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

2. 2 Methods 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. 3 Methods 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. 4 Methods 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. 5 Methods 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. 6 Methods 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. 7 Results t 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. 8 Results 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. 9 Conclusion 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. 10 Conclusion Simply unbolding the epinephrine reference may be all that is required to mitigate that confusion.