Podcasts about Cardiopulmonary resuscitation

Sometimes V-fib doesn't respond to the shock at all. Sometimes it converts and comes right back. Those are two completely different problems.In this episode, Sarah breaks down the science behind why defibrillation fails, how to recognize the difference between refractory and recurrent V-fib, and respond when shocks aren't working. You'll learn how to start approaching the electrical storm at the bedside — that means understanding transthoracic impedance, optimizing your pad placement, and knowing when to reach for double sequential defibrillation.Topics discussed in this episode:Refractory vs. recurrent V-fibThe physiology of ventricular fibrillation and re-entry tachycardiasMisconceptions about defibrillationTransthoracic impedance and how to reduce itAnterior-lateral vs. anterior-posterior pad placementDouble sequential defibrillation: evidence and objectionsKey findings from the DOSE VF trialAmerican Heart Association. (2025). 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation.Cheskes, S., Dorian, P., Feldman, M., McLeod, S., Scales, D. C., Pinto, R., Turner, L., Morrison, L. J., Drennan, I. R., & Verbeek, P. R. (2020). Double sequential external defibrillation for refractory ventricular fibrillation: The DOSE VF pilot randomized controlled trial. Resuscitation, 150, 178–184. https://doi.org/10.1016/j.resuscitation.2020.02.010D. Hasegawa, A. Sharma, Y. I. Lee, & R. Sato. (2023). A systematic review and meta-analysis of esmolol for refractory ventricular fibrillation and pulseless ventricular tachycardia. Chest, 164(4 Suppl.), A1568. https://doi.org/10.1016/j.chest.2023.07.1077International Liaison Committee on Resuscitation. (2025). 2025 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR).Mentioned in this episode:CONNECT

For most of human history, when a person's heart stopped, that was considered the end.  Then, through centuries of trial and error, strange experiments, and medical breakthroughs, doctors discovered that death was not always instantaneous. A stopped heart could sometimes be restarted, and ordinary people could be taught how to help save a life.  The result was one of the most important emergency procedures ever developed. Learn more about the history and science of CPR on this episode of Everything Everywhere Daily. Sponsors Newspapers.com Honor the past by uncovering its stories at Newspapers.com  Promo Code EVERYTHINGEVERWHERE Samsara Don't wait for the next accident to take action. Head to Samsara.com/EVERYTHING ButcherBox Get your choice between chicken breast or top sirloin for a year OR ground beef for life, PLUS $20 off when you go to ButcherBox.com/everything Quince Go to quince.com/daily for 365-day returns, plus free shipping on your order! Mint Mobile Save 50% on Unlimited premium wireless plans starting at $15/month at MintMobile.com/EED Audible Listen to Project Hail Mary Audible.com/hailmary Fast Growing Trees Get 20% off your first purchase when using the code DAILY at checkout at fastgrowingtrees.com/daily Subscribe to the podcast!  https://everything-everywhere.com/everything-everywhere-daily-podcast/ -------------------------------- Executive Producer: Charles Daniel Associate Producers: Austin Oetken & Cameron Kieffer   Become a supporter on Patreon: https://www.patreon.com/everythingeverywhere Discord Server: https://discord.gg/Ds7Rx7jvPJ Instagram: https://www.instagram.com/everythingeverywhere/ Facebook Group: https://www.facebook.com/groups/everythingeverywheredaily Twitter: https://twitter.com/everywheretrip Website: https://everything-everywhere.com/  Disce aliquid novi cotidie Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Merritt Tuttle is both a Pediatric Intensivist and Medical Toxicologist at Brenner Children's Hospital in North Carolina associated with Atrium Health and Wake Forest Baptist Health. She completed her Pediatric Critical Care and Medical Toxicology training at the Medical College of Wisconsin.Learning Objective: By the end of this podcast, listeners should be able to discuss an evidence based and expert guided approach to the evaluation and management of the critically ill child with calcium channel blocker toxicity.References:St-Onge M, Anseeuw K, Cantrell FL et al, Experts Consensus Recommendations for the Management of Calcium Channel Blocker Poisoning in Adults. Crit Care Med. 2017 Mar;45(3):e306-e315.2023 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 CareLevine M, Curry SC, Padilla-Jones A, Ruha AM. Critical care management of verapamil and diltiazem overdose with a focus on vasopressors: a 25-year experience at a single center. Ann Emerg Med. 2013 Sep;62(3):252-8. doi: 10.1016/j.annemergmed.2013.03.018. Cole JB, Arens AM, Laes JR, Klein LR, Bangh SA, Olives TD. High dose insulin for beta-blocker and calcium channel-blocker poisoning. Am J Emerg Med. 2018 Oct;36(10):1817-1824. doi: 10.1016/j.ajem.2018.02.004. Epub 2018 Feb 6.Slamowitz A, Sweberg T, Labgold K, Nickerson T. Extracorporeal Membrane Oxygenation for Calcium Channel Blocker Intoxication: A Multicenter Retrospective Registry Review. ASAIO J. 2025 Oct 31. Poison Control: (800) 222-1222Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease 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.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.  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Commentary by Dr.  Jian'an Wang.

Commentary by Dr. Qin LU.

By Bram Duffee, PhD, EMT-P For EMS providers who respond to a traumatic cardiac arrest, the instinct to initiate CPR is almost automatic. But could this life-saving intervention inadvertently hinder recovery in cases of severe hemorrhagic shock? A recent study, “Effect of Cardiopulmonary Resuscitation on Perfusion in a Porcine Model of Severe Hemorrhagic Shock,” challenges conventional wisdom and offers new insights that could reshape trauma care protocols. The Study: A Closer Look at CPR in Trauma-Induced PEA The research, led by Dr. Patrick Greiffenstein, professor of clinical surgery at LSU New Orleans and trauma ICU director at the Norman McSwain Spirit of Charity Trauma Center, addresses a critical gap in trauma care. While CPR is a cornerstone of resuscitation in cardiac arrest, its application in trauma-induced pulseless electrical activity (PEA) has not been rigorously validated. Trauma PEA, unlike medical cardiac arrest, is a low-flow state caused by severe blood loss (hypovolemia), where the heart shows electrical activity but fails to generate a palpable pulse. “CPR is a cornerstone of resuscitation and cardiac arrest, but its application in trauma-induced PEA has not really been rigorously evaluated,” explains Dr. Greiffenstein. “Trauma PEA is fundamentally a low-flow state caused by hypovolemia—insufficient blood volume.” The study aimed to determine how CPR affects tissue perfusion—specifically oxygen delivery to the brain and skin—during severe hemorrhagic shock. Using a porcine model, researchers simulated life-threatening blood loss and compared outcomes between two groups: one receiving automated CPR and the other left untreated during the shock phase. Key Findings: When CPR May Do More Harm Than Good The results were both surprising and concerning: No Improvement in Perfusion: CPR did not enhance oxygenation in the brain or skin. In fact, skin perfusion was significantly lower in the CPR group during both the shock and recovery phases. Adverse Hemodynamic Effects: While CPR increased systolic blood pressure (SBP), it significantly reduced diastolic blood pressure (DBP), which is critical for coronary and organ perfusion. Potential Harm: CPR caused a threefold increase in intracranial pressure (ICP), suggesting that chest compressions might disrupt normal blood flow dynamics in the brain. “Knowing now that extreme efforts like lining people up to do CPR can cause turbulence within the system is a significant advancement,” says Dr. Greiffenstein. “It's possible to have perfusion at these unreadable MAP scores, which is a critical insight for trauma care.” Implications for Trauma Care These findings challenge the one-size-fits-all approach to CPR in cardiac arrest scenarios. In cases of hemorrhagic shock, CPR might: Divert attention from more effective interventions, such as rapid blood transfusion or surgical control of bleeding. Worsen perfusion to vital organs, potentially exacerbating the patient's condition. “In military cases, field medics often don't have the opportunity to perform full chest compressions on the battlefield. Sometimes, all they can do is drag a person to a safe position,” notes Dr. Greiffenstein. This study underscores the importance of prioritizing interventions that address the root cause of trauma PEA—severe blood loss—over traditional resuscitation techniques. A Call for Updated Guidelines The American Heart Association's current guidelines broadly recommend CPR for all pulseless patients. However, this study adds to a growing body of evidence suggesting that trauma-induced PEA requires a different approach. By focusing on restoring blood volume and controlling bleeding, paramedics and EMTs can improve outcomes for patients in hemorrhagic shock. As Dr. Greiffenstein puts it, “This research is a step toward more tailored and effective trauma care protocols. It's about understanding the unique physiology of trauma and adapting our interventions accordingly.” For EMS providers on the front lines, this study serves as a reminder to critically evaluate the tools and techniques we rely on in emergency care. While CPR remains a vital intervention in many scenarios, its role in trauma-induced PEA warrants careful reconsideration by physician medical directors. By staying informed about the latest research, we can continue to improve outcomes for the patients who depend on us most. Click below to watch the full interview Reference Greiffenstein, P., Cavalea, A., Smith, A., Sharp, T., Warren, O., Dennis, J., Gatterer, M. C., Danos, D., Byrne, T. C., Scarborough, A., Deville, P., & VanMeter, K. (2025). Effect of cardiopulmonary resuscitation on perfusion in a porcine model of severe hemorrhagic shock. The Journal of Trauma and Acute Care Surgery, 98(2), 251–257.      

It's so interesting to see how medical evidence evolves, and changes, over time. The result of course is that clinical practice evolves and changes as well. The story of umbilical cord management at time of delivery highlights this very issue very well. The ACOG first recommended delayed cord clamping (DCC) in 2012, for preterm infants, as data showed marked improvement in neonatal outcomes in that population. In this episode, we will briefly walk through the timeline from 2012 to the latest update on DCC which came from the AAP in October 2025, just one month after the ACOG had their DCC update. This story also exemplifies how professional medical societies don't always have the SAME recommendations, with small tweaks, in their guidance. So, Dr Chapa and I will summarize these key updates…Listen in for details!1. ACOG 2012: DCC for preterm infants only 2. ACOG 2016: ACOG Recommends Delayed Umbilical Cord Clamping for All Healthy Infants, including term: https://mdedge.com/obgynnews/article/121349/obstetrics/acog-supports-delayed-umbilical-cord-clamping-term-infants3. ACOG Dec 2020, CO 814: Delayed Umbilical Cord Clamping After Birth4. ACOG Obstet Gynecol. January 2022; 139(1): 121–137. doi:10.1097/AOG.0000000000004625. Management of Placental Transfusion to Neonates After Delivery5. ACOG (ePUB July ) Sept 2025: ACOG releases a Clinical Practice Update: An Update to Clinical Guidance for Delayed Umbilical Cord Clamping After Birth in Preterm Neonates6. AHA/AAP Oct 2025 Update: Neonatal Resuscitation: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Learning Objectives:By the end of this podcast, listeners should be able to:Describe the pathophysiology associated with anticholinergic toxidromeList the initial workup and management that every TCA ingestion patient should receive Discuss best practices for initial resuscitation in TCA ingestions About our Guest: Dr. Joshua Nogar is an emergency medicine physician and toxicologist at Northwell Health and an associate professor of emergency medicine at Hofstra University. He is also the chief of the division of Medical Toxicology and the program director of the Toxicology Fellowship at North Shore University Hospital & Long Island Jewish Medical Center. References: https://toxandhound.com/category/dantastictox/page/2/ 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 Carehttps://emcrit.org/ibcc/nacb/Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease 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. 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.

In this episode, host Alyssa Watson, DVM, welcomes Jake Wolf, DVM, DACVECC, to discuss his recent Clinician's Brief article, “Top 7 Updates for Veterinary Cardiopulmonary Resuscitation.” Dr. Wolf, one of the authors for the 2024 RECOVER guidelines update, reviews the important changes covered in the update, including compressions, capnography, epinephrine dosing. He also shares how we can all implement them in practice.Resources:https://cliniciansbrief.com/article/veterinary-cpr-updates-2024https://solensiavetteam.comContact:podcast@instinct.vetWhere To Find Us:Website: CliniciansBrief.com/PodcastsYouTube: Youtube.com/@clinicians_briefFacebook: Facebook.com/CliniciansBriefLinkedIn: LinkedIn.com/showcase/CliniciansBrief/Instagram: @Clinicians.BriefX: @CliniciansBriefThe Team:Alyssa Watson, DVM - HostAlexis Ussery - Producer & Multimedia Specialist

Hoy analizamos lo más importante de las Guías 2025 de Soporte Vital Pediátrico (PALS) publicadas por la American Heart Association (AHA). Discutimos los cambios que realmente impactan tu práctica clínica: desde las nuevas técnicas de compresión torácica y el manejo del cuerpo extraño, hasta la interpretación de la actividad cerebral postparo y la presencia familiar durante la reanimación.

Bienvenido al ECC Podcast, el espacio donde transformamos la ciencia en práctica para salvar más vidas. En este episodio analizamos las nuevas guías 2025 de la American Heart Association (AHA) para el soporte vital básico en adultos — lo que todo profesional de la salud debe saber para aplicar con seguridad y confianza. Este episodio está basado en nuestro artículo completo, que puedes leer aquí:

In the second half of this two part episode, Dr. David Leon unpacks some of the most hotly debated topics in resuscitation—fluids, blood products, ECMO, and post-arrest care. He breaks down the pros and cons of crystalloids (yes, even the “pasta water” debate), explains why lactated Ringer's is often preferred over normal saline, and dips into the use of albumin and colloids. Dr. Leon also discusses the promise and challenges of extracorporeal life support (ECLS), the evolving role of targeted temperature management (TTM), and even peeks into what advances the future might hold. It's a thoughtful, forward-looking conversation every resuscitationist should hear. What do you think of Dr. Leon's tips? Are you using these tools in your practice? We'd love to hear from you. Share them with us on social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest: Dr. David Leon, Assistant Professor of Emergency Medicine and Anesthesia at UC Davis Resources: American Heart Association (AHA) Algorithms Perman SM, Elmer J, Maciel CB, Uzendu A, May T, Mumma BE, Bartos JA, Rodriguez AJ, Kurz MC, Panchal AR, Rittenberger JC; American Heart Association. 2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2024 Jan 30;149(5):e254-e273. doi: 10.1161/CIR.0000000000001194. Epub 2023 Dec 18. PMID: 38108133. **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

In this high-yield two part episode, we dive into the evolving world of resuscitation with Dr. David Leon, Assistant Professor of Emergency Medicine and Anesthesia at UC Davis. From the shift in priorities from ABC (Airway-Breathing-Circulation) to CAB (Circulation first) to the practical use of peripheral vasopressors and rapid infusion catheters, this episode breaks down how frontline ED care is adapting to sicker patients, longer ICU boarding times, and limited resources. Tune in for insights on advanced access strategies, pre-hospital blood products, and why old tools, like whole blood and vasopressin, are making a powerful comeback. What do you think of Dr. Leon's tips? Are you using these tools in your practice? We'd love to hear from you. Share them with us on social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest: Dr. David Leon, Assistant Professor of Emergency Medicine and Anesthesia at UC Davis Resources: American Heart Association (AHA) Algorithms Perman SM, Elmer J, Maciel CB, Uzendu A, May T, Mumma BE, Bartos JA, Rodriguez AJ, Kurz MC, Panchal AR, Rittenberger JC; American Heart Association. 2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2024 Jan 30;149(5):e254-e273. doi: 10.1161/CIR.0000000000001194. Epub 2023 Dec 18. PMID: 38108133. **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Dr. Aaron Primm, editor for Summaries of Emerging Evidence (SEE), joins Dr. Adam Striker to discuss the time-dependent probabilities of favorable outcomes following in-hospital cardiac arrest and optimizing patient position after surgery with general anesthesia with respect to early postoperative hypoxemia, topics featured in SEE Volume 41B. Recorded July 2025.

Show Notes for Episode 41 of “The 2 View” – reversible cerebral vasoconstriction syndrome, cerebral venous thrombosis, cardiopulmonary resuscitation and emergency cardiovascular care science, prehospital tourniquets, blood pressure, and more. Segment 1 – Reversible cerebral vasoconstriction syndrome and cerebral venous thrombosis Ropper AH, Klein JP. Cerebral Venous Thrombosis. N Engl J Med. Published June 30, 2021. https://www.nejm.org/doi/full/10.1056/NEJMra2106545 Spadaro A, Scott KR, Koyfman A, Long B. Reversible cerebral vasoconstriction syndrome: A narrative review for emergency clinicians. Am J Emerg Med. ScienceDirect. Published December 2021. https://www.sciencedirect.com/science/article/abs/pii/S0735675721008093 Segment 2 – Cardiopulmonary resuscitation and emergency cardiovascular care science, Prehospital tourniquets, and more Greif R, Bray JE, Djärv T, et al. 2024 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. Circulation. AHA | ASA Journals. Published November 14, 2024. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001288?utmcampaign=sciencenews24-25&utmsource=science-news&utmmedium=phd-link&utmcontent=phd-11-14-24 Roberts M, Sharma M. The Center for Medical Education. 36 - Marijuana, Sunburns, Pulse Oximetry, Lower UTI's. 2 View: Emergency Medicine PAs & NPs. Published May 31, 2024. https://2view.fireside.fm/36 Roberts M, Sharma M. The Center for Medical Education. The 2 View: Episode 2. 2 View: Emergency Medicine PAs & NPs. Published February 3, 2021. https://2view.fireside.fm/2 Smith AA, Ochoa JE, Wong S, et al. Prehospital tourniquet use in penetrating extremity trauma: Decreased blood transfusions and limb complications. J Trauma Acute Care Surg. NIH: National Library of Medicine: National Center for Biotechnology Information. PubMed. Published January 2019. https://pubmed.ncbi.nlm.nih.gov/30358768/ STB home page. Stop the Bleed. American College of Surgeons. https://www.stopthebleed.org/ Teixeira PGR, Brown CVR, Emigh B, et al. Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury. J Am Coll Surg. NIH: National Library of Medicine: National Center for Biotechnology Information. PubMed. Published May 2018. https://pubmed.ncbi.nlm.nih.gov/29605726/ Segment 3 – Blood Pressure Bress AP, Anderson TS, Flack JM, et al. The Management of Elevated Blood Pressure in the Acute Care Setting: A Scientific Statement From the American Heart Association. Hypertension. NIH: National Library of Medicine: National Center for Biotechnology Information. PubMed. Published August 2024. https://pubmed.ncbi.nlm.nih.gov/38804130/ Liu H, Zhao D, Sabit A. Arm Position and Blood Pressure Readings: The ARMS Crossover Randomized Clinical Trial. Jamanetwork.com. JAMA Network. JAMA Internal Medicine. Published October 7, 2024. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2824754 Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

This episode of Critical Matters will close 2024 with a year in review. Dr. Sergio Zanotti is going solo and will discuss a couple of relevant clinical guidelines and review five clinical trials. To close, he'll share some of his favorite books for 2024. Additional Resources: Critical Care Management of Patients Post Cardiac Arrest (AHA/NCS): Hirsch KG, Abella BS, Amorim E, et al. Critical Care Management of Patients After Cardiac Arrest: A Scientific Statement from the American Heart Association and Neurocritical Care Society. Neurocrit Care. 2024;40(1):1-37: https://bit.ly/4087o1w 2024 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. Circulation 2024: https://bit.ly/4fD4o1R PREOXI Trial. Gibbs KW, Semler MW, Driver BE, et al. Noninvasive Ventilation for Preoxygenation during Emergency Intubation. N Engl J Med. 2024;390(23):2165-2177. doi:10.1056/NEJMoa2313680: https://bit.ly/4fD4pCX AMIKINHAL Trial. Ehrmann S, Barbier F, Demiselle J, et al. Inhaled Amikacin to Prevent Ventilator-Associated Pneumonia. N Engl J Med. 2023;389(22):2052-2062. doi:10.1056/NEJMoa2310307: https://bit.ly/4iQQvzU REVISE Trial. Cook D, Deane A, Lauzier F, et al. Stress Ulcer Prophylaxis during Invasive Mechanical Ventilation. N Engl J Med. 2024;391(1):9-20. doi:10.1056/NEJMoa2404245: https://bit.ly/3Pc4nqH TIGHT K Trial. O'Brien B, Campbell NG, Allen E, et al. Potassium Supplementation and Prevention of Atrial Fibrillation After Cardiac Surgery: The TIGHT K Randomized Clinical Trial. JAMA. 2024;332(12):979-988. doi:10.1001/jama.2024.17888: https://jamanetwork.com/journals/jama/fullarticle/2823246 BALANCE Trial. Daneman N, Rishu A, et al. Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections. N Engl J Med. Published online November 20, 2024. doi:10.1056/NEJMoa2404991: https://www.nejm.org/doi/abs/10.1056/NEJMoa2404991 CMD Study. Bodien YG, Allanson J, Cardone P, et al. Cognitive Motor Dissociation in Disorders of Consciousness. N Engl J Med. 2024;391(7):598-608. doi:10.1056/NEJMoa2400645: https://www.nejm.org/doi/full/10.1056/NEJMoa2400645 Books Mentioned in this Episode: Slow Productivity: The Lost Art of Accomplishment Without Burnout. By Cal New Port: https://amzn.to/4gTbkJ2 Meditations for Mortals: Four Weeks to Embrace Your Limitations and Make Time for What Counts. By Oliver Burkeman: https://bit.ly/4gURU6N Knife: Meditations After an Attempted Murder. By Salman Rushdie: https://bit.ly/3ZPsAIt

Send us a textWir besprechen die Arbeit von Perman et. al. aus Circulation zu der Frage, warum Frauen seltener von Laien reanimiert werden als Männer:Perman SM, Shelton SK, Knoepke C, et al. Public Perceptions on Why Women Receive Less Bystander Cardiopulmonary Resuscitation Than Men in Out-of-Hospital Cardiac Arrest. Circulation. 2019;139(8):1060-1068. doi:10.1161/CIRCULATIONAHA.118.037692Mit im Studio dabei: Ole Keim, wissenschaftlicher Mitarbeiter der Klinik für Anästhesiologie am UKHD

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

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.

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 

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  

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!

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  

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

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

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

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.

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

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

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

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

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/

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/

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

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!

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  

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.

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.

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.

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 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

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.

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

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," 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.     

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) 

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).

CPR and management for infant, Children & Adults

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.

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.