Rowley,
Sorry to contradict but your SHO got her protocols wrong! The dose of 3mg is
for a bradycardic PEA. If your patient had a ROSC with bradycardia you
correctly followed the bradycardia peri-arrest protocol by giving 0.5 mcg.
Tell you medical SHO to, a) re-read the protocols, and b) remember that they
are there to guide and common sense MUST prevail.
Andy
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Rowley Cottingham
Sent: 24 December 2001 22:23
To: [log in to unmask]
Subject: Protocols
There will be those of you who remember my grumbling about the Resuscitation
protocols. I had a rather fine example
today, when a patient who had arrested and had a ROSC became a little
bradycardic and dropped his pressure a bit.
Hmm, let's give 500 micrograms of atropine, I thought and did. I watched as
his rate gently climbed to 70or so and his
pressure improved. "Oh, that's not the correct dose in the
protocol!"announced the medical SHO, and promptly gave
another 2.5mg. Of course, the patient developed a rampaging
"adrenaline-induced" tachycardia (like 160) with fearsome
ST segment depression and total cardiovascular instability. Yes, it brought
his rate up, but at what cost? He needed
gentleness, not pedal to the metal. She didn't really understand the
pharmacology of what she had done, but she sure
knew her protocols.
Best wishes,
Rowley Cottingham
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http://www.emergencyunit.com
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