The american heart association explains the various medications for heart disease and cardiovascular conditions, such as anticoagulants, blood thinners, antiplatelet.
Post–cardiac arrest syndrome epidemiology, pathophysiology, treatment, and prognostication a consensus statement from the international liaison committee.
This chart graphically details the %dv that a serving of scallops provides for each of the nutrients of which it is a good, very good, or excellent source according. As we learned in the last article, gastroesophageal reflux disease (GERD) is an extremely prevalent condition in our society.
Since stomach acid plays a role in nutrient absorption, PPIs and other acid suppressing medications have a significant impact on vitamin and mineral absorption.  The literature reveals that absorption of various vitamins and minerals are impacted as a result of acid suppression. In fact, PPI therapy is so reliable in reducing iron absorption from food, it is now being used as a treatment for decreasing iron absorption from food in conditions of excess iron stores in the body called hemochromatosis. Another recent review of 4 cases examined the clinical consequences and mechanisms of electrolyte disorders that resulted from the elderly patients taking a PPI for a period of 1 to 13 years.[227]  They developed severe low magnesium levels  with low calcium levels, hypoparathyroidism (low parathyroid hormone), and extremely low urinary calcium and magnesium excretion. In one study, when folate was given to achlorhydric patients (with no stomach acid) along with an HCl supplement, absorption of folate increased by 54%.[235]  Although there is currently no available research on PPI risk of malabsorption of other nutrients, given that gastrointestinal pH plays an important role in absorption of various vitamins and minerals, one has to consider the probability that the absorption of other nutrients are affected as well.
Iron deficiency after Roux-en-Y gastric bypass: insufficient iron absorption from oral ironsupplements.
If spontaneous circulation does not return after the first round of antiarrhythmic drug therapy, the resuscitation team must also endeavor to identify and treat the clinically relevant conditions causing or contributing to the cardiac arrest [see Table 7].
The optimal role and the exact benefit of antiarrhythmic medications in cardiac resuscitation are yet to be fully elucidated.
The prognosis for asystole is generally regarded as dismal unless the patient is hypothermic or there are other extenuating but treatable circumstances.
Even when the resuscitation is successful, the patient’s situation remains tenuous and continued meticulous patient care is essential. If the patient is hypotensive, appropriate blood pressure management depends on the presence or absence of fluid overload, as judged at the bedside.
Throughout the resuscitation, the team leader must speak with calmness and authority, and all resuscitations should be orchestrated with clarity and finesse. With nontraumatic cardiac arrest in the prehospital setting (assuming proper equipment and medications are available and no extenuating circumstances suggest otherwise), full resuscitation efforts take place at the scene of the arrest in preference to rapid transport to an emergency department. After all resuscitation attempts, the code-team captain should debrief the team so that all may learn from the experience. About 70% of your body’s iron is found in the red blood cells of your blood called hemoglobin and in muscle cells called myoglobin.
Your body uses 99% of its calcium to keep your bones and teeth strong, thereby supporting skeletal structure and function. It helps to maintain normal nerve and muscle function, supports a healthy immune system, keeps the heart beat steady, and helps bones remain strong. The low magnesium condition promptly resolved when the PPI therapy was stopped and recurred if the PPI therapy was reintroduced. One patient developed encephalopathy (brain dysfunction) after a collapse likely caused by cardiac arrhythmia. Effect of gastric acid secretion on intestinal phosphate and calcium absorption in normal subjects. Nephrol Dial Transplant.
Proton pump inhibitor, H2 antagonists, and risk of hip fracture: a large population-based study.


Proton-pump inhibitor use is not associated with osteoporosis or accelerated bone mineral density loss. Proton pump inhibitor use and the risk of small intestinal bacterial overgrowth: a meta-analysis. The sources of these symptoms may be complex but often times they have a cardiac electrical cause that can be cured. In theory, the interventions conducted to this point should have resulted in a perfusing rhythm.
Despite many years of routine use, there are no controlled studies demonstrating a survival benefit with lido-caine, versus placebo, in the management of VF or pulseless VT. According to AHA guidelines, either amiodarone or lidocaine is an acceptable initial antiarrhythmic drug for the treatment of patients with VF or pulseless VT that is unresponsive to initial shocks, CPR, airway management, and administration of epi-nephrine or vasopressin plus shocks. When the cardiac monitor indicates what should be a perfusing rhythm, the rescuer should immediately confirm that the patient has a palpable pulse.
If an antiar-rhythmic drug has not yet been administered, it is usually started at this point to prevent the recurrence of VF or pulseless VT. The resuscitated patient requires urgent transfer to the optimal site for continued definitive care.
If possible, the code captain should make clinical decisions without directly performing specific procedures. Clearly, the circumstances of the event, patient comor-bidities, the nature of the lethal arrhythmia, and the resuscitation team’s ability to correctly identify and treat potential contributing causes of the arrest are all important considerations.
A prehospital resuscitation that has been appropriately conducted but has not resulted in at least temporary return of spontaneous circulation to the patient may be discontinued. Finally, marked empathy and skill are needed to carefully and compassionately inform family members about the outcome of the resuscitation. The rest of the calcium in your body plays key roles in cell signaling, blood clotting, muscle contraction and nerve function but calcium levels for these functions is usually tightly-regulated. FDA News Release, May 25, 2010).  Since then, PPIs and other acid-suppressing medications have been shown in numerous studies to decrease calcium absorption [208, 212-214] with omeprazole causing a 41% decrease in one study [208] and long-term PPI usage has been increasingly associated with an increased occurrence of bone fractures. It also helps regulate blood glucose levels and aids in the production of energy and protein.  So anything that impacts magnesium, can potentially cause a wide range of symptoms related to the muscles, nerves, brain, heart, bone and the immune system.
The others had cardiac abnormalities identified by electrocardiogram.  Low potassium levels were considered the cause for these arrhythmias.
Vitamin B(12) deficiency associated with histamine(2)-receptor antagonists and a proton-pump inhibitor. Effect of short- and long-term treatment with omeprazole on the absorption and serum levels of cobalamin. Association of long-term proton pump inhibitor therapy with bone fractures and effects onabsorption of calcium, vitamin B12, iron, and magnesium. Jensen.  Association of Long-term Proton Pump Inhibitor Therapy with Bone Fractures and effects on Absorption of Calcium, Vitamin B12, Iron, and Magnesium. Effect of intragastric pH on the absorption of oral zinc acetate and zinc oxide in young healthy volunteers. Increased incidence of small intestinal bacterial overgrowth during proton pump inhibitor therapy. Systems biology analysis of omeprazole therapy in cirrhosis demonstrates significant shifts in gut microbiota composition and function.


Proton pump inhibitors induce changes in colonocyte gene expression that may affect Clostridium difficile infection. The code team must ask why this has not occurred and then attempt to answer this question as the resuscitation continues. If the patient’s clinical status suggests normovolemia or hypo-volemia, intravenous crystalloid boluses (in 250 to 500 ml increments) can be administered instead of dopamine to support adequate tissue perfusion.
Depending on the circumstances, this may be either the cardiac catheterization laboratory or the intensive care unit. Cardiac arrests are emotionally charged, but the leader must insist on a composed, orderly, and technically sound resuscitation.
Resuscitation efforts beyond 30 minutes without a return of spontaneous circulation are usually futile unless the cardiac arrest is confounded by intermittent or recurrent VF or pulseless VT, hypothermia, cold-water submersion, drug overdose, or other identified and readily treated contributing conditions.
The low potassium levels were believed to be due to excess potassium excretion by the body resulting from the low magnesium. Association of Long-term Proton Pump Inhibitor Therapy with Bone Fractures and effects on Absorption of Calcium, Vitamin B12, Iron, and Magnesium.
Emergency laboratory studies that may prove helpful include a stat ABG measurement and measurements of hemoglobin, potassium, magnesium, and blood glucose levels (most of which can be obtained from the ABG specimen).
Pulseless electrical activity encompasses any of several forms of organized electrical activity in the pulseless patient; these include (c) normal sinus rhythm, (d) junctional rhythm, (e) bradycardic junctional rhythm, and (f idioventricular rhythm. The two core drugs for PEA management are epinephrine (repeated every 3 to 5 minutes for as long as the patient is pulseless) and atropine (up to 3 mg over time if the PEA rhythm on the monitor is inappropriately slow).
The two core drugs for asystole management are epinephrine (repeated every 3 to 5 minutes for as long as the patient is pulseless) and atropine (up to 3 mg over time).
In patients who are regaining consciousness, their level of comfort mandates careful assessment and administration of analgesia and sedation, as appropriate. If the perfusing postarrest arrhythmia is an idioventricular rhythm or third-degree heart block accompanied by an idioventricular escape rhythm, an antiarrhythmic medication should not be started at this time, because the antiarrhythmic agent could eliminate the ventricular perfusing focus and return the patient to a pulseless state. It is appropriate to invite suggestions from team members and to ensure that all members are comfortable with the decision to stop the resuscitation, should that time arrive. The decision whether to cease resuscitation efforts in the field is bolstered by direct discussion with EMS physicians. If any images that appear on the website are in Violation of Copyright Law or if you own copyrights over any of them and do not agree with it being shown here, please also contact us and We will remove the offending information as soon as possible..
Although not currently on the AHA PEA algorithm, vaso-pressin is probably a reasonable alternative to epinephrine. As with PEA, vasopressin appears to be a reasonable and possibly beneficial substitute for epinephrine in asystole. It is also essential that social services be available to provide immediate assistance and support to the family and loved ones of the patient who has now died.
The best hope for a successful resuscitation is to find and treat the cause of PEA; therein lies the exceptionally challenging aspect of PEA resuscitation management [see Tables 6 and 7].




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