Run Time: 5 minutes
Author: Christopher Holmes M.D.
- The New England Journal of Medicine produced a pamphlet in 1966 about the management of emergencies.
- Cardiac arrest treatment algorithm at that time consisted of a precordial thump, then artificial ventilation via mouth to mouth (as intubation wastes too much time), and then initiating compressions.
- The first line was to give epinephrine…by a cardiac needle directly into the cardiac muscle tissue every 3-5 minutes (Pulp Fiction style)! The next step was to perform a venous cut-down, instead of getting an IV. Then the standard of care was to give one amp of sodium bicarbonate every eight minutes!
- They also administered a medication called metaraminol (an alpha-agonist), 60 mg of levophed, and solu-cortef for each cardiac arrest.
- For the treatment of ventricular fibrillation, intracardiac epinephrine and calcium chloride would be given first and foremost. For defibrillation, the patient had a paste applied to their chest and were given 450 volts AC (which is 4 times the power of your home plug). For continued management, the patient was given procainamide, sodium bicarbonate, and made hypothermic.
Link to Podcast: http://medicalminute.madewithopinion.com/old-school-cpr/
References: For Subscribers: http://www.nejm.org/doi/pdf/10.1056/NEJM196607072750107