EM rap

[tyson]

on this month's em rap w/ weingart had interesting point about using vasopressin synergistically with Epi. so for each round of PEA, do 1 epi, 20 of vaso at same time. supposedly leads to better neurological outcomes for patients. 

any of you guys use vaso like this or even regularly? 

i find that i mostly just use epi, bicarb, calcium... usual baloney. 

also was some talk of using solumedrol in cardiac arrest. thoughts? 

would be interesting if we tried at least vas +epi q3-5 minutes on our upcoming codes and compared results. 


tyson

[Bjs04f]

I would suggest you read these. However as Ryno once told me "none of this shit works, we should just leave them there to get better or not."
pulmccm.org/2013/randomized-controlled-trials/vasopressin-steroid-epinephrine-cocktail-improved-cardiac-arrest-outcomes-jama/
circ.ahajournals.org/content/102/suppl_1/I-129.full
ccforum.com/content/18/3/308
I think this would be beneficial in the same was as vaso is helpful in non resposnive shock, it works synergistically with catecholamines, sensatizing their receptors, which is why its not titratable. Who knows though this seems to change seasonaly

[pbruss]

I really like the first paper and will try it on next arrest. I would like to point out that they looked at patients with in hospital cardiac arrest so don't know if will work in out of hospital arrest but worth a shot

[kemple]

OOH has both vaso and epi but not a lot of it, might also be difficult for one medic to draw it all up. I will say I can totally see this working because it takes micro doses of what we give in arrest to sensitize the receptors but it definitely works.