So we've talked about electricity. We've talked about airway and breathing. Let's talk a little bit about

the pharmacology in ACLS. Let's say you've got our 70-year-old woman that we described in the case in the

V-Fib arrest and you've shocked them a few times at maximal energy levels, given a few amps of epinephrine,

and they still remain in V-Fib. This is sometimes called refractory V-Fib.

What are some of the other moves you can make to get your patient into a perfusing rhythm?

So the sequencing of the drugs is pretty clear and pretty easy when you go through the guidelines.

Your first agent is going to be a vasopress or usually epinephrine. And the epinephrine is given every three to five minutes. So the second agent, right when, you know, if I have somebody in persistent V-Fib after only two shocks, they're often getting an antirethmic. So I won't be going through a few amps of epinephrine and end up with somebody in persistent, long refractory V-fib. It's actually I'm giving an anti-irthmic up front.

And in most cases, the antirhythmic right now, the antirthumic of choice is amyodorone.

That's based on a number of studies that have shown survival to hospital admission with a pulse.

Unfortunately, those studies were underpowered, or maybe there wasn't a sufficient effect

to detect survival

to hospital discharge, but amyodorant seems to be the antirthmic of choice for this patient.

Okay, so let's say you've given your epinephrine, you've given your amyodorone.

Is there any role for any of these patients for thrombolytics who are in persistent v-fib?

So there's been a number of studies in specific types of patients in cardiac arrest,

for instance, patients in P.E.A.

And there's been studies looking at patients with all rhythms blindly given Lytic,

irregardless of the situation.

And none of them have come up with any data to support

that Lidic should be given to patients in cardiac arrest in general.

Having said that, I think there is a role outside of the science to consider Lidic in

very special circumstances.

...