1

HypothesisHypothesis

Does the AHA encourage the inadvertent administration of epinephrine 1mg (1:10,000) IV bolus in the treatment of symptomatic bradycardia?

2

MethodsMethods

n= 738

Eighty-two teams of 9

Subjects were selected from students coming in randomly for ACLS Refresher training.

Teams were formed into a control group (n=41) and study group (n=41).

3

MethodsMethods

The control group received unaltered AHA crash cart cards to perform their resuscitation practice.

Each team was presented with a scenario of sinus bradycardia with poor perfusion.

Each team was allowed to follow the sinus bradycardia algorithm without interference.

4

MethodsMethods

Team leadership and individual skills were observed using video tape and SimMan event logs printed for each of the sinus bradycardia scenarios.

Each time epinephrine 1mg (1:10,000) was requested, it was documented.

Each time epinephrine 1mg (1:10,000) was administered, it was documented.

5

MethodsMethods

The study group received altered AHA crash cart cards to perform their resuscitation practice with epinephrine unbolded.

Each team was presented with a scenario of sinus bradycardia with poor perfusion.

Each team was allowed to follow the sinus bradycardia algorithm without interference.

6

MethodsMethods

Team leadership and individual skills were observed using video tape and SimMan event logs printed for each of the sinus bradycardia scenarios.

Each time epinephrine 1mg (1:10,000) was requested, it was documented.

Each time epinephrine 1mg (1:10,000) was administered, it was documented.

7

ResultsResults

In the group using the unaltered algorithm, epi 1mg was requested about 20% of the time and administered to the simulated patient about 10% of the time.

Poster Presentation 2010 IMHS

8

ResultsResults

In the study group using the altered algorithm with epinephrine unbolded, it was requested 5%, and administered 2% of the time in the simulated patient.

9

ConclusionConclusion

These findings suggest that the current format of the AHA bradycardia algorithm may cause sufficient confusion that the inadvertent administration of IV epinephrine 1mg (1:10,000) may result during treatment of symptomatic bradycardia in a simulated patient.

10

ConclusionConclusion

Simply unbolding the epinephrine reference may be all that is required to mitigate that confusion.