Emergency medical services
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Historically, epinephrine has been used in the treatment of cardiac arrest for its alpha effects of peripheral vasoconstriction to promote vital organ perfusion. Unfortunately, epinephrine, like many other pharmacological agents, targets other receptor sites that can have a detrimental effect on the patient in cardiac arrest. ⋯ The newest data on the impact of vasopressin in cardiac arrest is promising. Further studies are required to determine if vasopressin has a significantly positive impact in outcome as measured by discharge of the neurologically intact patient in the North American EMS model.
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The excellent safety profile of ketamine has made it the drug of choice for both pediatric sedation and much veterinary medicine. Fortunately, this safety record also means that few patients who deliberately overdose during recreational use will have substantial morbidity or mortality. Most morbidity and mortality will occur from accidents during the induced dysphoric state. Since vomiting occurs with high doses, aspiration is a distinct possibility in the deeply comatose patient.