>===== Original Message From The list will be of relevance to all trainees
including undergraduates and <[log in to unmask]> =====
>Dear All,
>
>I would welcome your views regarding cardiac arrest drugs for community
>services.
>
>I am trying to come up with a comprehensive "red box" in conjunction with
>our local hospital pharmacy for use by GPs and Community Hospitals.
>
>Having read the literature re: Calcium and Sodium Bicarbonate - I am tempted
>to leave these items out, concentrating our efforts on epinephrine and
>atropine for simplicity and evidence base. Also, a 999 ambulance will be
>called to all community based arrests, but patients are not necessarily
>going to be transported if dead.
>
Sounds reasonable! Both bicarbonate and calcium are now second line drugs -
the only place for calcium in your situation would be the patient with known
hyperkalaemia or calcium channel blockers overdose. It's a judgement call as
to the frequency of these events as to whether you carry one minijet of
calcium.
You correctly state that you should carry epinephrine. Atropine, whilst still
contentious, is now advised for bradycardic PEA as well as asystole (the
theory that a profound brady may not generate a palpable pulse and therefore
simulate PEA but does generate a pulse when speeded up).
The other addition to the formulary is amiodarone. This is now being
recommended for "consideration" in any pulseless ventricular dysrhythmia that
has failed to respond to the first three shocks. It is given as a one-off dose
of 300 mg bolus IV. Not surprisingly, there is a minjet being marketed with
this dose of amiodarone.
>
>It also makes me realise that there is a gap in the Resus Council's
>guidelines in addressing specifically out of hospital cardiac arrest, by
>GPs, community hospitals and even to some degree ambulance services.
>
Pre-hospital cardiac arrest is covered in the Ethics section of the "Consensus
on Science" document (Resuscitation 2000;46(1-3):1-448). This covers the
ethics of starting, withholding and terminating pre-hospital resuscitation
attempts.
Strictly speaking, the pre-hospital approach (either GP or paramedic) should
be no different to the hospital approach. The universal algorithm lends, as
its name suggests, guidance to any resuscitation situation. The BLS guidelines
include the use of AEDs now. The ALS course tends to be geared towards the
hospital approach with 'crash teams' as the participants tend to be hospital
based. I have however delivered scenarios in the past in "pre-hospital land"
for GPs, dentists etc doing the course. It may be of interest to you to know
that standardised testing scenarios are being developed for pre-hospital
participants as well as hospital participants on the course.
I would be interested to know where you feel the gaps are for future
reference. The Resus council guidelines are based upon the International
Guidelines but are made applicable to UK practice. Obviously its difficult to
make them strictly applicable to every situation but you are right in that
pre-hospital arrests are an important aspect of resuscitation. With the advent
of pre-hospital AEDs, there has been more emphasis on out of hospital cardiac
arrest in the literature.
Andy
Totalise - the Users ISP
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