Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Changes to Pennsylvania Protocols – Post-Resuscitation Care – Part III

Continued from Part I and from Part II on Pennsylvania’s updated Post-resuscitation Care protocol.

Now for some of the good stuff to be found in this protocol.


Yellow highlights are changes in the protocol, even if only changed to clarify something.

Administer oxygen (titrate to minimum O2 needed to achieve SpO2 > 94%)[1]

It is nice to have the protocols acknowledge that –

Oxygen is a drug.

As with most drugs, oxygen should be titrated to effect. Oxygen, dextrose, fentanyl, midazolam, albuterol, amiodarone, calcium (chloride or gluconate), captopril, . . . to list just some of the medications in the protocols may be are titrated to effect.

There are some that should not really be titrated. Adenosine and atropine are two examples of drugs that will not have the desired effect if given slowly, or in partial doses. Diphenhydramine and atropine are drugs that can produce anticholinergic toxicity if given in large doses. Atropine has a therapeutic window. Too much or too little can produce significant adverse effects.

Finally, dextrose is not required to be given to adults at the harmful 50% concentration. Yay! 😀

Dextrose can produce significant problems at higher concentrations – and 50% is a very high concentration.

Rebound hypoglycemia, hyperglycemia, and extravasation necrosis are a few of the possible complications from 50% dextrose. Shouldn’t we be titrating the dextrose, rather than giving a full 25 gm, when the patient does not need 25 gm?

If we are giving 10% dextrose to adults, what sense does it make to give 25% dextrose to children? 😕

Footnotes:

[1] Post-Resuscitation Care
Pennsylvania Statewide Advanced Life Support Protocols
3080 – ALS – Adult/Peds
Pages 34-36/128
Free Full Text PDF of All ALS Protocols

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