What aspects of temperature-targeted management are most important to EMS, and how should EMS guide sedation for the patient with a return of spontaneous circulation? Check out this interview w/ Dr. Leon Eydelman! The ROSC class referenced in this video can be found in FOAMfrat Studio!
Highlights
ROSC + FEVER = Bad.
Trust a high temperature and question a low one.
While most EMS agencies likely do not carry propofol, it is the most commonly used sedation medication in the ED because it washes out quickly and allows for neuro eval. Benzodiazepines are associated with higher rates of ICU delirium and complications. Running levophed to counteract the vasodilation aspect of propofol. Don't have propofol; hemodynamic-dosed ketamine is a good option as well.
The sedation dose should be reduced when the shock index is > 0.9. When a patient is in shock, their volume of distribution changes, and peripheral blood flow is reduced. This means more blood is shunted to the brain,, and lower doses of sedation will give the agent therapeutic brain levels.
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References
Dell'Anna, A. M., Taccone, F. S., Halenarova, K., & Citerio, G. (2014). Sedation after cardiac arrest and during therapeutic hypothermia. Minerva anestesiologica, 80(8), 954–962.
Pothiawala S. (2017). Post-resuscitation care. Singapore medical journal, 58(7), 404–407. https://doi.org/10.11622/smedj.2017060
Saigal, S., Sharma, J. P., Dhurwe, R., Kumar, S., & Gurjar, M. (2015). Targeted temperature management: Current evidence and practices in critical care. Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 19(9), 537–546. https://doi.org/10.4103/0972-5229.164806
Roberts, B. W., Kilgannon, J. H., Hunter, B. R., Puskarich, M. A., Shea, L., Donnino, M., Jones, C., Fuller, B. M., Kline, J. A., Jones, A. E., Shapiro, N. I., Abella, B. S., & Trzeciak, S. (2019). Association Between Elevated Mean Arterial Blood Pressure and Neurologic Outcome After Resuscitation From Cardiac Arrest: Results From a Multicenter Prospective Cohort Study. Critical care medicine, 47(1), 93–100. https://doi.org/10.1097/CCM.0000000000003474
