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jueves, 22 de septiembre de 2016

Cognitively Offloading During a Cardiac Arrest

Beyond ACLS
R.E.B.E.L.EM - September 22, 2016 - By Salim Rezaie
"Today I am giving a talk at the 25th National Emergency Medicine Symposium by Kaiser Permanente in Maui, HI. The focus of this talk was on how to cognitively offload our minds as we are running a resuscitation. ACLS provides us with a framework in treating adult victims of Cardiac Arrest (CA) or other cardiopulmonary emergencies. This helps get providers who don’t commonly deal with CA, to improve things, such as the quality of CPR, minimizing interruptions during CPR for pulse checks, and the timing/dosing of epinephrine. Emergency Medicine (EM) and the prehospital world are different than many environments in medicine. We get minimal information at the time of patient arrival while at the same time the disease process that is taking place has not quite defined itself. We are constantly expected to acutely manage and resuscitate anyone who comes in our doors 24-7-365, many times without crucial information. Our job therefore should be to ensure coronary and cerebral perfusion are at their highest quality, but also simultaneously putting the pieces of the puzzle together to figure out why our patient is in CA. It can be very difficult to do both and many times we sacrifice one for the other. It is therefore important to cognitively offload ourselves during the resuscitation of our patients in CA and focus our attention on why they are in CA. As a disclosure for this lecture I did state that some of the recommendations made have evidence to support them and others are more theoretical and certainly up for discussion...
Critical Take Home Points to go Beyond ACLS and Cognitively Offload During Resuscitation Efforts of Cardiac Arrest:
  • CPR: Mechanical CPR > Manual CPR
  • Access: IO Access > IV Access
  • Epinephrine: Epinephrine Drip > Epinephrine Bolus
  • PEA Workup: Ultrasound > H’s & T’s
  • Pulse Checks: EtCO2 + Bedside TTE > Manual Pulse Checks"