AHA Evidence Based Guidelines.ppt

AHA Evidence Based Guidelines How to proceed with scant evidence Levels of Evidence 1 Levels of Recommendation AHA Guidelines Cocaine-Induced Ventricular Dysrhythmias Recommended Therapies, Ordered By Preference: Sodium Bicarbonate (IIB), Lidocaine (IIB), Alpha Adrenergic Blockers (IIB) Inappropriate Therapies: Non-Selective Beta Blockers, Epinephrine (Both III) Cocaine-Induced Acute Coronary Syndrome (ACS) Recommended Therapies, Ordered by Preference: Benzodiazepines (IIB), Nitrates (IIB), Alpha-Adrenergic Antagonists (IIB) Inappropriate Therapies: Non-Selective Beta-Blockers (III) AHA Guidelines Calcium Channel Blocker Poisoning or Overdose Recommended Therapies, Ordered By Preference: Pacemaker, Vasopressors, High-Dose If Necessary(IIB), Calcium (IIB) Beta-Blocker Poisoning or Overdose Recommended Therapies, Ordered By Preference: Pacemaker, Vasopressors, High-Dose If Necessary (IIB), Glucagon (IIB) AHA Guidelines Tricyclic Antidepressant Poisonings Recommended Therapies, Ordered By Preference: Sodium Bicarbonate (IIB), Lidocaine Inappropriate Therapies: Procainamide (III) Refractory Drug-Induced Shock High-Dose Vasopressors (IIB), Circulatory Assist Devices (IIB), Vasopressin (Indeterminate) Opiate Poisoning: Ventilation before Naloxone?  Dr Andrew Dawson Director Hunter Area Toxicology Service Newcastle, Australia Opiate Poisoning: Ventilation before Naloxone? “Evidence supports the correction of respiratory failure with bag valve mask techniques followed by administration of naloxone in any patient suspected of opioid induced respiratory failure.” Are all clinical situations the same? 24 year male recreational heroin OD 75 year male IHD post operative narcosis 24 year old post heroin OD respiratory arrest being ventilated Naloxone Ventilation Grid Naloxone: Efficacy Animal Good controlled studies Clinical data Anaesthetic Good controlled studies Clinical Toxicology Case series indirectly address the issues Naloxone: Risk Incidence of possible ADR 1%