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Episode 16: Getting that sweet ROSC?

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Manage episode 157400836 series 1220119
Content provided by CritMedic. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by CritMedic or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://player.fm/legal.

Are we giving our patients a sweet chance at ROSC? Or consigning them to a sugary grave? We examine the evidence for and against Dextrose in Cardiac Arrest.

Two renown EMS blogs, Rogue Medic and Mill Hill Avenue Command, have already covered the topic before. But let’s take a deeper look at the evidence for and against Dextrose as well as discuss the cardiac physiology pertaining to Glucose metabolism. We’ll also cover how patients who become hypoglycemic end up going into cardiac arrest in the first place and whether we can accurately detect hypoglycemia in cardiac arrest.

Just like our Narcan podcast, we’re going to science and evidence the crap out of this one.

Here’s a breakdown of the points in this podcast.

  • Myocardial cells don’t use glucose as a primary source of fuel. As little as 4% of myocardial ATP is generated from glucose.
  • Giving dextrose during periods of ischemia increases anaerobic metabolism, promotes the conversion of pyruvate into lactate, causes intracellular acidosis, and may decrease cerebral blood flow, exacerbating cerebral ischemic injury.
  • We can’t accurately determine blood glucose in cardiac arrest using capillary blood glucose. Glucometry using a venous sample without a venous reagent strip is suspect and potentially inaccurate.
  • The largest study to date (Peng, 2015) shows worse overall survival to discharge.
  • The largest study to date (Peng, 2015) shows worse neurologic outcome.
  • The largest study to date (Peng, 2015) shows no association between dextrose administration and ROSC when propensity-matched analysis was used.
  • Studies show even D5W can worsen outcomes in cardiac arrest.

Here’s the total body of evidence for Dextrose in cardiac arrest resuscitation (click to enlarge)…

Pediatric Hypoglycemia

The above data has been reproduced in accordance with the provisions of 17 U.S. Code § 107 “Fair Use” for the purposes of criticism, comment, and non-commercial educational purposes.

Show Notes

  continue reading

22 episodes

Artwork
iconShare
 

Archived series ("HTTP Redirect" status)

Replaced by: CritMedic

When? This feed was archived on May 01, 2018 14:56 (6y ago). Last successful fetch was on April 28, 2018 08:08 (6y ago)

Why? HTTP Redirect status. The feed permanently redirected to another series.

What now? If you were subscribed to this series when it was replaced, you will now be subscribed to the replacement series. This series will no longer be checked for updates. If you believe this to be in error, please check if the publisher's feed link below is valid and contact support to request the feed be restored or if you have any other concerns about this.

Manage episode 157400836 series 1220119
Content provided by CritMedic. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by CritMedic or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://player.fm/legal.

Are we giving our patients a sweet chance at ROSC? Or consigning them to a sugary grave? We examine the evidence for and against Dextrose in Cardiac Arrest.

Two renown EMS blogs, Rogue Medic and Mill Hill Avenue Command, have already covered the topic before. But let’s take a deeper look at the evidence for and against Dextrose as well as discuss the cardiac physiology pertaining to Glucose metabolism. We’ll also cover how patients who become hypoglycemic end up going into cardiac arrest in the first place and whether we can accurately detect hypoglycemia in cardiac arrest.

Just like our Narcan podcast, we’re going to science and evidence the crap out of this one.

Here’s a breakdown of the points in this podcast.

  • Myocardial cells don’t use glucose as a primary source of fuel. As little as 4% of myocardial ATP is generated from glucose.
  • Giving dextrose during periods of ischemia increases anaerobic metabolism, promotes the conversion of pyruvate into lactate, causes intracellular acidosis, and may decrease cerebral blood flow, exacerbating cerebral ischemic injury.
  • We can’t accurately determine blood glucose in cardiac arrest using capillary blood glucose. Glucometry using a venous sample without a venous reagent strip is suspect and potentially inaccurate.
  • The largest study to date (Peng, 2015) shows worse overall survival to discharge.
  • The largest study to date (Peng, 2015) shows worse neurologic outcome.
  • The largest study to date (Peng, 2015) shows no association between dextrose administration and ROSC when propensity-matched analysis was used.
  • Studies show even D5W can worsen outcomes in cardiac arrest.

Here’s the total body of evidence for Dextrose in cardiac arrest resuscitation (click to enlarge)…

Pediatric Hypoglycemia

The above data has been reproduced in accordance with the provisions of 17 U.S. Code § 107 “Fair Use” for the purposes of criticism, comment, and non-commercial educational purposes.

Show Notes

  continue reading

22 episodes

All episodes

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