ACLS, hypertension: Yours for the clicking
ACLS, hypertension: Yours for the clicking
Scour the Internet for information you need
Surf to these three Web sites this month:
1. www.med.ufl.edu/medinfo/baseline/aclsthms.html. Here you’ll find 20 currently accepted algorithms for advanced cardiac life support. When a drug is mentioned in the protocol, it’s hyperlinked to information on its use and potential complications. Here are two excerpts:
• Torsade de Pointes.
V Tach with polarity switching from negative to positive.
Often caused by drugs that lengthen QT interval (stop them in the face of prolonged QT or torsade):
— procainamide
— disopyramide
— tricyclic antidepressants
— phenothiazines
Requires continuous EKG monitoring. Correct electrolyte abnormalities (especially hypokalemia and hypomagnesemia). Consider magnesium sulfate therapy even if serum magnesium is normal. Consider pacing if torsade continues.
Related topics: v fib/v tach algorithm:
• Stable v tach algorithm
Lidocaine 1.0-1.5 mg/kg IV
— continued v tach? YES -> lidocaine 0.5-0.75 mg/kg IV every 5-10 min up to 3 mg/kg
— continued v tach? YES -> procainamide 20-30 mg/min up to 17 mg/kg (avoid if hypotension, pulmonary edema or unconsciousness are present)
— continued v tach? YES -> bretylium 5-10 mg/kg over 8-10 min up to 30 mg/kg.
Related Topics: tachycardia algorithm
2. www.med.stanford.edu/school/DGIM/Teaching/Modules/HTN.htm This site covers treatment of hypertension and includes having patients track their own blood pressure, use of the different classes of drugs, and the overall cost of drug therapy. Here’s an excerpt regarding a recent long-term cost-effectiveness analysis of several initial monotherapies using a computer simulation of overall mortality as well as mortality, morbidity and cost of coronary heart disease:
For 20 years of simulated therapy the cost per year of life saved was projected to be $10,900 for propranolol, $16,400 for hydrochlorthiazide, $31,600 for nifedipine, $61,900 for prazosin, and $72,100 for captopril. Lowering diastolic blood pressure by 1 mm Hg was equivalent to lowering the cholesterol level by 6%. Although these projections require multiple estimates and assumptions that can be disputed, propranolol appears to be the preferred initial option in a cost-effective analysis.
3. www.gen.emory.edu/MEDWEB/keyword/cardiology.html. This site from Emory University in Atlanta is a directory of many cardiology resources on the Internet, including software, societies, journals, conferences, and studies. Click on stroke,’ for example, and you land on a list of hyperlinks, including one called Heart and Stroke Facts, a publication of the American Heart Association. If you click on that, you land at another list of hyperlinks containing: "Arrhythmias and Sudden Death," within which is "Who’s at risk for sudden cardiac death?" If you click there, you’re taken to information including:
Certain electrical heart abnormalities may be responsible for sudden cardiac death in the young. These include a short circuit between the upper and lower chambers (Wolff-Parkinson-White syndrome). This can sometimes allow dangerously rapid rates to develop in the lower chamber when there’s a rapid rhythm disturbance in the upper chamber and a congenitally prolonged electrical recovery after each heartbeat (long-QT syndrome) that may set the stage for fatal ventricular arrhythmias.
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