ACLS review

236.  What special considerations are made for a cardiac arrest victim who is hypothermic with a core temperature less than 86° F (< 30° C)?

It is appropriate to attempt an initial defibrillation in a hypothermic patient cardiac arrest victim.  But if the patient fails to respond to the initial defibrillation then subsequent attempts and drug therapy should be deferred and resuscitative efforts should focus on effective CPR and active rewarming until the patient’s core temperature is above 86° F (< 30° C).  

237.  What is the major concern about administering cardiac arrest medications to the hypothermic patient with a core temperature below 86° F (< 30° C)?

Since the patient’s metabolism is reduced, the hypothermic heart may be unresponsive to drug therapy.  Because of this, there is a concern that drug levels may rise to toxic levels with standard dosing regimens.

238.  What considerations are made for the hypothermic patient with a core temperature 86-93.2° F (30-34° C)?

For patients in moderate hypothermia attempt defibrillation and give medications spaced at longer intervals.

239.  When giving medications through a peripheral line during cardiac arrest, what three things can be done to facilitate them reaching the central circulation?

Administer the drug by bolus injections unless otherwise specified

Follow the medication with a 20-ml bolus of IV fluid

Elevate the extremity for about 10-20 seconds to facilitate delivery of the drug to the central circulation

240.  What drugs may be administered via the ET route?

Naloxone

Atropine

Epinephrine

Lidocaine

Reviewed 2/28/16