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Esmolol for Refractory VF/pVT - #PHARMFAX

After 3 defibrillations, 3 doses of epinephrine, and amiodarone or lidocaine administration puts us in the Refractory Ventricular Fibrillation and Pulseless Ventricular Tachycardia per the ACLS guidelines.

 

After 3 defibrillations, 3 doses of epinephrine, and amiodarone or lidocaine administration puts us in the Refractory Ventricular Fibrillation and Pulseless Ventricular Tachycardia per the ACLS guidelines. Defibrillation and CPR are the mainstay of therapy for shockable rhythyms. As you progress down the left branch of the ACLS algorithm, EPI 1 mg is considered every 3 to 5 minutes. Patients in refractory VF/pVT have high levels of endogenous and exogenous catecholamines. Getting to this point in a cardiac arrest is already associated with worse outcoes. Beta-blockade has been proposed to break the catechoalmine surge. Esmolol is rapid acting, beta-1 selective blocker with a short half life. Two small observational trials totaling 66 patients, one by Lee et al and the other from Driver and colleagues in 2014 and 2016, have shown promise in achieving ROSC, which the AHA is currently reviewing for official recommendations. Note the median CPR time was roughly an hour, 6 defibrillations and doses of EPINEPHRINE, in addition to 300 - 450 mg of amiodarone for these studies. Esmolol was generally given with a 500 mcg/kg bolus, followed by a bolus and uptitrating every 3 - 5 minutes each from 50/mcg/kg/min up to 300 mcg/kg/min. Patients and family’s wishes, downtime, and futility are always emphasized with continued resusctation in a cardiac arrest. What are your next steps if you do get ROSC? Check out another video on my page, share the #PHARMFAX with a friend, and I hope you learned something new. Recommended Read/Watch Cardiac Arrest: Shockable - https://www.instagram.com/p/CssGNYbAq-y/ Cardiac Arrest: Non-shockable - https://www.instagram.com/p/Csu-jcqASVg/ The ALL PHARMWYZE SOURCE (including links) | Follow @pharmwyze www.pharmwyze.com #esmolol #refractory #acls #cardiacarrest #pharmwyze #pharmfax #criticalcare #emergencymedicine #studentpharmacist #nursingstudent #medicalstudent #pharmacy #medicine #nursing #meded

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