with his wife of almost 14 years Michelle. More information here : http://cooleyfoundation.org/ James' book: https://amzn.to/3jZAzyr Michelle is a native of New York City, NY and currently resides in Fort Worth, Texas and Temecula, California. She has been married to James (JC) Cooley for almost 14 years. Her hobbies include walking, running and basically working out at the gym. Michelle has a Bachelor's Degree in Marketing Management, and a Masters Degree in Marketing from Concordia University Nebraska. She has been part of the JC Cooley Foundation since its inception in 2014. Her continued focus is on giving back to the community and finding ways to inspire and help those in need. Noah interviews guests that impact the San Diego community as a whole; sometimes these issues are local non-profits doing good throughout the county and other times they are national issues that also can directly impact our fine city. Noah has a passion for kids, being a father himself. He loves to talk about anything that can benefit the life of a child. He often likes to use the phrase, “It's about what matters locally to you”. Also, sail aboard "Noah's Ark" on KPRZ M-F; 9pm - midnight as Noah brings you through various national ministry programs. Noah enjoys world history, loves the film industry, and is a podcast aficionado. More information here : https://kprz.com/personality/2275 Support the show: http://www.cooleyfoundation.org/ See omnystudio.com/listener for privacy information.

The James Cooley Show - The Team That Makes It Happen

world nielsen leo tolstoy cardiac arrest anesthesiology intensive care helsingborg lund university clinical science ttm nick lane hospital cardiac arrest cardiopulmonary resuscitation

Play Episode Listen Later Oct 25, 2021 51:10

Getting to know the backgrounds of The James Cooley Show…IT'S YOUR LIFE Team James Cooley, Michelle Cooley, and Noah Dingley James, Michelle, and Noah discussing basic LIFE topics that deal with their personal and professional lives. James, a motivational speaker, and a retired Navy Officer was born in Chattanooga, Tennessee. He is the Host of The James Cooley Show…IT'S YOUR LIFE. He is the author of “Country Boy, City Boy, A Journey, That Ain't Over Yet” (2020) & Audiobook narrated by James Cooley (2021), The Book of Knowledge: “Your Pathway to Enlightenment (2015), My Path (2014). James is the President & CEO of JC Cooley Innovation Solutions, LLC, and The JC Cooley Foundation Options & Opportunities / The Choice Program. James was presented with the 1992 Senior Enlisted Admirals Gallery and Renken Award of Merit for the development of a Breakfast Tutoring Program for academically at-risk students. He also qualified and re-qualified over 1,000 military and civilian personnel in Cardiopulmonary Resuscitation as well as hosting 47 television shows titled “Cooley's Fitness Tips”. James was selected as one of the first George H. Bush's One-Thousand Points of Light recipients for outstanding community service. He resides in Temecula, California and Fort Worth, Texas with his wife of almost 14 years Michelle. Michelle is a native of New York City, NY and currently resides in Fort Worth, Texas and Temecula, California. She has been married to James (JC) Cooley for almost 14 years. Her hobbies include walking, running and basically working out at the gym. Michelle has a Bachelor's Degree in Marketing Management, and a Masters Degree in Marketing from Concordia University Nebraska. She has been part of the JC Cooley Foundation since its inception in 2014. Her continued focus is on giving back to the community and finding ways to inspire and help those in need. Noah interviews guests that impact the San Diego community as a whole; sometimes these issues are local non-profits doing good throughout the county and other times they are national issues that also can directly impact our fine city. Noah has a passion for kids, being a father himself. He loves to talk about anything that can benefit the life of a child. He often likes to use the phrase, “It's about what matters locally to you”. Support the show: http://www.cooleyfoundation.org/ See omnystudio.com/listener for privacy information.

TTM Post-Cardiac Arrest

Critical Matters

Play Episode Listen Later Sep 9, 2021 59:16

In this episode of Critical Matters, we will discuss the results of the recently published TTM2 clinical trial and the current state of evidence for Targeted Temperature Management in the post cardiac arrest patient. Our guest is Dr. Niklas Nielsen. Dr. Nielsen is an associate professor at the Department of Clinical Sciences at Helsingborg, Lund University, and consultant in Anesthesiology and Intensive Care at Helsingborg Hospital. He was the principal investigator for the TTM1 and TTM 2 clinical trials. Additional Resources: The International Cardiac Arrest Registry (INTCAR): https://bit.ly/2Xbe0yt Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest: https://bit.ly/3nad5Jo Targeted Temperature Management at 33C versus 36C after Cardiac Arrest: https://bit.ly/38THRO9 Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm: https://bit.ly/2X19aUj 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: https://bit.ly/3z0k7T3 Books Mentioned in this Episode: Oxygen: The Molecule that Made the World by Nick Lane: https://amzn.to/2WYMmVz Anna Karenina by Leo Tolstoy: https://amzn.to/3yVao0v

Incorporating the concept of L.I.F.E with James Cooley

ceo president tennessee llc bush concept enlightenment audiobooks incorporating chattanooga merit cooley fitness tips country boy city boy my path george h bush cardiopulmonary resuscitation over yet

Play Episode Listen Later Aug 23, 2021 52:45

Discover James Cooley's audiobook Country Boy, City Boy: A Journey that Ain't Over Yet Discuss his childhood background growing up Understand the acronym and meaning of L.I.F.E Learn about James' experience in the United States Navy Discuss the lessons he has learned in life James was born in Chattanooga,Tennessee. He is the Host of The James Cooley Show…IT'S YOUR LIFE, and the author of “Country Boy, City Boy, A Journey, That Ain't Over Yet” (2020) & Audiobook narrated by James Cooley (2021), The Book of Knowledge: “Your Pathway to Enlightenment (2015), and My Path (2014). James is the President and CEO of JC Cooley Innovation Solutions, LLC, and The JC Cooley Foundation Options; Opportunities / The Choice Program. James was presented with the 1992 Senior Enlisted Admirals Gallery and Renken Award of Merit for the development of a Breakfast Tutoring Program for academically at-risk students. He also qualified and re-qualified over 1,000 military and civilian personnel in Cardiopulmonary Resuscitation as well as hosting 47 television shows titled “Cooley's Fitness Tips”. James was selected as one of the first George H. Bush's One-Thousand Points of Light recipients for outstanding community service. http://cooleyfoundation.org/ https://amzn.to/37I1AQm Support the show: http://www.cooleyfoundation.org/ See omnystudio.com/listener for privacy information.

C.P.R.

Other People's Shoes

Play Episode Listen Later Jul 21, 2021 63:03

Cardiopulmonary Resuscitation, or CPR, is an emergency lifesaving procedure performed when the heart stops beating. Immediate CPR can triple the chances of survival after cardiac arrest. My guest today is Jodi Howe. Jodi is not a doctor, however, she believes she has been on a journey to help others receive that breath of life that can only come from one source. Her mission is to walk beside others and they navigate through the mental storms of life. Join me as we try on Jodi's Ugg boots.•To learn more about Jodi click here.•Remember when you walk in Other People's Shoes you get a different perspective!•Other People's Shoes would love your financial gift to help support the show click here•Have questions or want to give feedback call or text: 203-548-SHOE•If you enjoy the show consider subscribe on your favorite podcast platforms, so you don't miss an episode. We would also love it if you could leave us a review click here!•To hear other episodes go to:www.opspodcast.com•Social Media:**Facebook: Instagram: Twitter: ** @opspodcas

shoes cpr ugg cardiopulmonary resuscitation

Ramai Yang Tidak Tahu Lakukan Cardiopulmonary Resuscitation(CPR) & Pentingnya Pengetahuan CPR Di Rumah | Kool FM AG, Haiza, Muaz

Catch Up Kool FM

Play Episode Listen Later Jun 15, 2021 25:56

Kool FM AG, Haiza, Muaz

tidak rumah pentingnya ramai pengetahuan cardiopulmonary resuscitation kool fm

OA/SOAP Fellows Webinar Series: March 2021

OpenAnesthesia Multimedia

Play Episode Listen Later Apr 4, 2021 44:37

Cardiopulmonary Resuscitation in Pregnancy with Michelle Eddins

pregnancy soap fellows webinar series cardiopulmonary resuscitation

Article of the Month - February 2021 - Cristobal Añez

OpenAnesthesia Multimedia

Play Episode Listen Later Feb 10, 2021 12:48

Dr. Cristobal Añez discusses his article “Cardiopulmonary Resuscitation in the Prone Position in the Operating Room or in the Intensive Care Unit” from the February 2021 issue of Anesthesia & Analgesia.

cristobal intensive care units operating room cardiopulmonary resuscitation

The 2 View: Episode 2

2 View: Emergency Medicine PAs & NPs

Play Episode Listen Later Feb 3, 2021 58:34

View the full show notes on Google Docs here: http://bit.ly/3cpvlJc 2020 BLS/ACLS Guideline Changes Merchant RM, Topjian AA, Panchal AR, et al. Part 1: Executive summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. Published October 21, 2020. Accessed January 20, 2021. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000918 Highlights of the 2020 American Heart Association Guidelines for CPR and ECC. American Heart Association. Published 2020. Accessed January 20, 2021. https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts2020eccguidelinesenglish.pdf Edelson DP, Sasson C, Chan PS, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates with Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get with The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association. Circulation. Published April 9, 2020. Accessed January 20, 2021. https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.120.047463 Topjian A, Aziz K, Kamath-Rayne BD, et al. Interim Guidance for Basic and Advanced Life Support in Children and Neonates with Suspected or Confirmed COVID-19. Pediatrics. Published 2020. Accessed January 20, 2021. https://pediatrics.aappublications.org/content/early/2020/04/13/peds.2020-1405 Hunt EA, Jeffers J, McNamara L, et al. Improved Cardiopulmonary Resuscitation Performance with CODE ACES2: A Resuscitation Quality Bundle. Journal of the American Heart Association. Published December 7, 2018. Accessed January 20, 2021. https://www.ahajournals.org/doi/10.1161/JAHA.118.009860 Procedural Pearl of the Month - Fish Hooks Roberts M, Roberts JR. The Proceduralist. https://www.theproceduralist.org/. Accessed January 20, 2021. The Procedural Pause by James R. Roberts, MD, & Martha Roberts, ACNP, PNP. Fishing Out the Fishhook. Emergency Medicine News. Published September 1, 2020. Accessed January 20, 2021. https://journals.lww.com/em-news/blog/theproceduralpause/pages/post.aspx?PostID=108 Droperidol DeFranco, C, DO. Oldie but a Goodie: 10 Pearls of Droperidol. Acep.org. Published 2021. Accessed January 20, 2021. https://www.acep.org/how-we-serve/sections/pain-management/news/may-2020/oldie-but-a-goodie-10-pearls-of-droperidol/ Ho, J, FAAEM MD, Perkins J, FAAEM MD. Clinical Practice Statement: Safety of Droperidol Use in the Emergency Department. Aaem.org. Published September 7, 2013. Accessed January 20, 2021. https://www.aaem.org/UserFiles/file/Safety-of-Droperidol-Use-in-the-ED.pdf Cisewski, D MD. Droperidol Use in the Emergency Department – What's Old is New Again. Emdocs.net. Published August 1, 2019. Accessed January 20, 2021. http://www.emdocs.net/droperidol-use-in-the-emergency-department-whats-old-is-new-again/ Ken's Third View SGEM#315: Comfortably Numb with Topical Tetracaine for Corneal Abrasions. Thesgem.com. Published January 16, 2021. Accessed January 20, 2021. http://thesgem.com/2021/01/sgem315-comfortably-numb-with-topical-tetracaine-for-corneal-abrasions/ Shipman S, Painter K, Keuchel M, Bogie C. Short-Term Topical Tetracaine Is Highly Efficacious for the Treatment of Pain Caused by Corneal Abrasions: A Double-Blind, Randomized Clinical Trial. Ann Emerg Med. Published October 27, 2020. Accessed January 20, 2021. https://pubmed.ncbi.nlm.nih.gov/33121832/ SGEM#316: What A Difference an A.P.P. Makes? Diagnostic Testing Differences Between A.P.P.S and Physicians. Thesgem.com. Published January 23, 2021. Accessed January 24, 2021. http://thesgem.com/2021/01/sgem316-what-a-difference-an-a-p-p-makes-diagnostic-testing-differences-between-a-p-p-s-and-physicians/ Pines JM, Zocchi MS, Ritsema TS, Bedolla J, Venkat A, US Acute Care Solutions Research Group. Emergency Physician and Advanced Practice Provider Diagnostic Testing and Admission Decisions in Chest Pain and Abdominal Pain. Acad Emerg Med. Published November 21, 2020. Accessed January 20, 2021. https://pubmed.ncbi.nlm.nih.gov/33107088/ Gonorrhea Questions Answered Scully BE, Fu KP, Neu HC. Pharmacokinetics of ceftriaxone after intravenous infusion and intramuscular injection. Am J Med. Published October 19, 1984. Accessed January 20, 2021. https://pubmed.ncbi.nlm.nih.gov/6093511/ Meyers BR, Srulevitch ES, Jacobson J, Hirschman SZ. Crossover study of the pharmacokinetics of ceftriaxone administered intravenously or intramuscularly to healthy volunteers. Antimicrob Agents Chemother. Published November 1983. Accessed January 20, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC185948/ Shatsky M. Evidence for the use of intramuscular injections in outpatient practice. Am Fam Physician. Published February 15, 2009. Accessed January 20, 2021. https://pubmed.ncbi.nlm.nih.gov/19235496/ Trivia Question: Send answers to 2viewcast@gmail.com Please note that for this month, if you get the trivia question correct, you will win 20% off any CCME course you want. That's right, ANY CCME course you want. You can buy it for yourself or give it to a friend - it's your 20% off. So, download and listen to the episode for the question! Please email us your guesses at 2viewcast@gmail.com, that's the number 2, view, cast @gmail.com and tell us who you want to give a shout-out to.

Episode 35- An expert talks: PALS

ER-Rx: An ER + ICU Podcast

Play Episode Play 36 sec Highlight Listen Later Dec 10, 2020 28:09

In part 2 of the cardiac arrest series, Dr. Rebecca Gragg, an ER pharmacist at a pediatric trauma center, discusses some key points from the 2020 PALS guidelines.References:Antevy, P. Handtevy method helps providers rapidly calculate pediatric drug dosages. JEMS. 2013; 8 (38). Available at: https://www.jems.com/2013/08/20/handtevy-method-helps-providers-rapidly/Topjian AA, Raymond TT, Atkins D, et al. Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020; 142: S469- 523

er pediatric cardiology pals peds cardiac arrest bls acls cardiopulmonary resuscitation advanced life support

SCCM Pod-430 Optimal Bundle of Management for Cardiac Arrest

management medicine optimal bundle cardiac arrest emergency medical services sccm cardiopulmonary resuscitation

Play Episode Listen Later Dec 10, 2020 35:22

Sudden cardiac arrest remains a leading cause of premature death worldwide.

SCCM Pod-430 Optimal Bundle of Management for Cardiac Arrest

iCritical Care: Critical Care Medicine

Play Episode Listen Later Dec 10, 2020 35:22

Sudden cardiac arrest remains a leading cause of premature death worldwide.

management medicine optimal bundle cardiac arrest emergency medical services sccm cardiopulmonary resuscitation

101: Actualización 2020 de ACLS - Parte 2

ER-Rx: An ER + ICU Podcast

Play Episode Listen Later Dec 4, 2020 31:03

Vea la parte 1 aquí. Taquicardias El algoritmo de taquicardias de la actualización 2020 de ACLS es, en esencia, el mismo algoritmo anterior. Aunque no hay cambios en las recomendaciones, el algoritmo aclara algunas situaciones, y complica otras. Existen diferentes tipos de desfibriladores bifásicos que pueden administrar diferentes niveles de energía logrando el mismo resultado. Aunque 100 J sean un punto común de partida para la cardioversión sincronizada de la mayoría de las arritmias, algunas tecnologías específicas pueden lograr lo mismo con menos energía. Un aspecto relevante a recordar es que: El beneficio de cardiovertir una arritmia hemodinámicamente inestable es mayor que el potencial daño al músculo cardiaco, aún con niveles altos de energía. Si no convierte, aumente la energía para la segunda dosis. Algunas arritmias son notables porque NO convierten con dosis bajas de energía. Por ejemplo, es relativamente común tener que cardiovertir una fibrilación atrial con niveles altos. Si se comenzara inadvertidamente con una dosis baja, simplemente se aumenta la energía en una descarga subsiguiente. El algoritmo anterior reflejaba esto diciendo que la primera descarga debía ser entre 120 J y 200 J bifásicos (que equivalen a 360 J monofásicos). El algoritmo nuevo no hace esta aclaración o distinción debido a la variación que puede haber entre una marca de equipo y otro. Por ejemplo, puede ver aquí el protocolo de desfibrilación de ZOLL. Este otro documento habla de las diferencias entre la energía bifásica y la bifásica truncada. Por otro lado, el otro cambio que el algoritmo tiene es precisamente diciendo lo mismo que acabo de mencionar. El algoritmo tiene un nuevo segmento que dice qué hacer cuando la cardioversión no funciona. Si la cardioversión no funciona, ¡aumenta la dosis de energía! En adición, sugiere identificar la causa de la taquicardia y/o añadir un antiarrítimico al manejo. Sonografía durante el paro cardiaco En este episodio previo del ECCpodcast hablamos sobre el rol de la sonografía para entender lo que ocurre con el paciente en paro cardiaco. Es importante señalar que el rol de la sonografía en este momento no es el pronosticar el éxito del intento de reanimación y/o decidir que se debe detener la reanimación basado en ausencia de signos alentadores a través de la sonografía (ausencia de movimiento de la pared ventricular, etc.). El rol de la sonografía en este momento debe ser en ayudarnos a entender la causa del paro cardiaco e identificar qué acciones pueden tener la mayor oportunidad de éxito. Situaciones especiales: intoxicación con opioides La intoxicación con opioides provoca depresión respiratoria. La depresión respiratoria puede ser desde leve hasta provocar apnea. Aunque la naloxona (IN, IM o IV) es el antídoto a la intoxicación con opioides, lo primero que debe ser obvio es la necesidad de mantener la vía aérea abierta y una ventilación adecuada. No ignore la posibilidad de que el paciente esté en paro cardiaco por otra razón. Puede ver el algoritmo de paro cardiaco por intoxicación con opioides aquí. Situaciones especiales: Paro cardiaco en mujeres embarazadas Vea el algoritmo de cuidado a mujeres embarazadas en paro cardiaco aquí. Debido a que las pacientes embarazadas son más propensas a sufrir hipoxia, se debe priorizar la oxigenación y el manejo de la vía aérea durante la reanimación del paro cardíaco. (Clase de Recomendación: 1, Nivel de Evidencia: C-LD) Debido a la posible interferencia con la reanimación materna, no se debe llevar a cabo el monitoreo fetal durante el paro cardíaco en embarazadas. (Clase de Recomendación: 1, Nivel de Evidencia: C-EO) Recomendamos un manejo específico de la temperatura para embarazadas que permanecen en estado comatoso después de la reanimación del paro cardíaco. (Clase de Recomendación: 1, Nivel de Evidencia: C-EO) Durante el manejo específico de la temperatura de la paciente embarazada, se recomienda supervisar continuamente al feto para detectar bradicardia como una posible complicación, y se debe realizar una consulta obstétrica y neonatal. (Clase de Recomendación: 1, Nivel de Evidencia: C-EO) Cuidado médico pos-paro Vea el algoritmo de cuidado posparo aquí. El algoritmo de las guías 2015 presentaba cuatro aspectos importantes. Los cuatro elementos importantes que el paciente posparo necesita son: Mantener una oxigenación adecuada Mantener una perfusión adecuada Corregir la causa (en adultos, sospechar el SCA) Proteger el cerebro Esta lista no es exhaustiva. El curso PALS provee una lista de cotejo mucho más detallada que incluye otros aspectos a considerar. Cuidado médico pos-paro: Mantenerlo vivo El algoritmo muestra dos pasos iniciales muy importantes: mantener una ventilación y circulación adecuada. Estos dos pasos se enseñan secuencialmente pero se hacen simultáneamente. La frecuencia respiratoria debe ser lo suficiente para mantener un PaCO2 entre 35 mmHg y 45 mmHg y una oxigenación entre 92% a 98%. Anteriormente la recomendación era simplemente mantener la saturación sobre 94%. El monitorear los niveles de CO2 puede ser importante en pacientes que tengan presión intracranial elevada ya que la circulación cerebral responde a los niveles de CO2. Si el PaCO2 disminuye de 35 mmHg, ocurre vasoconstricción en la circulación cerebral. Vice versa, cuando los niveles de CO2 aumentan sobre 45 mmHg, ocurre vasodilatación en la circulación cerebral. Bajo condiciones normales, el cuerpo humano puede autorregular el flujo sanguíneo para mantener una presión intracranial aceptable. En pacientes cuyo problema incluya un problema de aumento en la presión intracranial, previo al cuidado definitivo, es importante proteger al cerebro de una lesión secundaria si los niveles de CO2 cambian y la circulación cerebral se disminuye o aumenta inapropiadamente. Colocación temprana del tubo endotraqueal Primum non nocere. Primero, no cause más daño. La intubación endotraqueal y ventilación mecánica en pacientes posparo es común. A no ser que el paciente recupere consciencia inmediatamente ocurra el retorno de circulación espontánea, el paciente posparo está inconsciente y por lo tanto no puede confiársele proteger su propia vía aérea. También pudiera ser que recupere pulso, pero no recupere respiración inmediatamente y requiera ser ventilado. La causa del paro cardiaco pudiera incluir alguna etiología que trastoque el equilibrio ácido-base y la ventilación del CO2 excesivo pudiera ser esencial para corregir la acidosis. Sin embargo, en otros episodios del ECCpodcast hemos discutido la importancia de cómo prevenir el paro cardiaco peri-intubación. El paciente en paro cardiaco puede estar hipoxémico, hipotenso y acidótico. Cada uno de estos tres factores pueden provocar hipotensión y/o un colapso circulatorio inmediatamente antes, durante o después de la intubación endotraqueal. Entonces, primero resucite y oxigene el paciente... luego lo intuba. Eso nos lleva al siguiente punto, corregir la hipotensión, lo cual pudiera ser necesario realizar concurrentemente mientras se prepara al paciente y al personal para la intubación. La presión arterial sistólica mínima debe ser 90 mmHg (presión arterial media de 65 mmHg). Es importante considerar mejorar la precarga para subir la presión, pero debemos dejar de pensar solamente en los fluidos como herramienta para mejorar la presión. Es necesario tener una cantidad adecuada de fluidos. Si la causa de la hipotensión es hipovolemia, el administrar fluidos puede ser útil. Sin embargo, si la causa no es hipovolemia, darle más fluido no debe ser la única estrategia. En este caso, el uso temprano de vasopresores puede ser útil. En este otro episodio del ECCpodcast se discute el uso de vasopresores en bolo para el manejo de hipotensión temporal, por ejemplo, secundaria al manejo de la vía aérea en un paciente susceptible. Cuidado médico pos-paro: Neuropronóstico Se teoriza que una de las posibles causas de malos resultados por paro cardiaco pudiera ser el retirar el cuidado médico demasiado temprano. A veces puede ser que algunos cerebros simplemente necesiten más tiempo. La actualización 2020 de ACLS provee una referencia más tangible de qué herramientas pueden servir para evaluar el paciente que tuvo un insulto cerebral anóxico y está comatoso posterior al retorno de circulación espontánea. Como parte de la evaluación en la unidad de cuidados intensivos. es importante medir inmediatamente el nivel de glucosa, electrolitos, y considerar los medicamentos de sedación, anestesia o bloqueo neuromuscular que pueden alterar el nivel de consciencia posterior al retorno de circulación espontánea, pero esto ya es valorado en el cuidado posparo en toda unidad de cuidados intensivos. La actualización 2020 de ACLS hacen referencia al uso de pruebas multimodales solamente luego de las primeras 72 horas posterior al retorno de circulación espontánea. Rehabilitación y recuperación Recomendamos que los sobrevivientes de un paro cardíaco tengan una evaluación y un tratamiento de rehabilitación multimodales para trastornos físicos, neurológicos, cardiopulmonares y cognitivos antes del alta hospitalaria. (Clase de Recomendación: I, Nivel de Evidencia: C-LD) Recomendamos que los sobrevivientes de un paro cardíaco y sus cuidadores reciban una planificación del alta integral y multidisciplinaria que incluya recomendaciones de tratamiento médico y de rehabilitación y las expectativas de regreso a la actividad / trabajo. (Clase de Recomendación: I, Nivel de Evidencia: C-LD) Recomendamos realizar una evaluación estructurada de la ansiedad, la depresión, el estrés postraumático y la fatiga de los sobrevivientes de paro cardíaco y sus cuidadores. (Clase de Recomendación: I, Nivel de Evidencia: B-NR) Los pacientes necesitan apoyo para entender la causa por la cual tuvieron el evento, y cómo prevenir una nueva ocurrencia. Esto puede inclusive incluir apoyo para el regreso a actividad niveles normales pre-evento. Debido a la importancia que tiene la rehabilitación y recuperación, la AHA ha añadido un eslabón más a la icónica "cadena de sobrevivencia" que ilustra los elementos en el sistema de cuidado para el éxito del paciente con paro cardiaco. Debriefing para los respondedores Pueden ser beneficiosos los debriefings y las derivaciones para dar apoyo emocional a reanimadores legos, proveedores de SEM y trabajadores de la salud hospitalarios después de un paro cardíaco. (Clase de Recomendación: IIb, Nivel de Evidencia: C-LD) Conclusión de la actualización 2020 de ACLS La siguiente infográfica ayuda a resumir algunos de los aspectos claves de la actualización. La actualización 2020 de ACLS provee cambios importantes en el manejo del paciente. El adiestramiento completo, prácticas frecuentes y retroalimentación efectiva salva vidas. Referencias Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, Kudenchuk PJ, Kurz MC, Lavonas EJ, Morley PT, O’Neil BJ, Peberdy MA, Rittenberger JC, Rodriguez AJ, Sawyer KN, Berg KM; on behalf of the Adult Basic and Advanced Life Support Writing Group. Part 3: adult basic and advanced life support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(suppl 2):S366–S468. doi: 10.1161/CIR.0000000000000916 Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, et al: on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation. 2020;141:e139–e596. doi: 10.1161/CIR.0000000000000757

heart sin tambi cada esto vice iv puede co2 aunque cuidado eso sem pueden bajo primero algunas aha entonces existen nivel epidemiology mantener american heart association debido clase pals circulation paro situaciones actualizaci debriefings recomendaci recomendamos caba jg anteriormente zoll rehabilitaci acls cir corregir vea mmhg colocaci iib primum cardiopulmonary resuscitation paco2 american heart association council svca

Episode 34- Adult ACLS: Updated recommendations and clinical pearls

Play Episode Play 24 sec Highlight Listen Later Dec 3, 2020 9:33 Transcription Available

In part 1 of the cardiac arrest series, we review some key recommendations and clinical pearls from the 2020 adult BLS and ACLS guidelines. References: Panchal AR, Bartos JA, Cabanas JG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020; 142: S366-S468Edelson DP, Sasson C, Chan PS, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19. Circulation. 2020; 141 (25): e933- 943Velissaris D, Karamouzos V, Pierrakos C, et al. Use of sodium bicarbonate in cardiac arrest: current guidelines and literature review. J Clin Med Res. 2016; 8 (4): 277-283Murchison C. Sodium bicarbonate therapy does not work in cardiac arrest. Updated November 5, 2018. Accessed December 1, 2020. http://www.emdocs.net/sodium-bicarbonate-therapy-does-not-work-in-cardiac-arrest/

children adult basic adults recommendations guidelines cardiology sodium cardiac arrest bls acls clinical pearls cardiopulmonary resuscitation advanced life support interim guidance

Episode 33- Shock through the heart: Is two better than one?

ER-Rx: An ER + ICU Podcast

Play Episode Play 31 sec Highlight Listen Later Nov 26, 2020 6:25 Transcription Available

What is dual/double defibrillation? How does it work? Does it improve patient outcomes? Find out this week! References:Miraglia D, Miguel LA, Alonso W. Double defibrillation for refractory in- and out-of-hospital cardiac arrest: a systematic review and meta-analysis. J Emerg Med. 2020; 59 (4): 531-541Panchal AR, Bartos JA, Cabanas JG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020; 142: S366-S468

shock cardiology cardiac arrest better than one cardiopulmonary resuscitation advanced life support

Cardiopulmonary Resuscitation-Associated Lung Edema (CRALE)

Out of the Blue: An AJRCCM Podcast

Play Episode Listen Later Nov 25, 2020 22:37

Dr. Michael Lanspa sits down with Dr. Aurora Magliocca to discuss their article "Cardiopulmonary Resuscitation-Associated Lung Edema (CRALE) - A Translational Study".

lung edema cardiopulmonary resuscitation

I Don’t Like Those Odds: Greater Chance of a Knee Replacement After an ACL Reconstruction

Sports Medicine Research Podcast

Play Episode Listen Later Oct 31, 2020

Welcome to Sports Med Res’ this week in review podcast where we highlight the news in sports medicine research from the week ending on October 30, 2020. This week’s podcast focused on total knee replacements after an ACL reconstruction. * 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science as well as First Aid Science with Treatment Recommendations * People with an ACL Reconstruction are Five Times More Likely to Need a Knee Replacement Later On * Return to Play for Athletes After Coronavirus Disease 2019 Infection—Making High-Stakes Recommendations as Data Evolve RSS Feed, Apple Podcasts, or Google Play Evidence-Based CEU Courses from Sports Med Res and Human Kinetics (3-10 EBP CEUs/course) The post I Don’t Like Those Odds: Greater Chance of a Knee Replacement After an ACL Reconstruction appeared first on Sports Medicine Research.

sports training research medicine odds athletic acl reconstruction week in review knee replacement human kinetics cardiopulmonary resuscitation

On the Streets #9: Advanced Applications of Capnography

cpr cardiopulmonary resuscitation

Play Episode Listen Later Oct 14, 2020 71:44

Capnography is the measurement of the partial pressure of exhaled CO2 and is an indirect measurement of your cellular respiration. It is displayed visually as a block-like waveform during the exhalation phase of respiration and monitors ventilation in real-time. Capnography is the gold standard for monitoring sedated and intubated patients in the hospital and the field and can be used in many other situations to discern more information about your patient. Our host Jordan Ourada is joined by Dr. Eric Hill who is a board certified Emergency Physician, EMS Director for 9 agencies around Colorado, a retired military physician with the Army, former paramedic firefighter and combat veteran to discuss advanced applications of capnography to monitor a range of different patients in the pre-hospital setting. Tune in to learn how to apply capnography to monitor your patients and detect serious conditions like sepsis and DKA and initiate time-sensitive interventions that reduce mortality in patients. Quick Educational Pearls: Normal range is between 35 - 45 mmHg Low capnography indicates they are blowing off CO2 High capnography indicates they are retaining CO2 Normal waveform morphology is box-like with gradual expiratory plateau after expiratory upstroke Monitor your patient’s status and interpret the capnography numbers, rate and waveforms accordingly Time Stamps 1:32 Capnography definition 6:36 Normal range 7:40 Reading capnography waveforms 12:36 Capnography monitoring in sedated/intubated patients 13:36 Intubation monitoring 18:03 VQ match vs mismatch 21:42 Asthmatic patients 24:30 Capnography cannula 26:24 Cardiac arrest uses 31:28 Acid-base physiology 37:28 Diabetic patients 40:15 COPD patients 41:42 CHF patients 45:18 Head injury patients 52:07 Sepsis detection and subsequent prehospital management 1:08:15 Closing thoughts on using capnography in the field REFERENCES Brandt, P. “Current Capnography Field Uses.” JEMS. 2010, Nov. DiCorpo,P.,etal.“CapnographyProvidesBiggerPhysiological Picture to Maximize Patient Care.” JEMS. 2015, Nov. Eckstein,M.,etal.“End-tidalCO2asapredictorofsurvivalinout-of- hospital cardiac arrest.” Prehosp Disaster Med. 2011 Jun;26(3):148-50 Kodali,B.“Physicsofcapnography.”2014 Poste,J.,etal.“Airmedicaltransportofseverelyhead-injured patients undergoing paramedic rapid sequence intubation.” Air Med J. 2004 Jul-Aug;23(4):36-40 Davis, D., et al. “Predictors of Intubation Success and Therapeutic Value of Paramedic Airway Management in a Large, Urban EMS System.” Prehospital Emergency Care. 2006: Vol. 10, Iss. 3. Grmec, S. “Comparison of three different methods to confirm endotracheal tube placement in emergency intubation.” Intensive Care Medicine. 2002; 28: 701-4. Silvestri, et al. “The Effectiveness of out of hospital use of continuous end-tidal carbon dioxide monitoring on the rate of unrecognized misplaced intubation within a regional emergency medical services system.” Ann Emerg Med. 2005; 45: 497- 503. Hartman, et al. “Systematic Review and Meta- Analysis of End-Tidal Carbon Dioxide Values Associated With Return of Spontaneous Circulation During Cardiopulmonary Resuscitation.” Journal Intensive Care Med. 2015, Oct;30 (7) 426-35. Levine, et al. “End-tidal carbon dioxide and outcome of out-of-hospital cardiac arrest.” N England J Med. 1997, Jul 31; 337(5): 301-6. AHA 2015 Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Hunter CL, et al. “A prehospital screening tool utilizing end-tidal carbon dioxide predicts sepsis and severe sepsis.” American Journal of Emergency Medicine. 2016 May; 34(5):813-819. Bou Chebi, R, et al. “Diagnostic value of end tidal capnography in patients with hyperglycemia in the emergency department.” BMC Emerg Med. 2016 Jan 29; 16:7 Soleimanpour, H, et al. “Predictive value of capnography for suspected diabetic ketoacidosis in the emergency department.” West J Emerg Med. 2013;14(6): 590-4. The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at www.emergencymedicalminute.com/cme-courses/ and create an account.

OrderCast 1-12 (Cardiopulmonary Resuscitation - CPR)

OrderCast

Play Episode Listen Later Jul 20, 2020 11:09

یکی از مهارت‌های حیاتی که هر پزشک باید اون رو به طور دقیق بلد باشه، CPR یا همون احیای قلبی-ریویه. در اپیزود دوازدهم، همراه جناب آقای دکتر فرهمندراد، متخصص طب اورژانس، هستیم تا این مهارت رو به شکل کاربردی‌تری یاد بگیریم.

What do strokes and sudden hearing loss have in common?

Sound Advice: A Hearing Friendly Business Podcast

Play Episode Listen Later May 12, 2020 21:49

Teresa Barnes, RN is the business owner of HearCommunication an educational company that helps businesses CONNECT with the hearing impaired to increase sales, customer service, effective hearing friendly communication, ADA communication compliance, inclusion, and better well-being for your employees. Teresa has had hearing loss since birth and she is a former ED Manager. She is author of Sound Advice: Tune Into Listening that's available on Amazon. She is the host of Sound Advice: A Hearing Friendly Business Podcast and is available for keynote and breakout sessions. Episode 14 Notes: F.A.S.T for stroke recognition: https://en.wikipedia.org/wiki/FAST_(stroke)F is for face drooping, uneven smile, numbnessA is for arm weakness. Is the person able to raise both hands over their head?S is for slurred speech or sudden hard to understand difficult speech.T is for time to call 911. Record time, make sure potential patient is physically safe from further harm, and remain as calm as you can.Sudden hearing loss HUM Checker: "Hum aloud to yourself. With normal hearing the sound equally in both ears. If you do this when you have a new loss of hearing in one ear, the humming will shift to one side or the other. For example, if your right ear is affected and the hum is louder in that ear, then the hearing loss, is more likely a conductive loss, and probably due to blockage from a cold or build-up ear wax. (You can simulate this effect by humming while you cover your right ear.) However, if the humming is louder in the left ear, it suggest the right ear hearing loss is due to recent nerve damage, and that requires prompt medical attention.https://www.health.harvard.edu/?utm_source=delivra&utm_medium=email&utm_campaign=GB20200506-Hearing&utm_id=2136735&dlv-emuid=b5426784-12b5-48cb-a02c-5c7520fd0c20&dlv-mlid=2136735 Check out more on and CONNECT to Make the Changes Needed for 21st Century Hearing Awareness Communities with the Hearing Friendly Signage. www.hearcommunication.comhttps://www.facebook.com/teresabarnesrnhttps://www.facebook.com/hearcommunication/https://www.linkedin.com/in/hearteresabarnesrn/https://www.instagram.com/teresabarnesrn/https://twitter.com/TeresaBarnesRN

Airway Management with Scott Hardy (part 2)

The PREMED Podcast

Play Episode Listen Later May 1, 2020 48:49

We're back! Thank you all so much for listening, and for your kind feedback. Its really encouraging to see so much engagement and I'm looking forward to sharing some more meaningful conversations with you in the future. In part two of my discussion with Critical Care Paramedic Scott Hardy, we spoke about the management of foreign body airway obstruction, airway management in trauma patients, out-of-hospital cardiac arrest, and paramedic intubation. Scott is such a knowledgeable practitioner and it was great to hear his thoughts on the nuances of these topics. I hope you find this episode useful. Please do subscribe, leave us a quick review, and feel free to get in touch with any comments, opinions, or feedback. Peace! -- Silas References Complicated and Complex Systems: What Would Successful Reform of Medicare Look Like? (Glouberman and Zimmerman, 2002) Iatrogenic intracranial placement of nasopharyngeal airway after trauma (Swanson, Nickele, and Kuo, 2015) Busting Top Trauma Myths (Collopy et al, 2015) Rapid Sequence Intubation (Lafferty, 2020) The AIRWAYS-2 Trial (Benger et al, 2018) The success of pre-hospital tracheal intubation by different pre-hospital providers: a systematic literature review and meta-analysis (Crewdson et al, 2017) Prehospital endotracheal intubation: elemental or detrimental? (Pepe, Roppolo, and Fowler, 2015) Advanced airway management during adult cardiac arrest: A systematic review (Granfeldt et al, 2019) International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (Soar et al, 2019) A Critical Reassessment of Ambulance Service Airway Management in Pre-Hospital Care (JRCALC Airway Working Group, 2008) Airway management policy and procedure (London Ambulance Service, 2018) Paramedic Intubation Consensus Statement (College of Paramedics, 2018) The PART Trial (Wang et al, 2018) Sound recordist Jack Neuman Hosted on Acast. See acast.com/privacy for more information.

peace sound acast pepe fowler zimmerman swanson paramedics airway airways kuo prehospital airway management iatrogenic cardiopulmonary resuscitation london ambulance service crewdson scott hardy roppolo

Podcast 537: Thoughts on Cardiac Arrest

Pin-Up-Docs-titriert – pin-up-docs – don't panic

Play Episode Listen Later Feb 3, 2020 5:15

Contributor: Don Stader, MD Educational Pearls: High-quality compressions are an essential, and probably one of the most important, part of cardiac arrest Actual evidence for drugs in cardiac arrest included in ACLS are limited, including epinephrine, bicarbonate, amiodarone, etc. Early defibrillation for ventricular tachycardia (VT) or ventricular fibrillation (VF) has a plethora of supporting evidence Double-sequential defibrillation (nearly simultaneous defibrillation using 2 machines) may be considered for refractory dysrhythmias like VF tPA during a cardiac arrest can be considered in the setting of massive PE (although the evidence supporting this practice is poor) Ending a cardiac arrest resuscitation is a difficult decision and use of ultrasound may be helpful to assess for meaningful cardiac function/activity References Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK, Neumar RW, O'Neil BJ, Paxton JH, Silvers SM, White RD, Yannopoulos D, Donnino MW . Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015 Nov;132(18 Suppl 2):S444-64. Wang Y, Wang M, Ni Y, Liang B, Liang Z. Can Systemic Thrombolysis Improve Prognosis of Cardiac Arrest Patients During Cardiopulmonary Resuscitation? A Systematic Review and Meta-Analysis.J Emerg Med. 2019;57(4):478. Epub 2019 Oct 5. Eric Cortez, William Krebs, James Davis, David P. Keseg, Ashish R. Panchal. Use of double sequential external defibrillation for refractory ventricular fibrillation during out-of-hospital cardiac arrest. Resuscitation. Volume 108. 2016. Pages 82-86, Atkinson PR, Beckett N, French J, Banerjee A, Fraser J, Lewis D. Does Point-of-care Ultrasound Use Impact Resuscitation Length, Rates of Intervention, and Clinical Outcomes During Cardiac Arrest? A Study from the Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED) Investigators. Cureus. 2019;11(4):e4456. Published 2019 Apr 13. doi:10.7759/cureus.4456 Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

"titriert" Journal Club Januar 2020

Play Episode Listen Later Jan 16, 2020 46:17

8 spannende Studien haben wir dieses Mal für Euch, hört rein ! Duff, Jonathan P., et al. „2019 American Heart Association Focused Update on Pediatric Advanced Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.“ Circulation 140.24 (2019): e904-e914. Guihard, Bertrand, et al. „Effect of Rocuronium vs Succinylcholine on Endotracheal Intubation Success […] Der Beitrag "titriert" Journal Club Januar 2020 erschien zuerst auf pin-up-docs - don't panic.

studien bertrand duff circulation der beitrag journal club cardiopulmonary resuscitation succinylcholine rocuronium

Patients Should Help Lead the Way: Chronic Low Back Pain

Sports Medicine Research Podcast

Play Episode Listen Later Dec 6, 2019

Welcome to Sports Med Res’ this week in review podcast where we highlight the news in sports medicine research from the week ending on December 06, 2019. This week we will focus on a patient-centered approach to treating chronic low back pain. * ICON 2019-International Scientific Tendinopathy Symposium Consensus: There are nine core health-related domains for tendinopathy (CORE DOMAINS): Delphi study of healthcare professionals and patients * International Society of Sports Nutrition Position Stand: nutritional considerations for single-stage ultra-marathon training and racing * Consensus Statement on Sports-Related Concussions in Youth Sports Using a Modified Delphi Approach * 2019-2020 NFL and NFL Physician Society Orthobiologics Consensus Statement * Updated Recommendations on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (5 statements) * Recommendations for Enhancing Sports Medicine Fellowship Training * Physiotherapist-led treatment for young to middle-aged active adults with hip-related pain: consensus recommendations from the International Hip-related Pain Research Network, Zurich 2018 * Multidisciplinary integrated approach for older adults with symptomatic osteoarthritis: SIMFER and SI-GUIDA Joint Position Statement * Policy Statement: Unique Needs of the Adolescent * Patient-led goal setting is superior to standardized exercise programs when treating chronic low back pain * Positive Effect of Platelet-Rich Plasma on Pain in Plantar Fasciitis: A Double-Blind Multicenter Randomized Controlled Trial The post Patients Should Help Lead the Way: Chronic Low Back Pain appeared first on Sports Medicine Research.

nfl sports training pain research medicine patients recommendations athletic icon zurich international society week in review multidisciplinary positive effects platelet rich plasma chronic low back pain consensus statement cardiopulmonary resuscitation

SCCM Pod-402 Early Palliative Care Consultations in the ICU

iCritical Care: Critical Care Medicine

Play Episode Listen Later Dec 4, 2019 17:46

Kyle B. Enfield, MD, and Marin H. Kollef, MD, discuss the findings and design of the cluster randomized crossover trial on early palliative care consultation in the medical intensive care unit (ICU) published in the December 2019 issue of Critical Care Medicine.

medicine md icu palliative care critical care consultations enfield quality improvement critical care medicine sccm cardiopulmonary resuscitation kyle b enfield

SCCM Pod-402 Early Palliative Care Consultations in the ICU

Play Episode Listen Later Dec 4, 2019 17:46

Kyle B. Enfield, MD, and Marin H. Kollef, MD, discuss the findings and design of the cluster randomized crossover trial on early palliative care consultation in the medical intensive care unit (ICU) published in the December 2019 issue of Critical Care Medicine.

medicine md icu palliative care critical care consultations enfield quality improvement critical care medicine sccm cardiopulmonary resuscitation kyle b enfield

Actualización 2019 de las Guías de ACLS - Manejo de Vía Aérea

Play Episode Listen Later Nov 16, 2019 15:46

La actualización 2019 de las guías de ACLS de la American Heart Association fue publicada en la revista Circulation el 14 de noviembre del 2019. La actualización 2019 incluye varios otros documentos en adición al ACLS, tales como sistemas de cuidado, RCP asistida por despachadores, primeros auxilios, RCP pediátrica y soporte vital avanzado pediátrico. Todos estos documentos están disponibles en https://eccguidelines.heart.org/circulation/cpr-ecc-guidelines/ En este artículo vamos a discutir únicamente lo concerniente a la actualización 2019 de las guías de ACLS. Puede descargar el documento original aquí, libre de costo. El curso Soporte Vital Cardiovascular Avanzado, o Advanced Cardiovascular Life Support (ACLS) enseña a los profesionales de la salud la resucitación cardiopulmonar avanzada en adultos. Proceso de Actualización 2019 de las Guías de ACLS Para beneficio de las personas que no están familiarizadas con la metodología de actualización de las Guías de la American Heart Association para Atencion Cardiovascular de Emergencia, permítanos primero repasar el proceso de actualización en pie desde el 2015. Según hemos reportado anteriormente, el proceso de actualización de las guías ya no será una publicación cada 5 años, sino una publicación continua de la evidencia Cuando existe nueva evidencia significativa, ILCOR realiza la revisión sistemática de la literatura. Luego del análisis de la literatura, el panel decide si existe consenso en publicar una nueva recomendación. Usted puede ver los Consensos de Ciencia y Recomendaciones de Tratamiento (CoSTR, por sus siglas en inglés) siguiendo este enlace. Para ver los CoSTR que están abiertos a opinión pública antes de ser publicados, puede ver este otro enlace. Una vez ILCOR realiza la publicación de sus recomendaciones, la AHA realiza la actualización de sus guías. Aunque la publicación de las recomendaciones de ILCOR se hacen de forma simultánea con la AHA, las recomendaciones pasan por un periodo de análisis público. Por lo tanto, es posible ver el proceso actual que se está llevando a cabo y tener una idea de las decisiones que puedan estarse llevando a cabo en el futuro. Portal central de Guías American Heart Association La forma más fácil de ver la información más reciente y presentada de forma uniforme es visitar el portal de la American Heart Association de las Guías de Atención Cardiovascular de Emergencia, https://eccguidelines.heart.org. El hecho de que las guías son actualizadas por segmentos quiere decir que la versión completa contiene referencias a recomendaciones anteriores que aún siguen vigentes. Es decir, el documento completo hace referencia a recomendaciones vigentes con fecha del 2010, 2015, 2017, 2o18, y ahora 2019. 2019: Vía aérea, vasopresores y ECMO La Actualización 2019 de las Guías de ACLS se centra en los temas que ya han sido publicados anteriormente, y que hemos discutido en otros episodios del ECCpodcast. Las recomendaciones descritas en la Actualización 2019 de las Guías de ACLS conciernen exclusivamente al manej0 del paciente que sufre paro cardiaco y no necesariamente aplican a otras circunstancias. ¿Por qué se repite si ya se discutió? Las guías representan el consenso sobre la ciencia actual y las recomendaciones expertas sobre el tratamiento a seguir. Como hemos discutido anteriormente, algunos de los estudios publicados en el pasado año han provocado debate debido a algunas controversias asociadas. Por ejemplo, el aspecto bioético de los pobres resultados neurológicos al administrar epinefrina, o las consecuencias de optar por una vía aérea avanzada supraglótica o la intubación endotraqueal. La Actualización 2019 de las Guías de ACLS representa la opinión experta que sirve como referencia y guía ya que surge a base del consenso. Manejo de la vía aérea La estrategia de usar un dispositivo bolsa mascarilla o una vía aérea avanzada puede ser considerada durante la RCP de adultos en paro cardiaco en cualquier lugar. (Clase 2b; Nivel de evidencia: B-R) El objetivo del manejo de la vía aérea del paciente en paro cardiaco es la ventilación efectiva y no causar daño por ventilación excesiva. El objetivo es uno fisiológico, no el de realizar un procedimiento particular. La razón para necesitar una vía aérea avanzada no debe ser la incompetencia de realizar una intervención fundamental como ventilar al paciente con un dispositivo de ventilación bolsa-mascarilla (BVM). Habiendo dicho esto, algunos pacientes van a necesitar una vía aérea avanzada porque el proveedor n0 ha sido efectivo en la ventilación con un dispositivo bolsa-mascarilla y los esfuerzos de ventilación no han funcionado. Si se usa una vía aérea avanzada, una vía aérea supraglótica puede ser usada en adultos con paro cardiaco fuera del hospital en lugares con baja tasa de éxito en intubación endotraqueal u oportunidades mínimas de adiestramiento en cómo col0carlos. (Clase 2a; Nivel de evidencia B-R) Si se usa una vía aérea avanzada, tanto una vía aérea supraglótica como la intubación endotraqueal pueden ser usadas en adultos con paro cardiaco fuera del hospital en lugares con alta tasa de éxito en intubación endotraqueal u oportunidades óptimas de adiestramiento en la colocación de estos dispositivos. (Clase 2a; Nivel de evidencia B-R) Si se usa una vía aérea avanzada en el escenario hospitalario por proveedores expertos entrenados en estos procedimientos, tanto un dispositivo supraglótico como el tubo endotraqueal puede ser usado. (Clase 2b; Nivel de evidencia B-R). Los dispositivos supraglóticos son efectivos y fáciles de usar. El tubo endotraqueal es efectivo pero es difícil de colocar. A la hora de decidir cuál estrategia usar: tubo supraglótico o tubo endotraqueal, es importante recordar que ambas van a ser efectivas, y que ambas pueden fracasar. Es decir, si usted decide usar un dispositivo supraglótico, sepa que algunos pacientes van a requerir una eventual intubación. Vice versa, si usted decide usar un tubo endotraqueal, sepa que algunos pacientes van a requerir que usted deje de intentar seguir intubando al paciente y simplemente inserte un tubo supraglótico. Esto implica que el proveedor que quiera realizar una intubación endotraqueal debe tener un plan de acción que contemple estas dos variantes. Tener, ensayar e un plan de acción para cualquiera de estos dos escenarios donde se intercambia el equipo a usar es uno de los signos de un proveedor bien adiestrado. Experiencia frecuente o readiestramiento frecuente es recomendado para proveedores que realizan la intubación endotraqueal. (Clase 1; Nivel de evidencia B-NR) La intubación endotraqueal tiene muchos pasos críticos que deben ser ensayados individualmente y de forma integrada. Por ejemplo, es importante practicar la laringoscopía como destreza individual inicialmente, pero en la misma sesión de práctica el proveedor debe ser capaz de insertar el tubo con la mínima interrupción posible en las compresiones. Si el operador va a tener que realizar el procedimiento en un escenario donde hay múltiples partes en movimiento, la sesión de adiestramiento tiene que evolucionar hasta el punto en que todos esos factores estén siendo recreados a la mayor fidelidad posible. No es suficiente decir "imagínate que están dando las compresiones de alta calidad". En este episodio del ECCpodcast discutimos el tema de los factores humanos y la simulación de alta fidelidad. El adiestramiento es importante para ensayar la toma de decisiones. Por ejemplo: optar por una vía supraglótica versus la intubación endotraqueal, y optar por abandonar una estrategia e intercambiarla por otra cuando sea necesario. Los servicios de emergencias médicas que realizan la intubación endotraqueal deben proveer un programa de mejoría continua de calidad para minimizar las complicaciones y medir las tasas generales de éxito en la colocación de los dispositivos supraglóticos y los tubos endotraqueales. (Clase 1; Nivel de evidencia C-EO). Si usted es el director médico de un sistema de emergencias médicas, usted debe poder obtener razonablemente la siguiente información del sistema que usted tiene la obligación contractual de supervisar: ¿Cuántas inserciones de un dispositivo avanzado (supraglótico versus tubo endotraqueal)? ¿Cuál fue el número de intentos? Nombres de quién realizó cada intento (para tabulación) Número de veces que cada proveedor ha intentado y porciento de éxito ¿Cuál fue el nivel de dificultad de cada intento? Resultado del paciente luego de cada intento y luego de la disposición final Causas más comunes de intentos fallidos Número de eventos adversos asociados a la intubación, incluyendo hipotensión o paro cardiaco peri-intubación Número de pacientes que requirieron una vía aérea quirúrgica Es posible que, al implementar un monitoreo de los indicadores de calidad en el manejo de la vía aérea, se identifiquen oportunidades adicionales de mejoras. Los adiestramientos subsiguientes deben incorporar esta retroalimentación para atender las necesidades individuales del proveedor y del sistema en cuestión. Cada sistema tiene particularidades que lo hacen diferente a otros, aún en su misma categoría. Esto, dicho de otra manera, también sugiere que tener un mecanismo efectivo de monitoreo de los parámetros de calidad puede reflejar que el plan de trabajo para adiestramiento y readiestramiento es, o no es, efectivo. Para más información, puede oir los siguientes tres episodios del ECCpodcast: Cómo manejar la vía aérea durante el paro cardiaco fuera del hospital Uso de vasopresores en paro cardiaco Recomendamos que la epinefrina sea administrada a pacientes en paro cardiaco. (Clase 1; Nivel B-R) A base del protocolo usado en los estudios de investigación, es razonable administrar 1 mg cada 3-5 minutos. (Clase 2a; Nivel de evidencia C-LD). El estudio PARAMEDIC 2, discutido en este episodio del ECCpodcast, tuvo resultados sorprendentemente malos. El porciento de pacientes que obtuvo retorno de circulación espontánea y un resultado neurológicamente favorable fue muy bajo. El porcentaje de pacientes que fue egresado del hospital con un mal resultado neurológico fue considerablemente más alto. Sin embargo, la razón por la cual sigue siendo recomendada es porque la epinefrina sí provoca un aumento a corto tiempo en el porciento de pacientes que obtiene retorno de circulación espontánea. Una de las críticas del estudio PARAMEDIC 2 fue el largo tiempo transcurrido antes de la primera administración del medicamento (o placebo). Se desconoce cuál sería el efecto si el estudio se replicara en un entorno donde el tiempo a la administración del medicamento sea mucho menor, por ejemplo: dentro del hospital. Otro elemento a considerar que tiene un impacto en el resultado neurológico a largo plazo es la calidad del cuidado posparo. Aunque el estudio PARAMEDIC 2 fue pragmático y evaluó el cuidado ofrecido actualmente incluyendo tanto ls lugares que tienen un buen cuidado como un menor cuidado posparo, se desconoce el efecto de la epinefrina si se controlan estas variables. Debido al potencial de un mejor efecto si el medicamento se administra más rápido, y del efecto combinado de la rápida administración y un cuidado posparo dirigido a proteger el cerebro mientras se tratan las causas, la epinefrina sigue en el algoritmo de paro cardiaco. Epinefrina versus vasopresina Aunque en esta sección no hay cambios significativos, la Actualización 2019 de las Guías de ACLS provee claridad en función de los nuevos estudios publicados posterior a la última revisión del tema. Vasopresina puede ser considerada en el paro cardiaco pero no ofrece ventaja como un substituto de la epinefrina en el paro cardiaco. (Clase 2b; Nivel de evidencia C-LD) Vasopresina en combinación con epinefrina puede ser considerada durante el paro cardiaco pero no ofrece ventaja como substituto de la epinefrina solamente. (Clase 2b; Nivel de evidencia C-LD) No es un error usar vasopresina. Simplemente no es superior a la epinefrina en el contexto del manejo del paro cardiaco en adultos. Cuándo administrar la epinefrina El administrar la epinefrina no debe retrasar el manejo de la causa del paro cardiaco. Con relación al tiempo, para el paro cardiaco con un ritmo no-desfibrilable, es razonable administrar la epinefrina tan pronto sea posible. (Clase 2a; Nivel de evidencia C-LD) En dos episodios del ECCpodcast discutimos anteriormente las diferentes causas del paro cardiaco con un ritmo no-desfibrilable. En este discutimos la identificación del pseudo-PEA y cómo entender lo que está ocurriendo nos permite tomar mejores decisiones sobre el manejo. En este otro discutimos también el manejo del paro cardiaco por trauma. Si se desconoce la causa del paro con ritmo no-desfibrilable, quizás la epinefrina pueda ser la primera intervención. Pero si se conoce la causa del paro cardiaco, la(s) intervención(es) dirigida(s) a directamente corregir la causa debería(n) ocurrir antes que administrar epinefrina (adrenalina). Lo mismo ocurre en el paro cardiaco con un ritmo desfibrilable. La intervención para corregir el paro cardiaco es la desfibrilación, no la epinefrina. Con relación al tiempo, para el paro cardiaco con ritmo desfibrilable, puede ser razonable administrar epinefrina luego de que los primeros intentos de desfibrilación hayan fallado. (Clase 2b; Nivel de evidencia C-LD) En algunos estudios referenciados en esta Actualización 2019 de las Guías de ACLS, la administración de la epinefrina fue hecha luego de la tercera descarga. RCP Extracorpóreo Según el documento de Actualización 2019 de las Guías de ACLS, la resucitación extracorpórea consiste en la canalización de dos grandes vasos: uno venoso y uno arterial y el inicio de oxigenación y circulación venoarterial para mantener la perfusión a los órganos vitales mientras se resuelven las causas tratables que puedan requerir un personal especializado. A esto se le conoce también como ECMO (extracorporeal membrane oxygenation), o RCP-E. No hay suficiente evidencia para recomendar el uso rutinario de RCP-E para pacientes en paro cardiaco. RCP-E puede ser considerado para pacientes selectos como terapia de rescate cuando los esfuerzos de RCP convencional han fracasado en escenarios donde puede ser implementado rápidamente y apoyado por proveedores con experiencia. (Clase 2b; Nivel de evidencia C-LD) La heterogeneidad de los estudios hace que no se puedan combinar para un análisis colectivo, y la variabilidad en la medición de los resultados hace que no se puedan llegar a mayores conclusiones. Referencias Panchal AR, Berg KM, Hirsch KG, Kudenchuk PJ, Del Rios M, Cabañas JG, Link MS, Kurz MC, Chan PS, Morley PT, Hazinski MF, Donnino MW. 2019 American Heart Association focused update on advanced cardiovascular life support: use of advanced airways, vasopressors, and extracorporeal cardio- pulmonary resuscitation during cardiac arrest: an update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emer- gency Cardiovascular Care. Circulation. 2019;140:eXXX–eXXX. doi: 10.1161/ CIR.0000000000000732. https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000732

Actualización 2019 de las Guías de ACLS - Vasopresores y ECMO

The Health Technology Podcast

Play Episode Listen Later Nov 16, 2019 13:17

La actualización 2019 de las guías de ACLS de la American Heart Association fue publicada en la revista Circulation el 14 de noviembre del 2019. La actualización 2019 incluye varios otros documentos en adición al ACLS, tales como sistemas de cuidado, RCP asistida por despachadores, primeros auxilios, RCP pediátrica y soporte vital avanzado pediátrico. Todos estos documentos están disponibles en https://eccguidelines.heart.org/circulation/cpr-ecc-guidelines/ En este artículo vamos a discutir únicamente lo concerniente a la actualización 2019 de las guías de ACLS. Puede descargar el documento original aquí, libre de costo. El curso Soporte Vital Cardiovascular Avanzado, o Advanced Cardiovascular Life Support (ACLS) enseña a los profesionales de la salud la resucitación cardiopulmonar avanzada en adultos. Proceso de Actualización 2019 de las Guías de ACLS Para beneficio de las personas que no están familiarizadas con la metodología de actualización de las Guías de la American Heart Association para Atencion Cardiovascular de Emergencia, permítanos primero repasar el proceso de actualización en pie desde el 2015. Según hemos reportado anteriormente, el proceso de actualización de las guías ya no será una publicación cada 5 años, sino una publicación continua de la evidencia Cuando existe nueva evidencia significativa, ILCOR realiza la revisión sistemática de la literatura. Luego del análisis de la literatura, el panel decide si existe consenso en publicar una nueva recomendación. Usted puede ver los Consensos de Ciencia y Recomendaciones de Tratamiento (CoSTR, por sus siglas en inglés) siguiendo este enlace. Para ver los CoSTR que están abiertos a opinión pública antes de ser publicados, puede ver este otro enlace. Una vez ILCOR realiza la publicación de sus recomendaciones, la AHA realiza la actualización de sus guías. Aunque la publicación de las recomendaciones de ILCOR se hacen de forma simultánea con la AHA, las recomendaciones pasan por un periodo de análisis público. Por lo tanto, es posible ver el proceso actual que se está llevando a cabo y tener una idea de las decisiones que puedan estarse llevando a cabo en el futuro. Portal central de Guías American Heart Association La forma más fácil de ver la información más reciente y presentada de forma uniforme es visitar el portal de la American Heart Association de las Guías de Atención Cardiovascular de Emergencia, https://eccguidelines.heart.org. El hecho de que las guías son actualizadas por segmentos quiere decir que la versión completa contiene referencias a recomendaciones anteriores que aún siguen vigentes. Es decir, el documento completo hace referencia a recomendaciones vigentes con fecha del 2010, 2015, 2017, 2o18, y ahora 2019. 2019: Vía aérea, vasopresores y ECMO La Actualización 2019 de las Guías de ACLS se centra en los temas que ya han sido publicados anteriormente, y que hemos discutido en otros episodios del ECCpodcast. Las recomendaciones descritas en la Actualización 2019 de las Guías de ACLS conciernen exclusivamente al manej0 del paciente que sufre paro cardiaco y no necesariamente aplican a otras circunstancias. ¿Por qué se repite si ya se discutió? Las guías representan el consenso sobre la ciencia actual y las recomendaciones expertas sobre el tratamiento a seguir. Como hemos discutido anteriormente, algunos de los estudios publicados en el pasado año han provocado debate debido a algunas controversias asociadas. Por ejemplo, el aspecto bioético de los pobres resultados neurológicos al administrar epinefrina, o las consecuencias de optar por una vía aérea avanzada supraglótica o la intubación endotraqueal. La Actualización 2019 de las Guías de ACLS representa la opinión experta que sirve como referencia y guía ya que surge a base del consenso. Manejo de la vía aérea La estrategia de usar un dispositivo bolsa mascarilla o una vía aérea avanzada puede ser considerada durante la RCP de adultos en paro cardiaco en cualquier lugar. (Clase 2b; Nivel de evidencia: B-R) El objetivo del manejo de la vía aérea del paciente en paro cardiaco es la ventilación efectiva y no causar daño por ventilación excesiva. El objetivo es uno fisiológico, no el de realizar un procedimiento particular. La razón para necesitar una vía aérea avanzada no debe ser la incompetencia de realizar una intervención fundamental como ventilar al paciente con un dispositivo de ventilación bolsa-mascarilla (BVM). Habiendo dicho esto, algunos pacientes van a necesitar una vía aérea avanzada porque el proveedor n0 ha sido efectivo en la ventilación con un dispositivo bolsa-mascarilla y los esfuerzos de ventilación no han funcionado. Si se usa una vía aérea avanzada, una vía aérea supraglótica puede ser usada en adultos con paro cardiaco fuera del hospital en lugares con baja tasa de éxito en intubación endotraqueal u oportunidades mínimas de adiestramiento en cómo col0carlos. (Clase 2a; Nivel de evidencia B-R) Si se usa una vía aérea avanzada, tanto una vía aérea supraglótica como la intubación endotraqueal pueden ser usadas en adultos con paro cardiaco fuera del hospital en lugares con alta tasa de éxito en intubación endotraqueal u oportunidades óptimas de adiestramiento en la colocación de estos dispositivos. (Clase 2a; Nivel de evidencia B-R) Si se usa una vía aérea avanzada en el escenario hospitalario por proveedores expertos entrenados en estos procedimientos, tanto un dispositivo supraglótico como el tubo endotraqueal puede ser usado. (Clase 2b; Nivel de evidencia B-R). Los dispositivos supraglóticos son efectivos y fáciles de usar. El tubo endotraqueal es efectivo pero es difícil de colocar. A la hora de decidir cuál estrategia usar: tubo supraglótico o tubo endotraqueal, es importante recordar que ambas van a ser efectivas, y que ambas pueden fracasar. Es decir, si usted decide usar un dispositivo supraglótico, sepa que algunos pacientes van a requerir una eventual intubación. Vice versa, si usted decide usar un tubo endotraqueal, sepa que algunos pacientes van a requerir que usted deje de intentar seguir intubando al paciente y simplemente inserte un tubo supraglótico. Esto implica que el proveedor que quiera realizar una intubación endotraqueal debe tener un plan de acción que contemple estas dos variantes. Tener, ensayar e un plan de acción para cualquiera de estos dos escenarios donde se intercambia el equipo a usar es uno de los signos de un proveedor bien adiestrado. Experiencia frecuente o readiestramiento frecuente es recomendado para proveedores que realizan la intubación endotraqueal. (Clase 1; Nivel de evidencia B-NR) La intubación endotraqueal tiene muchos pasos críticos que deben ser ensayados individualmente y de forma integrada. Por ejemplo, es importante practicar la laringoscopía como destreza individual inicialmente, pero en la misma sesión de práctica el proveedor debe ser capaz de insertar el tubo con la mínima interrupción posible en las compresiones. Si el operador va a tener que realizar el procedimiento en un escenario donde hay múltiples partes en movimiento, la sesión de adiestramiento tiene que evolucionar hasta el punto en que todos esos factores estén siendo recreados a la mayor fidelidad posible. No es suficiente decir "imagínate que están dando las compresiones de alta calidad". En este episodio del ECCpodcast discutimos el tema de los factores humanos y la simulación de alta fidelidad. El adiestramiento es importante para ensayar la toma de decisiones. Por ejemplo: optar por una vía supraglótica versus la intubación endotraqueal, y optar por abandonar una estrategia e intercambiarla por otra cuando sea necesario. Los servicios de emergencias médicas que realizan la intubación endotraqueal deben proveer un programa de mejoría continua de calidad para minimizar las complicaciones y medir las tasas generales de éxito en la colocación de los dispositivos supraglóticos y los tubos endotraqueales. (Clase 1; Nivel de evidencia C-EO). Si usted es el director médico de un sistema de emergencias médicas, usted debe poder obtener razonablemente la siguiente información del sistema que usted tiene la obligación contractual de supervisar: ¿Cuántas inserciones de un dispositivo avanzado (supraglótico versus tubo endotraqueal)? ¿Cuál fue el número de intentos? Nombres de quién realizó cada intento (para tabulación) Número de veces que cada proveedor ha intentado y porciento de éxito ¿Cuál fue el nivel de dificultad de cada intento? Resultado del paciente luego de cada intento y luego de la disposición final Causas más comunes de intentos fallidos Número de eventos adversos asociados a la intubación, incluyendo hipotensión o paro cardiaco peri-intubación Número de pacientes que requirieron una vía aérea quirúrgica Es posible que, al implementar un monitoreo de los indicadores de calidad en el manejo de la vía aérea, se identifiquen oportunidades adicionales de mejoras. Los adiestramientos subsiguientes deben incorporar esta retroalimentación para atender las necesidades individuales del proveedor y del sistema en cuestión. Cada sistema tiene particularidades que lo hacen diferente a otros, aún en su misma categoría. Esto, dicho de otra manera, también sugiere que tener un mecanismo efectivo de monitoreo de los parámetros de calidad puede reflejar que el plan de trabajo para adiestramiento y readiestramiento es, o no es, efectivo. Para más información, puede oir los siguientes tres episodios del ECCpodcast: Cómo manejar la vía aérea durante el paro cardiaco fuera del hospital Uso de vasopresores en paro cardiaco Recomendamos que la epinefrina sea administrada a pacientes en paro cardiaco. (Clase 1; Nivel B-R) A base del protocolo usado en los estudios de investigación, es razonable administrar 1 mg cada 3-5 minutos. (Clase 2a; Nivel de evidencia C-LD). El estudio PARAMEDIC 2, discutido en este episodio del ECCpodcast, tuvo resultados sorprendentemente malos. El porciento de pacientes que obtuvo retorno de circulación espontánea y un resultado neurológicamente favorable fue muy bajo. El porcentaje de pacientes que fue egresado del hospital con un mal resultado neurológico fue considerablemente más alto. Sin embargo, la razón por la cual sigue siendo recomendada es porque la epinefrina sí provoca un aumento a corto tiempo en el porciento de pacientes que obtiene retorno de circulación espontánea. Una de las críticas del estudio PARAMEDIC 2 fue el largo tiempo transcurrido antes de la primera administración del medicamento (o placebo). Se desconoce cuál sería el efecto si el estudio se replicara en un entorno donde el tiempo a la administración del medicamento sea mucho menor, por ejemplo: dentro del hospital. Otro elemento a considerar que tiene un impacto en el resultado neurológico a largo plazo es la calidad del cuidado posparo. Aunque el estudio PARAMEDIC 2 fue pragmático y evaluó el cuidado ofrecido actualmente incluyendo tanto los lugares que tienen un buen cuidado como un menor cuidado posparo, se desconoce el efecto de la epinefrina si se controlan estas variables. Debido al potencial de un mejor efecto si el medicamento se administra más rápido, y del efecto combinado de la rápida administración y un cuidado posparo dirigido a proteger el cerebro mientras se tratan las causas, la epinefrina sigue en el algoritmo de paro cardiaco. Epinefrina versus vasopresina Aunque en esta sección no hay cambios significativos, la Actualización 2019 de las Guías de ACLS provee claridad en función de los nuevos estudios publicados posterior a la última revisión del tema. Vasopresina puede ser considerada en el paro cardiaco pero no ofrece ventaja como un substituto de la epinefrina en el paro cardiaco. (Clase 2b; Nivel de evidencia C-LD) Vasopresina en combinación con epinefrina puede ser considerada durante el paro cardiaco pero no ofrece ventaja como substituto de la epinefrina solamente. (Clase 2b; Nivel de evidencia C-LD) No es un error usar vasopresina. Simplemente no es superior a la epinefrina en el contexto del manejo del paro cardiaco en adultos. Cuándo administrar la epinefrina El administrar la epinefrina no debe retrasar el manejo de la causa del paro cardiaco. Con relación al tiempo, para el paro cardiaco con un ritmo no-desfibrilable, es razonable administrar la epinefrina tan pronto sea posible. (Clase 2a; Nivel de evidencia C-LD) En dos episodios del ECCpodcast discutimos anteriormente las diferentes causas del paro cardiaco con un ritmo no-desfibrilable. En este discutimos la identificación del pseudo-PEA y cómo entender lo que está ocurriendo nos permite tomar mejores decisiones sobre el manejo. En este otro discutimos también el manejo del paro cardiaco por trauma. Si se desconoce la causa del paro con ritmo no-desfibrilable, quizás la epinefrina pueda ser la primera intervención. Pero si se conoce la causa del paro cardiaco, la(s) intervención(es) dirigida(s) a directamente corregir la causa debería(n) ocurrir antes que administrar epinefrina (adrenalina). Lo mismo ocurre en el paro cardiaco con un ritmo desfibrilable. La intervención para corregir el paro cardiaco es la desfibrilación, no la epinefrina. Con relación al tiempo, para el paro cardiaco con ritmo desfibrilable, puede ser razonable administrar epinefrina luego de que los primeros intentos de desfibrilación hayan fallado. (Clase 2b; Nivel de evidencia C-LD) En algunos estudios referenciados en esta Actualización 2019 de las Guías de ACLS, la administración de la epinefrina fue hecha luego de la tercera descarga. RCP Extracorpóreo Según el documento de Actualización 2019 de las Guías de ACLS, la resucitación extracorpórea consiste en la canalización de dos grandes vasos: uno venoso y uno arterial y el inicio de oxigenación y circulación venoarterial para mantener la perfusión a los órganos vitales mientras se resuelven las causas tratables que puedan requerir un personal especializado. A esto se le conoce también como ECMO (extracorporeal membrane oxygenation), o RCP-E. No hay suficiente evidencia para recomendar el uso rutinario de RCP-E para pacientes en paro cardiaco. RCP-E puede ser considerado para pacientes selectos como terapia de rescate cuando los esfuerzos de RCP convencional han fracasado en escenarios donde puede ser implementado rápidamente y apoyado por proveedores con experiencia. (Clase 2b; Nivel de evidencia C-LD) La heterogeneidad de los estudios hace que no se puedan combinar para un análisis colectivo, y la variabilidad en la medición de los resultados hace que no se puedan llegar a mayores conclusiones. Referencias Panchal AR, Berg KM, Hirsch KG, Kudenchuk PJ, Del Rios M, Cabañas JG, Link MS, Kurz MC, Chan PS, Morley PT, Hazinski MF, Donnino MW. 2019 American Heart Association focused update on advanced cardiovascular life support: use of advanced airways, vasopressors, and extracorporeal cardio- pulmonary resuscitation during cardiac arrest: an update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emer- gency Cardiovascular Care. Circulation. 2019;140:eXXX–eXXX. doi: 10.1161/ CIR.0000000000000732. https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000732

Keith Lurie: Innovation in Cardiopulmonary Resuscitation

Play Episode Listen Later Oct 7, 2019 47:23

Keith G. Lurie, MD Dr. Keith Lurie is a practicing cardiac electrophysiologist and resuscitation scientist who, over the past 30 years, has developed novel ways to resuscitate patients experiencing sudden cardiac arrest. As one of the leading innovators in the field, he has helped to develop new devices and methods that optimize cardiopulmonary resuscitation and improve the likelihood of survival following cardiac arrest. In addition, he is a respected thought leader in developing and implementing an internationally-recognized systems-based approach to managing and treating cardiac arrest. Some of his most notable contributions include the development and assessment of various resuscitative techniques such as the impedance threshold device (ITD), active compression-decompression (ACD) CPR, use of active intra-thoracic pressure regulation to modulate cerebral and systemic circulation in states of severe hypotension and head injury, and the development of devices to elevate the head and thorax during CPR. He has mentored scores of research and clinical fellows over the past 30 years and he actively collaborates with multiple scientific colleagues worldwide. A professor of Emergency Medicine and Internal Medicine at the University of Minnesota, Dr. Lurie also directs a NIH-funded research laboratory at Hennepin County Medical Center in Minneapolis and he is a co-founder and Chief Medical Officer for Advanced Circulatory Solutions. His scientific publications have been cited over 10,000 times in the medical literature. He previously founded and then sold Advanced Circulatory Systems Incorporated to ZOLL Medical in 2015.

university innovation minnesota minneapolis cpr chief medical officers nih internal medicine emergency medicine lurie itd cardiopulmonary resuscitation hennepin county medical center

Circulation June 04, 2019 Issue

Circulation on the Run

Play Episode Listen Later Jun 3, 2019 25:35

Dr Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. We're your co-hosts. I'm Dr Carolyn Lam, Associate Editor from the National Heart Center and Duke National University of Singapore. Dr Greg Hundley: I'm Greg Hundley, Associate Editor for Circulation and Director of the Pauley Heart Center in Richmond, Virginia at VCU Health. Dr Carolyn Lam: So Greg, ever wondered if prophylactic use of ICDs would help prevent sudden cardiac death in dialysis patients? Well, guess what? We're going to be discussing it in the feature discussion of the ICD II trial coming right up. First, I hear you've got a very interesting probabilistic paper. Dr Greg Hundley: Yes. It's very sweet. This is from Renata Micha at Tusk University and it's examining the cost effectiveness of the US Food and Drug Administration added sugar labeling policy for improving diet and health. So Carolyn, in this study, investigators used a validated micro simulation US impact food policy model to estimate cardiovascular disease and type II diabetes mellitus cases averted, quality adjusted life years, policy costs, health care, informal care, and loss productivity in health related savings and cost effectiveness of two different policy scenarios. First, the implementation of the US Food and Drug Administration added to your labeling policy or just the sugar label. And second, further accounting for corresponding industry reformulation the sugar label plus reformulation. The models used nationally represented demographic and dietary intake data from the national health and nutrition examinations survey and diseased data from the centers for disease control and preventive wonder data base and policy affects in diet disease effects from meta-analysis and policy and health related costs from established sources. Probabilistic sensitivity analysis accounted for model parameter uncertainties and population heterogeneity. Dr Carolyn Lam: Sweet indeed, so tell us all about probabilistic analysis Greg. Dr Greg Hundley: Okay Carolyn, so between 2018 and then forecasting out into the future, so this is probabilistic, in the year 2037. The sugar label would prevent 354,400 cardiovascular disease cases, and 599,300 diabetes mellitus cases, gain 727,000 quality adjusted life years, and save 31 Billion dollars in net health care costs. Or 61.9 Billion dollars in societal costs incorporating reduce loss productivity and informal care costs and similar findings were accomplished for the sugar label plus reformulation scenario, both scenarios were estimated with greater than 80% probability to be cost saving by the year 2023. Thus, the results of this simulation exercises indicated that implementing the FDAs added sugar labeling policy could generate substantial health gains and cost savings for the US population particularly if the new label stimulates industry reformulation. The authors point out that the compliance date for updating the nutrition facts label including the added sugar perversion has been continuously delayed. And the authors believe, their findings highlight the need for timely implementation of this label so as to maximize health and economic gains. An excellent editorial was written by Elizabeth Magnuson at Saint Luke's Mid America Heart Institute revealing the strengths of this work and explains some of the variants that could occur in the results based on assumptions that were used in the authors micro simulation model. Dr Carolyn Lam: That is so interesting Greg, thanks. So from policy to guidelines and this time on cardiopulmonary resuscitation or CPR, now we know that an out of hospital cardiac arrest, chest compression only CPR has emerged as an alternative to the standard CPR where we use both chest compressions and rescue breathes. Since 2010, CPR guidelines recommend chest compression only CPR for both untrained bystanders and trained bystanders who are unwilling to preform rescue breaths. The current study really aimed to describe the changes in the rate and type of CPR perform before the arrival of emergency medical services doing three consecutive guideline periods with gradual adoption of compression only CPR and this was in Sweden. Now these were authors led by Dr Hollenberg from The Center of Resuscitation Science, Karolinska Institute in Stockholm, Sweden and colleagues and basically, they study all bystander witness out of hospital cardiac arrest reported in the Swedish register for CPR from 2000 to 2017. They found that there was a six fold higher proportion of patients receiving compression only CPR and a concomitant almost double rate of CPR before emergency medical services arrival, and these changes occurred over time. Any type of CPR was associated with doubled survival rates in comparison with cases not receiving CPR, and this association was observed in all time periods studied. They also found a small but significantly higher chance of survival after CPR with compression and ventilation in comparison with compression only CPR. Dr Greg Hundley: So Carolyn, does this mean we should go back to standard CPR? Dr Carolyn Lam: Well, remember these we observational findings, albeit really amazingly done and nationwide. But the findings really support continuous endorsement of the compression only CPR as an option and that's because its associated with higher CPR rates and overall survival of the no CPR skill. The authors ended up calling for randomized controlled trials, which are really needed to answer the question of whether or not CPR with compression and ventilation is superior to compression only CPR, especially in cases where bystanders have had the previous CPR training. Now, this is discussion in a wonderful editorial by Drs. Hsu and Neumar from University of Michigan Medical School. Dr Greg Hundley: Very nice, so you're going to tell us a little bit about troponin? Dr Carolyn Lam: Well, the question is "Is Plasma Troponin I measured by the high sensitivity assay associated with incident cardiovascular disease in the community?" Well, Dr Ballantyne from Baylor College of Medicine and colleagues decided to answer this question by looking at the ARIC Study participants age 54 to 74 years without base line cardiovascular disease and what they found was that elevated high sensitivity troponin I was strongly associated with increased global cardiovascular disease incidents in this general population, and this was independent of traditional risk factors. They also found differences between black and white individuals and between men and women. Dr Greg Hundley: What kind of differences? Dr Carolyn Lam: Well high sensitivity troponin I had a stronger association with incident global cardiovascular disease events in white compares to black individuals and a stronger association with incident coronary heart disease in women than in men. The authors also did a comparative association of high sensitivity troponin I vs. troponin T, they found that the high sensitivity troponins I and T show only moderate correlation with each other but were complementary rather than redundant in risk assessment for incident cardiovascular events in individuals without known clinical cardiovascular disease at base line. The bottom line is, adding biomarkers to traditional risk prediction models presents a potentially effective approach for future risk prediction algorithms for cardiovascular disease in the general community. Dr Greg Hundley: You know, think I might read that paper looking at that complimentary risk assessment. That sounds really interesting Carolyn. Well, I'm going to go back to the world of basic science and discuss a paper from Kun Wang discussing the long non encoding RNA regulation of cardiomyocyte proliferation and cardiac repair. Carolyn, post mitotic cardiomyocytes in the adult heart exit from the cell cycle and cease to proliferate, and that's the basis for their poor regenerative capacity and defective repair in response to say a myocardial infraction. Interestingly, the nonmammalian vertebrates such as our friend the zebra fish, their heart exhibits a robust capacity for regeneration. And it can efficiently regenerate its lost cardiac tissue throughout life due to this retain cardiomyocyte proliferation capability. Dr Carolyn Lam: Interesting indeed Greg about our friend the zebra fish. So what did the authors find? Dr Greg Hundley: Okay, in this study, Wang and associates investigated whether long non-encoding RNAs had a role in the regulation of cardiomyocyte proliferation and cardiac repair. Using bioinformatics and initial analysis, the identified a long coding RNA named Cardiomyocyte Proliferation Regulator or CPR that was comparatively higher in the adult heart as opposed to hearts in the fetal stage. The silencing of the Cardiomyocyte Proliferation Regulator or CPR significantly increased the cardiomyocyte proliferation in the postnatal in adult hearts, more over CPR deletion restored the heart function after myocardial injury which was evident from increased cardiomyocyte proliferation, improvement of myocardial function and reduce scar formation. Also, neonatal cardiomyocyte proliferation in cardiac regeneration where markedly suppressed in CPR overexpressing heart cells, therefore CPR acts as a negative regulator of cardiomyocyte proliferation and regeneration in fetal hearts. So, Carolyn the conclusion of this paper is that the inactivation or silencing of CPR accelerates cardiomyocyte proliferation along with significant restoration of cardiac structure and function after myocardial injury in adult hearts. And as such, further studies may investigate whether the therapeutic inter fashion of CPR could be a useful strategy to trigger the expansion of cardiomyocyte populations and myocardial repair. Dr Carolyn Lam: Nice Greg, so we've talked about CPR as in Cardiopulmonary Resuscitation to CPR as in Cardiomyocyte Proliferation Regulator, how about that? Well, that's as much as we go for now, let’s get to our feature discussion. Dialysis patients are known to have a high mortality rate, a large proportion of which have been attributed to sudden cardiac death and yet compared to patients with heart failure, these patients with dialysis have been either excluded or only nominally enrolled in all previous trials of implantable defibrillators or ICDs. Now that's why our feature paper this week is so important, and it is the Cardioverter-Defibrillator in the prevention of sudden cardiac death in dialysis patients that prospective randomized controlled ICD to trial. So pleased to have with us, the corresponding author Dr Wouter Jukema from Leiden University Medical Center as well as associate editor Dr Mark Link from UT South Western to discuss this very important paper. Wouter, congratulations, this is a very difficult, very important to do the study though, could you tell us a bit about what you did and what you found? Dr J. Wouter Jukema: Actually, you just referred to it as a very difficult study to perform and indeed it was. Many years ago, actually, twelve years ago, we noticed that now a lot of death in dialysis patients was attributed to sudden cardiac death, before we tried to make these type of patients better with all types of medications, but did not really work and suddenly the idea was, that came also from death certificates and death records that they have sudden cardiac death and we said we should monitor it and we should treat it in a prospective randomized study. We initiated the study after careful thoughts and we thought we would do it in 4-6 years but it took us 12. So it was quite an effort to set up this rightly and spread it around the Netherlands and activate a Nephrologist and a Cardiologist to take part in this prospective randomized controlled study in dialysis patients. Of course, you can easily imagine that you could have great benefit from this ICD devise, but you could also easily imagine that you would have complications of the implication of the device. So explaining that we should show it out, I think was the most important job we had to do and think that was a great effort, and it was not easy to do. Dr Carolyn Lam: And that in it of itself is very important observation. Dr Mark Link: So you picked patients without doubts, which is great I mean this is a difficult study, but you also picked with an LDF greater than 35% and traditionally, ICDs are indicated for under 35%, can you give us a little explanation on why you chose the greater than 35% population? Dr J. Wouter Jukema: Yeah, I think this is perhaps the most important remark on the study, because when we designed the study we had to choose at that time we had guidelines in general that under 35% of injection fraction you were entitled to receive an ICD, however of course almost never dialysis patients were included so there was no formal recommendation on that not to include them or not to exclude them, but dialysis patients have a death rate at that time to sudden cardiac death, anyway regardless of the injection fraction and we thought okay, the patient population that is first at high risk of sudden cardiac deaths so any dialysis patients but also they are entitled to have a meaningful extension of the lives because the prognosis of patients that are on dialysis with an injection fraction under 35% is in general so poor that it would be unfair to start there and most of the Nephrologists also would not allow it anyway, these patients are at the end of life and if you extended for two or three months its useless. Anyway, so we thought we'd pick the high-risk population and we prove that there were still on high risk but when we could do something meaningful to extend their lives, so we thought we do not pick the worst patients we pick the patients that we think we can really help. We screened them well, we treated them well and we see if an ICD on the patient will benefit them. And that's why we picked the over 35% rage. You need another study to do below 35%, but I don't think that our results are substantiating such an effort. Dr Mark Link: The population with EFs was 6-50%, which also has a high risk of sudden death in patients with dialysis but it’s still not looking with the population of less than 35%. Dr J. Wouter Jukema: No, I completely agree, and we acknowledge that in the manuscript, it was always in the manuscript within the revision that was also pointed out to us that it should be more clearly acknowledged, why we choose this patient population and finally, we can of course not make a formal recommendation on dialysis patients with an injection fraction of less than 35%. You can extrapolate data but we have no formal prof of course for this type of population. I fully agree. Dr Carolyn Lam: Before we go further, could you first describe, what did you find? Dr J. Wouter Jukema: Basically, the conclusions are the prophylactic ICD therapy in patients on chronic dialysis with an injection fraction of 35% or higher was not associated with a reduced rate of sudden cardiac death nor of all cause of mortality and besides that the preference of sudden cardiac death in this type of patients on dialysis was actually significantly lower compared to its reports from literature, so that's what we very often see of course if you fill out a death certificate, you have to fill out a cause of death and of course in many patients the heart stops, and you say it's a sudden cardiac death. But that's not what this study actually showed and finally it's also no authority that this population was not too healthy to see any benefit, if you look at the results over the years, then you'll see that after five or six years more than half of the patients are dead anyway, but due to all kind of causes and not to a sudden cardiac death. So, I think that this is from a pathophysiological background, this is also a very interesting study because we now have finally data, real data on sudden cardiac deaths in these types of patients. Dr Carolyn Lam: Indeed, and Mark, I know that you invited the editorial from Rod Passman, just discussing why did we see the results that we did. Not quite what we expected I suppose, what do you think Mark? Dr Mark Link: First, I want to congratulate Dr Jukema for finishing this study, this was a massive task and a difficult and long one. I think I was surprised, there has been reported to be a very high rate of sudden death in dialysis patients regardless of their LDF. The ICD is very good at preventing sudden deaths, but not good at preventing other types of deaths, so I would extrapolate to say, well you can prevent sudden death in dialysis patients, you should prolong their life and this study did not show that at all. And I was surprised, and it just goes to what Dr Jukema was telling us, that what's reported on a death certificate as sudden death is not necessarily sudden death and could be other types of death and at the end all death is sudden. Dr J. Wouter Jukema: I fully agree with that remark because that makes is cumbersome to have the right interpretation of the data, so you have to feel like something and then finally your heart stops. Dr Carolyn Lam: What seems that most of the reasoning seems to be maybe a lower rate of sudden cardiac death than we expected, but there were also other factors that were considered, for example, if you could clarify by dialysis did you mean both hemodialysis as well as peritoneal dialysis, do you think that made a difference? For example, do you think ICDs work differently in presence of uremic precipitant of arrhythmias vs. not and so on, what do you have to say about those factors? Dr J. Wouter Jukema: We include on purpose both types of patients, the peritoneal dialysis and the hemodialysis patients because you could easily in-visit that there could be a difference, for instance to fluid or electrolyte sheaths that are more sudden in the hemodialysis patients than in peritoneal dialysis and we did a sub-analysis where we looked at both types, but the results are essentially the same, it doesn't seem to matter a great deal of what type of dialysis you have, the amount of sudden cardiac is lowered and expected. By the way occasionally, of course the ICD did work in sudden cardiac death, was aborted. So, it’s not that the apparatus doesn't function it does, it takes it properly and if functions properly. But finally, it doesn't prolong the life and you will die of something else, mostly infections in general well-being when finally, the nephrologist will say this is end of life you have to stop the dialysis procedures anyway. Dr Carolyn Lam: Right, great points, now in the last few minutes, I'm dying to ask, what do you think of the next steps from here. Mark, what do you think first? And then perhaps I'll give the last word to Wouter? Dr Mark Link: I'll start with a question to Wouter myself, the question is what are we going to do now with the individuals on dialysis that are under 35%? I think this study has pretty clearly said that were not going to extend our CDs to people on dialysis with greater than 35%. But we still have a population that currently fits indication for a ICD if their expected longevity is greater than a year. And currently those people are included in the guidelines for ICDs, I think this study gives us some pause about what to do with our population. And many of that population are getting our CDs and I'd be curious to what Dr Jukema thinks about that population and whether that population warrants some randomized trial or whether we should continue with our current guidelines that recommend implantation of an ICD in any individual less than 35%, as long as their expected life span is greater than a year. Dr J. Wouter Jukema: I think these are excellent questions with excellent remarks, of course, finally, we do not know because we didn't investigate it, I can only imagine the difficulties we would have if we were to do a new additional trial with injection fractions patients less than 35%. I could tell you we had great great difficulty in persuading Nephrologists to take part in the study, because many of them were very reluctant, this is their principal, these are very ill patients, and a lot of them are more or less going towards the end of their lives so you cannot do this when we have Nephrologists telling us that they considered it an unethical study. A lot of them did not want to participate they said, "You shouldn't do this to this patient, they have troubles enough, they suffer from infections and all kinds of things." Having said this, I do not advocate that you should never implant an ICD in a dialysis patient, I think in our study we also clearly show that in dialysis patients, implantation of an ICD is feasible within acceptable although better complication risk and infection risk, so if you have a patient on dialysis where you feel this patient has a good life expectancy, for instance, he already suffers an episode of arrhythmia, I think you are entitled to discuss this with the patient and have it a try, it might work and prolong their life. So I would not say never do it, I think our studies show that you can do it, yes, it sometimes works but do not expect too much of it. You will never hear me say that in general you should not do it, if you have a clear indication for it you may do it, secondary effect may require a good reason, but primary prophylactic indication, that's a difficult one I think and to do this study in patients that are even more ill, with injection fraction of less than 35%, I feel will be exceeding the difficult. Dr Mark Link: One other comment I have is the issue of the SUBCU ICD I think changes the equation in a bit because the risk of infection is much lower with a SUBCU IDC in patients on dialysis, did you have any SUBCU ICDs in your study or was it all transvenous? Dr J. Wouter Jukema: We don't have any data, when we designed and the developed study, the such a device was not even there so we couldn't do that, and during the study we did not adapt that but of course there is also no formal proof yet that it's a lot safer, a lot better, and once again this time of subcutaneous ICD I think you can do it at an acceptable complication rate. But it’s not effective enough, it's not that the patients were dying from infections of their ICD, they were dying of all kinds of infections and malignancies. Infections due to the ICD were facing procedures, real complications were rare. Dr Carolyn Lam: Great! Thank you Wouter, thank you Mark, what an important study and what a lot of lessons that we learned here. Thank you very much audience for listening as well, you've been listening to Circulation on the Run, don't forget to tune in again next week. This program is copyright American Heart Association 2019

#137 Neurologists as medical actuaries

BrainWaves: A Neurology Podcast

Play Episode Listen Later Apr 25, 2019 26:41

For patients who survive cardiopulmonary arrest, but do not wake up, neurologists are called to the bedside to prognosticate. And the question of 'How much will this patient recover?' is not unlike 'What is the benefit of aggressive therapy to await possible recovery?' In that way, you might consider neurologists to be the actuaries of hospital medicine. In this week's program, we review the clinical and diagnostic data that neurologists incorporate into their model for outcome prediction following anoxic brain injury. IF YOU'RE TAKING YOUR NEUROLOGY BOARDS, and not sure how to prepare, check out the 2019 Penn Neurology Board Review Course at https://upenn.cloud-cme.com/default.aspx?P=5&EID=54399. BrainWaves' listeners get $150 off their enrollment fee using the promo code 'WAVES2019'. Produced by James E. Siegler. Music courtesy of Swelling, Soft and Furious, Rafael Archangel, Lovira, and Dark Room. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES Young GB. Clinical practice. Neurologic prognosis after cardiac arrest. The New England journal of medicine. 2009;361:605-11. Sandroni C, Cariou A, Cavallaro F, Cronberg T, Friberg H, Hoedemaekers C, Horn J, Nolan JP, Rossetti AO and Soar J. Prognostication in comatose survivors of cardiac arrest: an advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine. Resuscitation. 2014;85:1779-89. Sandroni C and D'Arrigo S. Neurologic Prognostication: Neurologic Examination and Current Guidelines. Semin Neurol. 2017;37:40-47. Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M, Pellis T, Stammet P, Wanscher M, Wise MP, Aneman A, Al-Subaie N, Boesgaard S, Bro-Jeppesen J, Brunetti I, Bugge JF, Hingston CD, Juffermans NP, Koopmans M, Kober L, Langorgen J, Lilja G, Moller JE, Rundgren M, Rylander C, Smid O, Werer C, Winkel P, Friberg H and Investigators TTMT. Targeted temperature management at 33 degrees C versus 36 degrees C after cardiac arrest. The New England journal of medicine. 2013;369:2197-206. Seder DB. Management of Comatose Survivors of Cardiac Arrest. Continuum (Minneap Minn). 2018;24:1732-1752. Booth CM, Boone RH, Tomlinson G and Detsky AS. Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest. JAMA : the journal of the American Medical Association. 2004;291:870-9. Callaway CW, Donnino MW, Fink EL, Geocadin RG, Golan E, Kern KB, Leary M, Meurer WJ, Peberdy MA, Thompson TM and Zimmerman JL. Part 8: Post-Cardiac Arrest Care: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132:S465-82. Jorgensen EO and Holm S. The natural course of neurological recovery following cardiopulmonary resuscitation. Resuscitation. 1998;36:111-22. Seder DB, Sunde K, Rubertsson S, Mooney M, Stammet P, Riker RR, Kern KB, Unger B, Cronberg T, Dziodzio J, Nielsen N and International Cardiac Arrest R. Neurologic outcomes and postresuscitation care of patients with myoclonus following cardiac arrest. Critical care medicine. 2015;43:965-72.

"ECMO Global Trends And Use In Cardiopulmonary Resuscitation" By Ravi Thiagarajan For OPENPediatrics

OPENPediatrics

Play Episode Listen Later Mar 21, 2019 39:52

Listen as Dr. Ravi Thiagarajan, Chief of the Division of Cardiac Critical Care at Boston Children’s Hospital, and Professor of Pediatrics at Harvard Medical School, outlines past and present trends in ECMO use across the globe. He also reviews the major challenges faced by ECMO providers today, with a focus on ECMO use during cardiopulmonary resuscitation. Upon viewing this presentation, participants will be able to: • Describe global trends in ECMO that have developed over time • Understand the most frequent clinical applications of ECMO • Identify common complications that arise during ECMO • Understand how ECMO is utilized during cardiopulmonary resuscitation Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.

professor chief hospitals harvard medical school pediatrics ravi boston children ecmo global trends world federation boston children's hospital cardiopulmonary resuscitation

Ep.3 AED vs CPR

Pilot Talk Thailand podcast

Play Episode Listen Later Dec 8, 2018 9:05

AED ย่อมาจาก Automated External Defibrillator CPR ย่อมาจาก CardioPulmonary Resuscitation ปฐมพยาบาลเบื้องต้นบนท้องฟ้า เค้าทำกันอย่างไร?

aed cardiopulmonary resuscitation

SCCM Pod-364 Characterization of Pediatric In-Hospital CPR Quality Metrics

iCritical Care: Pediatric Critical Care Medicine

Play Episode Listen Later Jul 5, 2018 17:56

Margaret Parker, MD, MCCM, speaks with Dana E. Niles, MS, about the article Characterization of Pediatric In-Hospital Cardiopulmonary Resuscitation Quality Metrics Across an International Resuscitation Collaborative, published in the May 2018 issue of Pediatric Critical Care Medicine.

ms medicine hospitals md metrics pediatric characterization sccm cardiopulmonary resuscitation pediatric critical care medicine

SCCM Pod-364 Characterization of Pediatric In-Hospital CPR Quality Metrics

ms medicine hospitals md metrics pediatric niles characterization sccm cardiopulmonary resuscitation pediatric critical care medicine

Play Episode Listen Later Jul 5, 2018 17:56

Margaret Parker, MD, MCCM, speaks with Dana E. Niles, MS, about the article Characterization of Pediatric In-Hospital Cardiopulmonary Resuscitation Quality Metrics Across an International Resuscitation Collaborative, published in the May 2018 issue of Pediatric Critical Care Medicine.

"Thoracentesis During Cardiopulmonary Resuscitation" by Samuel Rice-Townsend for OPENPediatrics

OPENPediatrics

Play Episode Listen Later Mar 5, 2018 6:37

In this video, Dr. Samuel Rice-Townsend reviews the procedural steps to performing Thoracentesis as well as reviewing indications, contraindications and risk factors for patients experiencing tension hydro, hemo, or pneumothorax. Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children’s Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

hospitals rice townsend boston children world federation cardiopulmonary resuscitation thoracentesis

"Pericardiocentesis During Cardiopulmonary Resuscitation" by Traci Wolbrink for OPENPediatrics

OPENPediatrics

Play Episode Listen Later Jan 12, 2018 7:18

Dr. Traci Wolbrink reviews the procedural steps to performing Pericardiocentesis as well as reviewing indications, contraindications and risk factors for patients experiencing Cardiac Tamponade. Please visit: http://www.openpediatrics.orgOPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children’s Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

hospitals boston children world federation cardiopulmonary resuscitation

Podcast #248: Family Presence During Resuscitation

family presence resuscitation nejm cardiopulmonary resuscitation

Play Episode Listen Later Sep 8, 2017 3:32

Author: Aaron Lessen, M.D. Educational Pearls Traditionally the family is removed from the room during procedures and codes, but recent research shows that family presence may be beneficial. 50% patients want family present during a code. Family-related outcomes were improved with presence. There was no change in medical outcomes, and no increased incidence of medicolegal issues. References: Jabre et al. Family Presence during Cardiopulmonary Resuscitation. NEJM. 2013.

Support for presence during cardiopulmonary resuscitation if it is a child or relative

EBN podcast

Play Episode Listen Later Jul 11, 2017 15:39

In this episode Roberta Heale, Associate Editor of EBN, talks to Dr May Ann Pascuale, Assistant Professor of Nursing at Cedar Crest College. They discuss the recently published paper "Support for presence during cardiopulmonary resuscitation if it is a child or relative, though views differ by gender" Full paper >> http://ebn.bmj.com/content/19/2/58

May 30 2017 Issue

Neurology® Podcast

Play Episode Listen Later May 29, 2017 17:17

Show description/summary:1) Evidence-based guideline summary: Reducing brain injury following cardiopulmonary resuscitation2) Neurology Today® paper: “Prolonged Holter-ECG monitoring found to improve detection of atrial fibrillation after acute stroke”This podcast begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discussing highlighted articles from the May 30, 2017 issue of Neurology. In the first segment, Dr. Andrew Schomer talks with Dr. Romergryko Geocadin about the AAN practice guideline on reducing brain injury following cardiopulmonary resuscitation. In the next part of the podcast Dr. Matthew Ehrlich focuses his interview with Dr. Rolf Wachter on the Neurology Today feature, “Prolonged Holter-ECG monitoring found to improve detection of atrial fibrillation after acute stroke.” Disclosures can be found at Neurology.org. DISCLOSURES:Dr. Geocadin serves on the DSMB for the PEARL Study: “A Randomized Pilot Clinical Trial of Early Coronary Angiography Versus No Early Coronary Angiography for Post-Cardiac Arrest Patients with No ST Segment Elevation on the ECG” funded by the State of Arizona Biomedical Research Commission; serves on editorial boards for Neurocritical Care and Resuscitation; receives research support from NIH (grant R01 HL071568); and is co-author of "Post-Cardiac Arrest Care: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care."All other participants report no disclosures.

state chief journal reducing neurology nih aan ecg disclosures resuscitation neurocritical care cardiopulmonary resuscitation robert gross dsmb disclosures dr neurology today

18 - Cuándo detener la RCP

Play Episode Listen Later Nov 9, 2015 41:57

Uno de los temas más controversiales sobre el manejo de un paro cardiaco es cómo decidir terminar los esfuerzos de resucitación. Como profesionales de la salud tenemos un deseo innato de intentar resucitar a todo paciente en paro cardiaco, pero la vida es eventualmente finita. Una vez aprendí, y nunca he olvidado, que en la medicina tenemos el honor de presenciar dos de los eventos más significativos de un ser humano...su nacimiento y su muerte. Cuando las circunstancias se dan para que estos dos momentos ocurran, van a ocurrir indistintamente de lo que nosotros hagamos para evitarlo. Es nuestro deber honrar este proceso natural. La muerte no siempre representa el fracaso de nuestros esfuerzos, sino el fin de un proceso natural. Las Guías 2010 y 2015 de la American Heart Association proveen mucha información sobre los aspectos éticos a considerar a la hora de discutir el tema de detener la resucitación. La intención de este episodio no es discutir los aspectos éticos, aunque hay algunos aspectos que es inevitable considerarlos. No obstante, no es la intención de este artículo discutirlos todos, por lo que los invito a visitar la página de la AHA para las Guías 2015, disponibles gratuitamente en http://eccguidelines.heart.org. El tiempo no es relevante El tiempo del intento de resucitación no es el factor principal en la toma de decisiones. Debemos dejar de usar el tiempo para decidir si hemos intentado mucho o poco la resucitación. El uso del tiempo como factor exclusivo denota desconocimiento de los objetivos de la reanimación. ¿Debo mencionarlo nuevamente? El tiempo es un elemento muy subjetivo. La subjetividad del tiempo El tiempo es objetivo. Lo medimos con un reloj...segundos, etc... de eso no cabe duda. Podemos medirlo con precisión atómica. Lo que varía es nuestra percepción del tiempo. Aunque parezca irónico, la percepción del tiempo es una de las cosas más subjetivas que hay. Haga usted la prueba... cuando usted quiere que el tiempo corra rápido, toma una eternidad. Viceversa, cuando quiere que el tiempo se detenga, pasa todo muy rápido. Es común oir frases como "esto acaba de ocurrir ahora mismo"...pero ya van unos 10 minutos. Por otro lado es posible oir "la ambulancia está tardando una eternidad". pero solo han pasado 2 minutos y 35 segundos desde que terminó la llamada al 9-1-1. ¿Cuándo no iniciar la resucitación? En muchos casos no es apropiado ni siquiera iniciar la resucitación. Tiempo de resucitación = 0 minutos. No se intentó la resucitación. Algunos ejemplos son: Situaciones donde intentar realizar la resucitación pondría al rescatador en peligro Directriz avanzada, testamento u orden de no resucitar (DNR) Signos obvios de muerte irreversible (decapitación, rigor mortis, descomposición, etc.) En estos casos, desde el inicio, se sabe que el intento de resucitación va a ser inconsecuente y futil. Cabe señalar que el no iniciar la resucitación y el dar por terminado los esfuerzos de resucitación son ambos éticamente equivalentes. Ante la duda, saluda Ante ausencia de alguna buena razón para no comenzar (ver anterior), siempre que creamos que podemos resucitar al paciente, debemos fallar a favor del paciente e intentar la resucitación. Pero si fuera así, todavía estaríamos intentando resucitar a los padres de la patria. Tiene que haber una forma para decidir detenerse. DNR A veces la mejor forma de detener la resucitación es una forma (formulario) indicando las intenciones del paciente. Nunca es demasiado temprano para comenzar una discusión, en el momento oportuno, con un paciente sobre sus deseos al final de la vida. Es nuestro deber encontrar ese momento oportuno. Esta página ayuda a las familias a comenzar esta discusión de la manera correcta: http://deathoverdinner.org/ Pero cuando esto no ocurre, el médico debe hacerlo. El programa POLST provee unos fundamentos para lograrlo: Conversación entre el paciente, profesionales de la salud, y familiares cercanos Toma de decisión compartida entre el paciente y su profesional de la salud acerca de el cuidado que el paciente desea recibir al final de su vida Asegurar que los deseos del paciente se cumplan, documentándolo en un formulario Tenemos que mejorar nuestro conocimiento de cuidado de fin de la vida. Cuidado paliativo no es retirar el cuidado...es proveer comodidad al final de la vida. De igual manera, tenemos que aprender a manejar ese cuidado paliativo una vez se comenzaron a realizar medidas avanzadas, tales como la intubación endotraqueal y ventilación mecánica. El no saber extubar a un paciente en etapa terminal resulta en preguntas erróneas tales como "¿desea que lo intuben"? en vez de "¿desea que lo resuciten?". El National Institute for Health and Care Excellence del Reino Unido publica sus guías de fin de la vida para adultos, disponibles aquí. En adición, aquí hay un ejemplo de un protocolo de cuidado para la extubación terminal de un paciente: http://www.aacn.org/WD/Palliative/Docs/terminal_weaning_st_thomas.pdf Como siempre, siga sus protocolos locales. Los hospitales que miden tazas de sobrevivencia se benefician de tener órdenes de DNR debidamente firmadas ya que estos pacientes terminales entonces no entrarán a los registros de intentos de reanimación. A veces la evidencia de una orden DNR llega luego que la reanimación ha comenzado. En el caso de los proveedores fuera del hospital, se debe seguir el protocolo local. Si no existe un protocolo de cómo proceder en estos casos, se debe consultar al control médico para detener la resucitación. El objetivo final debe ser respetar los últimos deseos válidos y legítimos del paciente. Protocolo de Terminación de BLS en paro cardiaco fuera del hospital American Heart Association. Web-based Integrated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care – Part 3: Ethical Issues. ECCguidelines.heart.org. En términos generales, la RCP se realiza hasta que: Retorno de circulación espontánea Transferencia de cuidado a un equipo que provea soporte vital avanzado (en cuyo caso la resucitación puede continuar, pero bajo el control de los nuevos proveedores) El rescatador no puede continuar debido a cansancio o riesgo a su seguridad. Se cumplen criterios confiables de muerte cerebral irreversible, se identifican criterios de muerte obvia, o criterios para terminar la resucitación. A nivel de profesionales de BLS, los criterios incluyen: El paro cardiaco no fue presenciado por el primer respondedor o proveedor del SEM No hay retorno de circulación espontánea luego de 3 rondas de RCP y análisis del DEA El DEA no emitió ninguna descarga Es importante que la decisión se consultada con el médico para detener la reanimación a nivel de BLS. Los proveedores deben ser instruídos acerca de cómo comunicarse con la familia durante este momento de crisis. https://eccguidelines.heart.org/wp-content/uploads/2015/10/ACLS-Termination-of-Resuscitation.png American Heart Association. Web-based Integrated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care – Part 3: Ethical Issues. ECCguidelines.heart.org. https://eccguidelines.heart.org/wp-content/uploads/2015/10/ACLS-Termination-of-Resuscitation.png El paro cardiaco no fue presenciado por el primer respondedor o proveedor del SEM. Ningún testigo realizó RCP No hubo RCE (retorno de circulación espontánea) luego de un intento completo de resucitación en la escena. El AED no recomendó ninguna descarga. El paciente vive o muere en la escena La única oportunidad de sobrevivencia del paciente en paro cardiaco es que se obtenga retorno de circulación espontánea en la escena. Las Guías 2015 de la AHA recomiendan que el paciente sea atendido en el lugar donde se encontró. Es más conveniente, en términos generales, atender al paciente en la misma escena que dentro de la ambulancia ya que en la escena comúnmente hay más espacio y comodidad que en espacio cerrado de la ambulancia. El paciente que no obtiene retorno de circulación espontánea en la escena tiene 0.7% de sobrevivencia, a diferencia del que sí obtiene RCE, cuya posibilidad de sobrevivencia asciende a un 17.2%. (Prehosp Emerg Care. 2012 Oct-Dec;16(4):451-5) La RCP durante el transporte es pésima. No produce ningún flujo sanguíneo significativo, pone a los proveedores en riesgo de accidentes, y no está asociado a aumento en sobrevivencia. No se debe realizar RCP en movimiento. ¿Cómo resucitar a un paciente? Paso 1: Proteger al cerebro mediante compresiones cardiacas Paso 2: Tratar la causa del paro ¿Por qué su paciente está en paro cardiaco? Los pacientes en paro cardiaco se pueden dividir, según el algoritmo, en dos tipos: los que tienen un problema de ritmo [arritmias como fibrilación ventricular (FV) y taquicardia ventricular (TV) sin pulso] vs los que no tienen un problema de ritmo. Identificar esto es fácil si se tiene un monitor cardiaco. Una simple revisión rápida del ritmo nos provee esta respuesta. Todo paciente en paro cardiaco recibe el siguiente tratamiento: Compresiones de alta calidad, con la menor cantidad de interrupciones. Análisis del ritmo cardiaco inicialmente y cada dos minutos. Si el ritmo es desfibrilable, se desfibrila, si el ritmo no es desfibrilable, no se desfibrila. Epinefrina 1 mg cada 4 minutos (3-5 minutos) Tratar las causas reversibles probables. (si es una arritmia, se administra un antiarrítmico) Causas Reversibles Las causas reversibles son: "Heart" (arritmias del corazón) - desfibrilación + antiarrítmicos Hivolemia - líquidos y sangre Hipoxia - oxígeno Hidrógeno (acidosis) - bicarbonato si estaba acidótico antes del paro Hipotermia - calentar al paciente Hipoglucemia (especialmente en pediátricos) - dextrosa Hipo/hiperpotasemia - calcio, bicarbonato, dextrosa + insulina Toxinas - antídoto (naloxona si es un opioide, o lo que recomiende el Centro de Envenenamientos 1-800-222-1222) Tension, pneumotórax - descompresión Tamponada cardiaca - descompresión Trombosis coronaria - reperfusión Trombosis pulmonar - reperfusión Volvamos al Paso 1: Proteja al cerebro Primum non nocere (primero no cause más daño). En este caso, esto significa que no causemos más anoxia al cerebro. Si usted interrumpe las compresiones, pierde perfusión cerebral. Tenemos que volvernos una máquina perfecta de perfusión cerebral... ya sea manual o mecánica. De la forma en que yo lo veo, tenemos un problema (cualquiera de las H's y T's mencionadas anteriormente), y tenemos una solución. Entre medio del problema y la solución, tenemos un obstáculo: la pobre perfusión al cerebro está acabando con el cerebro rápidamente. En otras palabras, tenemos que actuar rápido. El problema es que algunas de las soluciones requieren TIEMPO. Es fácil y rápido descomprimir un pneumotórax a tensión, pero hacer una embolectomía por una embolia pulmonar, o una intervención coronaria percutánea toma más tiempo del que usualmente tenemos. Tenemos una solución a esto... RCP mecánico. Existe mucha controversia sobre el rol del RCP mecánico... pero si se decide que el paciente requiere un cuidado definitivo que va a durar más tiempo, no hay duda que las máquinas que proveen compresiones continuas tienen esa ventaja: proveer compresiones por largo tiempo. Lea este artículo de EMSWorld: qué hacer cuando su paciente en RCP mecánico recupera conciencia durante las compresiones. Sin leer el artículo, deducimos que la perfusión al cerebro fue tan buena que el paciente recuperó conocimiento durante las compresiones. Pero lo más importante de esto, en mi opinión, es que si podemos mantener el cerebro con buena perfusión infinitamente, tenemos un tiempo infinito para tratar de corregir la causa que tiene el paciente. Antes no nos enfocábamos mucho en la calidad de las compresiones. Las compresiones eran malas (y siguen siendo malas en muchos sitios) y esto provocaba que no hubiera buena perfusión cerebral. A su vez, esto provocaba daño cerebral en poco tiempo. Por lo tanto, antes, el tiempo era importante porque estaba asociado a muerte cerebral. Debido a las pobres compresiones, en pocos minutos empezaba a ocurrir acidosis respiratoria y era necesario tratar la acidosis. Ahora, la acidosis respiratoria se corrige gracias a las buenas compresiones. Ahora, si podemos perfundir perfectamente al paciente, hemos quitado la barrera. El tiempo no es el problema. El verdadero problema ahora es entender si hay algo que podamos hacer por el paciente. Si existe la posibilidad de hacer algo, se intenta. Si no existe la posibilidad, entonces es momento de suspender el esfuerzo. No es un asunto de tiempo, es un asunto de entender qué tiene el paciente y cuáles son las opciones reales. Es decir, el tiempo era el factor limitante. Si podemos perfundir perfectamente al paciente, hemos quitado la barrera. Escuchen este podcast sobre la embolia pulmonar que sufrió el Dr. Joseph Ornato, MD FACEP FACC FAHA. El Dr. Ornato es uno de los principales investigadores sobre el uso de oxigenación por membrana extracorporea (ECMO) durante paro cardiaco para realizar embolectomías. ¡Resulta que él fue uno de sus propios pacientes en su propio estudio! Óigalo contar su historia, la cual incluyó ECMO, compresiones cardiacas, hipotermia terapéutica por 1 semana, y una recuperación neurológica completa. Las guías 2015 de la AHA recomiendan que la RCP extracorpórea (ECPR) puede proveer tiempo adicional para tratar causas reversibles del paro cardiaco (tales como síndrome coronario agudo, embolia pulmonar, fibrilación ventricular refractaria, hipotermia extrema, intoxicación por drogas, y otras causas más). Lea más sobre ECPR en este website: http://edecmo.org/ El tiempo no es el factor determinante de cuándo detenemos la resucitación. Se detiene el esfuerzo cuando se han intentado las cosas que razonablemente se pueden intentar y no ha habido una respuesta. Se detiene la RCP cuando no hay más nada que hacer. Paro cardiaco por trauma Analicemos un caso hipotético: Los paramédicos llegan 8 minutos luego de que se reporta un serio accidente. Cuando llegan, el paciente está inconsciente, sin signos de vida. ¿Qué posiblemente le pudo haber pasado a este paciente? Probablemente una o varias de las siguientes: Lesión traumática cerebral Hipovolemia por un sangrado masivo Hipoxia Pneumotórax a tensión Tamponada cardiaca ¿Cuánta RCP y epinefrina va a resolver estos problemas anteriores? NINGUNA! Si su paciente se desangró, le administraron líquidos IV, sangre, no ha respondido y está en asístole, ¿cuál es el objetivo de realizar RCP por 20, 30, 60 minutos? De seguro usted realizó estas intervenciones mucho antes de 20 minutos. Si usted ya ha determinado que no hay respuesta y está en asístole... ¿cuánta RCP es necesaria? Probablemente ninguna. Si alguien necesita darle RCP por 30 minutos... pues que lo haga hasta que se sienta que "hizo todo lo posible". En un futuro, los libros de historia de la medicina mirarán esta época y contarán que: En el siglo 21 tuvimos una especie de "ritual de paso" para declarar a una persona muerta y dejarla descansar en paz. En este "ritual" le brindámanos epinefrina y ceremonialmente contábamos mientras comprimíamos el pecho rítmicamente y danzábamos alrededor del paciente realizando diferentes procedimientos como desfibrilación, intubación, canalización, etc., hasta que por fin decidíamos, por diferentes y siempre cambiantes razones, que debíamos parar. En cambio, si usted decide hacer algo, ¡realice intervenciones significativas! ¿Qué son intervenciones significativas? Las "intervenciones significativas", según John Hinds, son aquellas que directamente arreglan algo. Son intervenciones o acciones específicas. En momentos de crisis, donde el tiempo y los recursos pueden ser limitados, es críticamente importante que todas las personas envueltas no pierdan tiempo en cosas que no sean intervenciones significativas. Según el Dr. Hinds, las intevenciones significativas en el paciente de trauma son: Intubación usando un "bougie" y capnografía de onda Toracostomía digital (con el dedo) bilateral Colocar una faja pélvica (SAM Splint) Enderezar fracturas de huesos largos Administrar bolos de fluído (administrar sangre si está en el hospital) Luego de realizar esto, entonces analizan cuál es el estatus del paciente y cuáles son los problemas que se han descubierto para decidir cuáles son las alternativas (ver abajo más info sobre toracotomía de emergencia y sobre REBOA). (Nota: El Dr. Hinds falleció en un accidente de motora este año. Vea un tributo aquí). Pero dejemos que sean las propias palabras del fenecido John Hinds que describan lo que él mismo llamó "intervenciones significativas". Paro cardiaco por trauma... toracotomía de emergencia Si usted entiende que su paciente tiene un sangrado masivo, la mejor forma de estabilización es detener el flujo pinzando la aorta. Si usted está decidiendo resucitar al paciente de trauma y se va en paro cardiaco frente a usted... este es el momento. De lo contrario, recuerde que las compresiones cardiacas y la(s) epinefrina(s) son completamente inútiles en este momento. La toracotomía de emergencia está asociada a mortalidad excesivamente altas. El problema no es solamente encontrar la aorta, sino resolver lo que uno encuentre. Si usted no va a hacer esto, y su paciente requiere un control inmediato de un sangrado masivo abdominal, entonces considere si es útil continuar los esfuerzos. REBOA: una opción en el futuro cercano Donación de órganos En lugares que tengan un sistema de captación inmediata de órganos y un programa preparado para implementarlo efectivamente, los pacientes que no logran RCE podrían ser candidatos para donar hígado y riñones. Corazones muy buenos para morir A todos nos corre la adrenalina por las venas cuando llegamos a un paro cardiaco. La mejor satisfacción es ver a un equipo verdaderamente coordinado realizando un esfuerzo genuino e inteligente por corregir la causa. Aunque el obtener el pulso (retorno de circulación espontánea, o RCE) NO es el objetivo final (el objetivo final es lograr el egreso del hospital neurológicamente intacto o viable), el RCE es un paso importante en el progreso del paciente. A los que nos apasiona ese juego entre la vida y la muerte, saben que una de las mejores emociones es saber que puedes revertir el paro cardiaco, intentarlo, y luego de esforzarte, obtener ese retorno de circulación, sentir el pulso y ver una presión sanguínea en el monitor. A los que me conocen y han trabajado conmigo, saben que usualmente mi frase favorita es "¡buen trabajo mi gente... estamos en cancha todavía!" Conclusión...memento mori Recuerde que todos vamos a morir algún día, y si hacemos las cosas correctamente, la muerte puede ser tan digna como la vida. Referencias American Heart Association. Web-based Integrated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care – Part 3: Ethical Issues. ECCguidelines.heart.org.

Ep: 13: Guías AHA 2015: Soporte Vital Cardiovascular Avanzado (ACLS)