31/10/2019
- Grab a 20-mL (or 30-mL) syringe.
- Draw up the adenosine AND the normal saline in the same 20-mL syringe.
- Administer via fast IV push (can be through a running IV line).
The major advantage to this approach is that it obviates the need for any syringe switching or stopcock swiveling. There’s no need for additional flushes since your diluted adenosine syringe doubles as the flush. If you don’t have 20-mL syringes, you can still add the adenosine to 10-mL syringe to get the same effect. Flush volumes as low as 5 mL have been effective
Source: Academic Life in Emergency Medicine
While most drugs are metabolized in the liver, adenosine doesn’t even make it that far, being metabolized in the erythrocytes and vascular endothelial cells. With this extremely short half-life (10 seconds), it is important to help it reach the heart before it’s metabolized and excreted without being effective.
29/06/2016
The concept of double sequential defibrillation shocks was initially described in animal literature in a mid-1980s article presented in the Journal of American Cardiology. Using a canine model, investigators delivered single, double and triple exponential shocks to hearts in which v fib and myocardial infarction had been induced. The shocks were delivered one second apart and employed different vectors (i.e., pathways) across the heart. The researchers determined that “two sequential shocks over different pathways reduce both total energy and peak voltage required to terminate ventricular fibrillation.” Thus, both sequential shocks and multiple vectors help to reduce the v fib threshold and therefore terminate the arrhythmia.
Source: JEMS
DSED remains a potential exiting alternative therapy for patients presenting in refractory VF. Although controversy exists as to the mechanism of effect, current and future high-quality research trials may clarify the pragmatic effectiveness of DSED for refractory VF in the prehospital setting.
Interruptions in chest compressions during cardiopulmonary resuscitation can negatively impact survival. Several new endotracheal intubation (ETI) techniques including video laryngoscopy may allow for ETI with minimal or no interruptions in chest compressions.
Source: Pubmed
Stockholm 2005
In this study of CPR during out-of-hospital cardiac arrest, chest compressions were not delivered half of the time, and most compressions were too shallow. Electrocardiographic analysis and defibrillation accounted for only small parts of intervals without chest compressions.
Source: Pubmed
The majority of clinical research is based on male testing subjects. The Heart and Stroke Foundation website contains an article called “Read the Spotlight on women”
Source: Heart and Stroke Foundation