Guidelines for mandating the use of ipsec

In unnaturally high doses—much higher than those needed for antidiuretic hormone effects—vasopressin acts as a nonadrenergic peripheral vasoconstrictor.Vasopressin acts by direct stimulation of smooth muscle V receptors.The “standard” dose of epinephrine (1.0 mg) is not based on body weight.Historically a standard dose of 1 mg epinephrine was used in surgical operating rooms for intracardiac injections.Continuous infusions of epinephrine should be administered by central venous access to reduce the risk of extravasation and to ensure good bioavailability.Vasopressin is the naturally occurring antidiuretic hormone.If the 1 mg epinephrine every 3 to 5 minutes seemed to be ineffective, the 1992 guidelines accepted the use of higher doses of epinephrine in either escalating doses (1, 3, 5 mg), intermediate doses (5 mg per dose rather than 1 mg), or high doses based on body weight (0.1 mg/kg).

Therefore, high-dose epinephrine is not recommended for but can be considered if 1-mg doses fail (Class Indeterminate. There is conflicting evidence for and against the use of higher doses of epinephrine (up to 0.2 mg/kg) in cardiac arrest when 1-mg doses have failed (Class IIb: acceptable but not recommended; weak supporting evidence).Initial or escalating high-dose epinephrine has occasionally improved initial ROSC and early survival.But 8 randomized clinical studies involving more than 9000 cardiac arrest patients have found no improvement in survival to hospital discharge or neurological outcome, even in subgroups with initial high-dose epinephrine, compared with standard doses.Retrospective studies, however, have suggested that high cumulative epinephrine dosage is associated with worse hemodynamic and neurological outcome, but they do not prove causal effect.Careful laboratory studies corroborate both beneficial and harmful physiological effects and outcomes.

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