Friday October 2, 2009


Following pearl contributed by:

Tony Halat, MD
Clinical Instructor in Medicine
Department of Medicine, The Methodist Hospital

Weill Medical College, Cornell University

Limited codes do not work
There is no such thing as soft code

A study looked at the outcome of limited codes in which certain treatments were intentionally not provided versus full ACLS protocol codes. These limited codes had a much lower survival rate than those run with no such limitations (29.4% vs 58.6% p=0.023)

The authors concluded that limited codes have lower rates of survival and this information should be conveyed to patients and families when making decisions about code status.

Reference: click to get abstract

Analysis of limited resuscitations in patients suffering in-hospital cardiac arrest - Resuscitation. 2009 Sep;80(9):985-9. Epub 2009 Jul 5

Thursday October 1, 2009
Clonidine and Bradycardia!

Clonidine is a alpha adrenergic agonist with sympatholytic activity and has been used for various clinical indications beside blood pressure control including treatment for migraines, menopausal complaints, narcotic and alcohol withdrawal symptoms, spasticity after spinal cord injury, attention-deficit hyperactivity disorder as well as rate control for atrial fibrillation.

Mechanism of action: Symptomatic bradycardia is a side effect of clonidine which many times go ignored. Clonidine's central effect results in decreased sympathetic outflow and enhanced vagal tone, lowering blood pressure and heart rate. This also cause side effects of drowsiness, lethargy and dry mouth. Clonidine acts peripherally within the heart to inhibit norepinephrine release, contributing to further reductions in heart rate.

Risk factors: Patients at higher risk for clonidine-induced bradycardia seem to be those with an already-diseased conduction system, renal failure, high doses of clonidine, concomitant therapy with medications known to cause bradycardia or heart block, (eg, beta-blockers, verapamil, diltiazem, digoxin).

Treatment: For severe, symptomatic bradycardia, atropine can be used. For refractory symptomatic cases, isoproterenol, epinephrine, dopamine, and pacing may be required.