Subdued POTD Weds

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Today there will be no caps lock, no colors, no pizzazz. Just down to brass tax. That patient that we didn't give Apneic Oxygenation to the other day, coded. Boom. Dead. Asystole. Hasta la vista baby. Now we're coding him.

Epi, push push push, epi, push push push.

PULSE CHECK (sorry that called for all caps). Check the monitor, feel for pulse....get the ultrasound?

Maybe we shouldn't be getting the ultrasound routinely. A recent study showed pretty much what we all know. It showed that pauses in ACLS using POCUS echo were significantly longer than those without. While they didn't study patient mortality/mobility or outcomes, the results speak for themselves. We are taught longer the pause in CPR the lower the mean cardiac arterial pressure.

RESULTS Duration of Pulse Check: Without POCUS: 13.0 seconds (95% CI of 12-15) With POCUS: 21.0 seconds (95% CI of 18-24) p <0.001

Study was done prospectively with videos being reviewed of the cardiac arrests by a 3rd party. It wasn't controlled for POCUS user training (intern vs 3rd year vs attending).

Whether this changes your practice or not (I think this is pretty intuitive and not hugely practice changing), but maybe it serves to remind you that if you take a pause to take a look at the heart, don't spend to long trying to get a perfect picture. Maybe only take a look in the beginning of a code (rule out tamponade or R heart dilation, both problems that need to be fixed), or at the end of a code (to confirm cardiac standstill)