# Vasopressin Vs. Epi



## Sasha (Jan 28, 2009)

Today in class we were discussing Epi Vs. Vasopressin, all the medic instructors were in agreement that they don't like vasopressin, and only one had it in their local protocol. However vasopressin seems to have more positive effects than just epi alone.
*Vasopressin Vs. Epinephrine*
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2447575


> Vasopressin also has a vasoconstrictive action in the vascular network of the skeletal muscles, bowel, fat tissue, skin and, to a lesser degree, the coronary and renal vessels, while it causes vasodilation in the brain vessels. This results in an increase of the coronary perfusion pressure and, in general, an increase of blood flow to the vital organs without causing a dramatic increase in the myocardial oxygen consumption



And seems to be more successful than just epi alone.


> *Methods*
> Ventricular fibrillation was induced in 22 Landrace/Large-White piglets, which were left untreated for 8 minutes before attempted resuscitation with precordial compression, mechanical ventilation and electrical defibrillation. Animals were randomized into 2 groups during cardiopulmonary resuscitation: 11 animals who received saline as placebo (20 ml dilution, bolus) + epinephrine (0.02 mg/kg) (Epi group); and 11 animals who received vasopressin (0.4 IU/kg/20 ml dilution, bolus) + epinephrine (0.02 mg/kg) (Vaso-Epi group). Electrical defibrillation was attempted after 10 minutes of ventricular fibrillation.
> 
> 
> ...



I'm curious to know how many people's protocols use vasopressin and if it's a drug they feel is effective in their experience.


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## dmiracco (Jan 28, 2009)

The last study I read stated that there wasnt any data that suggested one was better than the other. My service does not carry it because I personally feel it is not cost effective to carry both. If you take into considertaion that usually you will still have to give epi after vasopressin, ie. a cardiac arrest that is worked for longer than 20 minutes, and you usually have to draw up the vasopressin vs prefilled epi I think that its not clinically sound to carry both. My opinion is from the evidence based medicine that I am aware of. 
I think its a moo point to carry both but there is a handful of EMS services that I know that carry both.


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## Sasha (Jan 28, 2009)

I'm aware that Vasopressin is just a one time dose and you still have to use epi, but as oppose to epi alone, granted I haven't spent a long time researching it but the few studies I've read have been positive. How much more expensive is Vasopressin?


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## Ridryder911 (Jan 28, 2009)

Cardiologist tend to disagree. One of our premier Heart Hospitals that perform a lot of research found that Vasopressin was one of the few drugs that did work; but the dosage was almost doubled than the recommended dosage. They as well believe ACLS form AHA is a joke.

Personally, I have found Vasopressin much more active in producing fine V-fib to course V-fib and as well, one does not have to repeat every 3 minutes alike Epi as the first round. One can prepare the patient for transport and by that time, it is ready to transport. 

R/r 911


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## dmiracco (Jan 28, 2009)

It was The New England Journal of Medicine july 2008 study that found this conclusion


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## Sasha (Jan 28, 2009)

dmiracco said:


> It was The New England Journal of Medicine july 2008 study that found this conclusion



Do you by chance have a link to that study? I'd like to read it!


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## rhan101277 (Jan 29, 2009)

I feel bad for the 22 Landrace/Large-White piglets.


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## Aidey (Jan 29, 2009)

I've never used Vasopressin, but I've heard about several studies that indicated that Vasopressin and Epi had statistically equal patient discharge rates. Essentially, it didn't matter if the patient was given Vasopressin or Epi, the same number of patients lived long enough to be discharged from the hospital. 

I was also told that they had changed ACLS and that now you can give Vasopressin instead of the first or second dose of Epi, but you also keep giving Epi q3-5. Has anyone else heard this?


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## jrm818 (Jan 29, 2009)

Sasha, here's the NEJM study

http://content.nejm.org/cgi/content/abstract/350/2/105

There's another one from 04 that was referenced in this one - found that VP was better than EPI for systole, no significant difference in any other dysrythmia.  

Differences between the two:

the 04 article has less stastical power than the 08 article (or so they claim, I'm not enough of a stastician to disagree)

Apparently there is a big difference in AED usage as well.  The 08 trial was done in France, and I guess they have a really good AED access program.  Thus the observed instances of Vfib in that trial were lower, but I can also envision that many patients who might have progressed from vfib to asystole before ALS got on scene were converted early and possibly prevented from going asystolic in the 08 study...that tampers with the number some.


still, interpreting these data can be difficult - there is much data in conflict.  Porcine studies seem to like VP alone or in combination, and have the strength of being well controlled studies but the drawbacks of variable physiology when compared to humans.  Human studies aren't quite so well controlled but are done in humans, and are pretty variable.  Once again, they confirm good CPR and early defib. are key...the difference between VP and EPI may be a drop in the bucket in the end.

By the way, I have issues with the "control" group used in the porcine study cited by Sasha (and several others on the same topic).  I think there should have been an additional group with an increased EPI dosage to control for the possibility that better VP outcomes were simply due to additive generic pressor effects, rather than a specific effect of VP.  Instead the study compared a single pressor dosage (EPI) to that pressor dosage plus a dosage of another pressor (VP).  eh.


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## Ridryder911 (Jan 29, 2009)

Aidey said:


> I've never used Vasopressin, but I've heard about several studies that indicated that Vasopressin and Epi had statistically equal patient discharge rates. Essentially, it didn't matter if the patient was given Vasopressin or Epi, the same number of patients lived long enough to be discharged from the hospital.
> 
> I was also told that they had changed ACLS and that now you can give Vasopressin instead of the first or second dose of Epi, but you also keep giving Epi q3-5. Has anyone else heard this?



The normal dosage is 40 units of Vasopressin IV, and one can hold Epi up to 10 minutes. Then start administering Epi q 5 minutes, as I described in my previous post. This buys time to prepare the patient for transport and then one can administer the Epi while enroute. 

p.s. : High dosage of Epi have been proven to be futile as well. 

R/r 911


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## Veneficus (Jan 29, 2009)

Ridryder911 said:


> The normal dosage is 40 units of Vasopressin IV, and one can hold Epi up to 10 minutes. Then start administering Epi q 5 minutes, as I described in my previous post. This buys time to prepare the patient for transport and then one can administer the Epi while enroute.
> 
> p.s. : High dosage of Epi have been proven to be futile as well.
> 
> R/r 911



But rid, once my cousin's uncle's nephew's brother's roomate saw high dose epi work when combined with MAST and 12L of infused saline 

Sorry I couldn't resist. h34r:

But about ACLS from AHA, what I tell the students in ACLS, PALS, and all those other courses. It is not advanced, it is not critical care medicine. It is what to do when you have some toys and are waiting for somebody who really knows what to do.

As for vaso vs. epi, they both have their place.


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## fma08 (Jan 29, 2009)

Just my personal experience... The one time I used Vaso in a code, we got the patient back. The times with epi alone, we didn't. (real scientific I know) Another question, we carried vaso in two 20u vials. Do they even sell it in a 40u vial or pre-filled syringe?


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## Aidey (Jan 29, 2009)

Ridryder911 said:


> The normal dosage is 40 units of Vasopressin IV, and one can hold Epi up to 10 minutes. Then start administering Epi q 5 minutes, as I described in my previous post. This buys time to prepare the patient for transport and then one can administer the Epi while enroute.



I'm sorry, I don't think I explained clearly. They were saying the Vaso counted as a dose of Epi, and there was no wait time anymore. You gave the Vaso, and kept the normal Epi every 3-5 minute schedule after that. 

Now that I think about it, the three times I've had ACLS they've changed the Vasopressin recommendations. The first time I took it we were taught to give the 40 units of Vasopressin and we didn't have to give Epi again unless the code was more than 40 minutes. Then we were taught to give the Vasopressin, but start giving Epi after 20 minutes. Now I've been told to give the Vasopressin and then just keep giving Epi on scheudle. I wish they would make up their minds!


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## emtbill (Jan 29, 2009)

I use vasopressin exclusively as the first line pressor in the cardiac arrests I work, then epi at the appropriate time. In all of the prehospital arrests I have been on that were worked ALS, those patients who were given vasopressin regained a pulse. That's evidence enough for me to use it.

As for the dosage, I can tell you that a progressive OMD for an agency in northern Virginia has his providers give 80 units of vasopressin every 5 minutes throughout the arrest exclusively. Contrast this to AHA's recommendation of 40 units once with another pressor given only after at least 8-10 minutes have passed.


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## emtjack02 (Jan 29, 2009)

I remember reading a paper that said there was a thearetical benefit for using vasopressin for asystole but not a lot of data.   I do enjoy that AHA has switched their recommendations so many times.  A lot of the people I work with forget that it can be used as the 2nd or 3rd epi dose w/ no need to wait longer than the 3-5m.  I have seen it work once or twice.  I do not believe they make it in a preject or in a 40u vial...you'd think they would.


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## medic5740 (Feb 11, 2009)

*ACLS a Joke?*

While I realize that ACLS may not be the best treatment protocol in the world for all providers, I have a problem describing it as a joke.  

Two questions that have are below.  Aren't the decisions made by the AHA made by cardiologists?  What other program would you suggest for paramedics, nurses, and even non-emergency physicians?

I realize that the 12-lead may be available in some places and not available in others.  If your medics don't have 12-lead and can't read them, isn't ACLS about all they have left?


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## Veneficus (Feb 11, 2009)

medic5740 said:


> While I realize that ACLS may not be the best treatment protocol in the world for all providers, I have a problem describing it as a joke.
> 
> Two questions that have are below.  Aren't the decisions made by the AHA made by cardiologists?  What other program would you suggest for paramedics, nurses, and even non-emergency physicians?
> 
> I realize that the 12-lead may be available in some places and not available in others.  If your medics don't have 12-lead and can't read them, isn't ACLS about all they have left?



I am not saying ACLS is a joke. What it is used for is imparting the basic information about cardiac emergencies that medical providers that use certain pieces of equipment. What is not supported by scientific research (for whatever reason) standards are made by consensus. Which many times in science has been proven faulty. (Pluto was once a planet) you are right, it is what we have, but it should not be mistaken for true expertise. The vast amount of knowledge required to make ACLS less of a skill set and more of an education cannot be done in 16 weeks, much less 16 hours.

Even the EP class requires knowledge beyond what is taught in national curriculum paramedic classes and the providers you see there are at the very least self educated to a higher standard or have considerable experience. Infact the only 2 medics in the last EP class I was involved in had >16 years experience each. Intending them no disrespect, they were completely lost when we discussed acid/base balance. They were also the only providers (among docs, RNs, and RRTs) arguing for high flow o2 on all patients.


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## Ridryder911 (Feb 11, 2009)

I'll say it and will ask others to prove me wrong. AHA ACLS course is a joke!... As one of the first non-physician ACLS instructors now over 28 years, I can attest the courses are not adequate for providers. I administered the test to our hospital janitor and he passed! Now, would you support this course to ensure a provider? 

Where did we ever come up with the idea that all those entered the classroom gets to touch patients? The world is harsh, and *NO* not everyone can be an astronaut nor an emergency care provider. 

To answer your questions you asked: 

*NO!* Not all the physicians making the decisions are cardiologist. Thank God! Ever seen a cardiologist run a code... talk about a cluster! As well, many of the cardiologists I have ever met despise AHA and definitely believe ACLS is a joke. Most of the views I have heard was that it now gives a "false security" that many assume they actually know about emergency resuscitation   measures and cardiology; when in fact they don't. 

What other programs? Instead of diversifying and making multiple courses; let's go back and have one good one. Again in lieu of having money making courses such as the : experienced provider, an advanced airway course, I/O and so on to make more profits, go back to having a credible course. Yes, many might fail... well, so what? They probably should not be performing care then. 

Performing and reading ECG is just *ONE* part of ACLS. Kinda like knowing how to  take a blood pressure is not really knowing medicine. If your medics do not know how to assess, obtain a detailed and accurate history, then be able to diagnose and treat an AMI without a XII lead, then they should not be medics. 

R/r 911


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## Veneficus (Feb 11, 2009)

Ridryder911 said:


> I'll say it and will ask others to prove me wrong. AHA ACLS course is a joke!... As one of the first non-physician ACLS instructors now over 28 years, I can attest the courses are not adequate for providers. I administered the test to our hospital janitor and he passed! Now, would you support this course to ensure a provider?



Rid,

I haven't been an instructor as long as you, but I am not new either. I think the new ACLS is trying to spend some time retraining providers in psychomotor skills/old habits that new science has proven ineffective or harmful. Yes, the test is easy, but I do not think it was meant to be a measure of knowledge. It is sort of like a fire drill. When the alarm goes off can you follow a few simple steps in order to give a patient a chance. Not the best chance, but better than nothing.

Also please consider that not everyone who has to take ACLS, PALS, or any of the other 2 day courses will ever have call to use it. How many providers who work in a doctor's office or non acute setting have we had to teach over the years who are required to have current cert but have never had an emergency in 30 years on the job? (I have had more than a few and I am sure you have had more than me) Truthfully, how many of those people would even remember 5% of what was taught if we extended the course curriculum if they were called upon to use it?

You are 100% right, not everyone is capable of seeing patients. Even fewer are capable of meeting the demands emergent patients place on providers.

We taught one of our janitors how to diagnose STEMI on a 12 lead in a shift. How many providers think that is a complex skill and leave it to the machine to read?

Saying "ACLS is a joke" is not fair, but providers should not hold onto the idea that it is resuscitation education either.(fault the provider not the course) It would be the same as calling yourself a firefighter because somebody let you practice spraying a fire extinguisher after you read and got tested on the directions.


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## triemal04 (Feb 11, 2009)

Rid and Veneficus-

I asked this once before and didn't get a responce, so here goes again.  While paramedic education is lacking in this country, how much of ACLS being dumbed down into the crap that it is now is JCAHO responsible for?  I experienced the same thing in the last class that I took that Veneficus alluded to; people who will never, EVER need the skills and knowledge taught in ACLS being REQUIRED to take the class because of JCAHO statutes.  As well, many of these people don't have the background to pick up the course content in a whopping 16 hours.  Have to wonder: with the course being required for so many people (that it shouldn't be required for) was the content dumbed down just to ensure a good passing rate so that it would remain the standard?


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## Veneficus (Feb 11, 2009)

triemal04 said:


> Rid and Veneficus-
> 
> I asked this once before and didn't get a responce, so here goes again.  While paramedic education is lacking in this country, how much of ACLS being dumbed down into the crap that it is now is JCAHO responsible for?  I experienced the same thing in the last class that I took that Veneficus alluded to; people who will never, EVER need the skills and knowledge taught in ACLS being REQUIRED to take the class because of JCAHO statutes.  As well, many of these people don't have the background to pick up the course content in a whopping 16 hours.  Have to wonder: with the course being required for so many people (that it shouldn't be required for) was the content dumbed down just to ensure a good passing rate so that it would remain the standard?



I can only answer your question with my opinion as I have no knowledge of JCAHO's inner workings or if they have any relationship to AHA, but here goes.

All providers should be trained to provide a basic response in an emergency. In most medical facilities there is equipment on hand. (code carts, manual defibs, etc) If you do not use AHA somebody has to come up with an entrely new course and go through the steps to have it nationally accedited. (You can bet anyone doing that will make money off of it, so that is a moot issue)

If you took an ACLS or similar course between 2000 and 2005 it was a change from earlier (tougher) standards. There was hope that making it less stressful and team oriented providers would have more success. That turned out to be wrong. People became too lax and were not regularly performing to standards on actual patients. The current course is set up to drill the basics into providers. Psychologists call it classical conditioning. (Pavlov would be proud) I expect in the 2010 guidlines, if not before, there will be another shift towards theory. The EP course adds a little for the people who routinely use these skills or are involved in emergency or critical care regularly. But it assumes you already know the science and medicine so you can be an active participant in the discussions. 

I would guess JCAHO required AHA out of convenience. I do not think AHA "dumbed down" the course for JCAHO.


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## TomB (Feb 11, 2009)

Veneficus said:


> We taught one of our janitors how to diagnose STEMI on a 12 lead in a shift. How many providers think that is a complex skill and leave it to the machine to read?



Recognizing a home run STEMI is easy, and yes a child could do it.

On the other hand, identifying ST segment elevation that is not STEMI can be difficult, and that's the real issue.

So yes, 12 lead ECG interpretation is a complex skill.


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## triemal04 (Feb 11, 2009)

I don't know.  When large numbers of people are required to take a class that they are not prepared for and will very, very likely never use, it could be argued that the content will very often change, simply because of the large numbers of people who are failing the class.  I guess that's what I'm curious about; so many people I talked to in my last class were there soley because it was required by JCAHO, and those were the people that were (admittedly in several cases) way out of their depth.  Not their fault; just that ACLS is something they were never exposed to.  If the standards had been even what they were 6 years ago when I took my first class, there is no way they could have passed.  But based on the how AHA teaches the class, their performance and knowledge was deemed acceptable.  (and the most recent class I took was much, much more "team" oriented that the previous one)

Again, I don't know.  But, it seems like when large numbers of people are required to do something/know something that is not applicable to their job, the way that they learn those things suffers.


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## Ridryder911 (Feb 11, 2009)

I understand the view but still to acclaim that Advanced Cardiac Life Support; one should understand that. It is not all psychomotor skills. True, JCAHO has recommended all nurses and code teams have knowledge in resuscitation measures. This does NOT mean that they should have watered down the curriculum. 

If they were able to develop new courses, then they should have developed one for those that "might happen" upon a code. True cardiac arrest and resuscitation measures are usually a cluster in any hospital setting. Yet, to acclaim have knowledge in Advanced Cardiac Life Support; one should be knowledgeable in such. 

The original ACLS was developed to ensure all were on an equal playing field. If one seen an ACLS insignia on the uniform, one could be assure they knew cardiology and definitely emergency resuscitation measures. In fact, I know of some areas automatically grandfathered one as a Paramedic when they passed the ACLS course. Of course, this was when one was expected to know oxyhemoglobin curve and how to establish a central line also. 

Now, when I hear someone completing an ACLS course, it means nothing to me. As one cannot fail it only to be re-mediated basically until they pass. So how weight does it mean? This is why me and so many others are recommending the termination of requiring ACLS as a re-registry requirement. 


R/r 911


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## VentMedic (Feb 11, 2009)

triemal04 said:


> so many people I talked to in my last class were there soley because it was required by JCAHO, and those were the people that were (admittedly in several cases) way out of their depth.


 
JCAHO does not specifically require ACLS but does require training appropriate for the work area. If the people in your class had a work place requirement to require ACLS, JCAHO is looking at how well they adhere to their own standards.   They could also write for the specific training without the ACLS card requirement.

Many code and rapid response teams teach resuscitation with the AHA guidelines but with their own information and equipment specific to the hospital's needs. 

The same goes for PALS. There is nothing worst then having experience PICU staff members attempt to sit through the PALS course unless it is taught onsite by people who know the needs of the team and make an effort to teach the guidelines without it sounding like a bedtime story meant for children.


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## MedicReneeInstructor (Feb 13, 2009)

My squad doesn't carry vasopressin for a few reasons, the cost and it's a quick and easy dose.  From dr's that I have talked with, in our setting which is a rural setting, the vasopressin won't help much because by the time we are called the patient is usually out of v-fib.   If it's a witnessed arrest the vasopressin might be a better choice in place of the first two rounds of Epi.  In that respect I can see why city or big city ambulances might carry it.


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## Sasha (Feb 13, 2009)

MedicReneeInstructor said:


> My squad doesn't carry vasopressin for a few reasons, the cost and it's a quick and easy dose.  From dr's that I have talked with, in our setting which is a rural setting, the vasopressin won't help much because by the time we are called the patient is usually out of v-fib.   If it's a witnessed arrest the vasopressin might be a better choice in place of the first two rounds of Epi.  In that respect I can see why city or big city ambulances might carry it.



Vasopressin is only for vfib?


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## MedicReneeInstructor (Feb 13, 2009)

Sasha said:


> Vasopressin is only for vfib?



I'm sorry no.  My mind was centered on just v-fib for some odd reason.  LOL   =)  Vasopressin is also used for V-tach.  =)   It has also been used to stop GI bleeds and in Diabetes Insipidus but for the Medic it's used in a cardiac incident which involves v-tach or v-fib.  =)


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## Sasha (Feb 13, 2009)

MedicReneeInstructor said:


> I'm sorry no.  My mind was centered on just v-fib for some odd reason.  LOL   =)  Vasopressin is also used for V-tach.  =)   It has also been used to stop GI bleeds and in Diabetes Insipidus but for the Medic it's used in a cardiac incident which involves v-tach or v-fib.  =)



I was under the impression that anytime soemone was in cardiac arrest. Asystole and the like, that you could use Vasopressin instead of the first dose of epi.


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## medic417 (Feb 13, 2009)

Sasha said:


> I was under the impression that anytime soemone was in cardiac arrest. Asystole and the like, that you could use Vasopressin instead of the first dose of epi.



It can replace either the first or second dose of Epi.  You give 40 U one time then return to Epi 1mg next time around.


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## triemal04 (Feb 13, 2009)

Sasha said:


> I was under the impression that anytime soemone was in cardiac arrest. Asystole and the like, that you could use Vasopressin instead of the first dose of epi.


You do, although it has more uses than just that.  A couple of studies have shown that it's actually more effective in asystole/PEA than in vfib/vtach as well though I believe most areas that have it use it for all codes.  As well, AHA has changed it's stance on vasopressin to treating it the same as epi; use one or the other, instead of always vasopressin first.


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## MedicReneeInstructor (Feb 13, 2009)

Sasha said:


> I was under the impression that anytime soemone was in cardiac arrest. Asystole and the like, that you could use Vasopressin instead of the first dose of epi.



Yes, you can replace for any pulseless rhythm the first two doses of Epi (1mg) with 40u Vasopressin.


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## medic5740 (Feb 13, 2009)

*If not ACLS, then what?*

Okay, so the treatment protocols are not the best in AHA ACLS.  Let's say that is true to consider the alternative.  Where is the alternative?  Where is the alternative to AHA PALS?  Where is the alternative to ITLS, PHTLS, PEEP, and a myriad of other programs.  It's fine to tear them apart, degrade them, and belittle those certified in providing care based upon those programs.  BUT what do you have to offer in place of those?  They are the programs that are available nationally.  Where are the national organizations to design better programs?  Why are we educating healthcare providers with the "wrong" treatment protocols, and where are the programs with the "right" treatment protocols?


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## VentMedic (Feb 13, 2009)

medic5740 said:


> Okay, so the treatment protocols are not the best in AHA ACLS. Let's say that is true to consider the alternative. Where is the alternative? Where is the alternative to AHA PALS? Where is the alternative to ITLS, PHTLS, PEEP, and a myriad of other programs. It's fine to tear them apart, degrade them, and belittle those certified in providing care based upon those programs. BUT what do you have to offer in place of those? They are the programs that are available nationally. Where are the national organizations to design better programs? Why are we educating healthcare providers with the "wrong" treatment protocols, and where are the programs with the "right" treatment protocols?


 
Many hospitals and specialty teams do have their own protocols and guidelines written by their medical director for specific types of patients. Examples: Vasopressin and use in children with specific diseases and transplants or both adults and children with LVADs or congenital defects

Both vasopressin and epinephrine have multiple applications in various protocols for different patients.

Blanket recipes do not always fit every patient. For prehospital, you may have to use the accepted guidelines because you are dealing with the unknown patient most of the time. 

AHA ACLS just does the research for what might be the broadest and easiest guidelines with the data available. The facilities that are active in the research may have moved on to other drugs and protocols that may become the future of the next ACLS set of guidelines.

There are many national organizations that are involved with the AHA and are not always in agreement with the published guidelines particularly in the area of pediatrics. Thus, you get NRP and STABLE as additional algorithms from the other associations for more specific treatment. 

Then you also have the European Cardiology Societies as well as the NZ/Australia associations which do their own research. Some are in agreement with the U.S. and some vary. Other examples can be some of the dissimilarities between the Canadian, European and NZ/Australian Societies for Pulmonary medicine. Often the differences will lie in the drug therapy and technology since other countries have access to meds and advanced equipment long before the U.S.

Just more reasons why I encourage people to read the medical journals and not only JEMS. You might be the first to know in your neighborhood what the future will hold for the next set of guidelines and protocols.


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## Veneficus (Feb 13, 2009)

medic5740 said:


> Okay, so the treatment protocols are not the best in AHA ACLS.  Let's say that is true to consider the alternative.  Where is the alternative?  Where is the alternative to AHA PALS?  Where is the alternative to ITLS, PHTLS, PEEP, and a myriad of other programs.  It's fine to tear them apart, degrade them, and belittle those certified in providing care based upon those programs.  BUT what do you have to offer in place of those?  They are the programs that are available nationally.  Where are the national organizations to design better programs?  Why are we educating healthcare providers with the "wrong" treatment protocols, and where are the programs with the "right" treatment protocols?



I think ACLS and the some other similar courses are good for what they are designed for. We must understand that it is not meant to be a substitute or replacement for a deeper understanding of the material or the ability to know when/how to deviate from the guidlines.

If I didn't think they had value I wouldn't be an instructor. (which is why I don't teach ITLS or PHTLS. Anyone capable of sitting in one of those classes can sit in ATLS) Some will flip out and complain how they don't know how or are not permitted to read x-rays, but how many providers who take ACLS or PALS are not permitted to intubate? We managed to address that quite well.


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## TomB (Feb 14, 2009)

In the November 2008 EMCast at EMedHome.com, Amal Mattu M.D. makes the case that cardiac arrest patients receive no benefit from Vasopressin and may have worse neurological outcomes when compared with Epinephrine (regardless of rhythm).


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## CurbDoc70 (Mar 12, 2009)

Yep, the biggest advantage to Vaso I know of is the 10 minutes it buys you to get your *** to the truck.


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## jason152318 (Mar 22, 2009)

The good thing about epi is it will hopefully increase the chances of producing a shockable rhythm. Along with its other actions. vasopressin has been studied by the AHA and has shown to have strong effects. It depends on the problem that is causing the crdiac arrest.


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## 8jimi8 (Mar 29, 2009)

One ACLS instructor that I spoke with preferred vasopressin first because of its peripheral effects.  He explained that a heart in AMI is already oxygen starved and that epinephrine only made it work harder.  Seems logical to me.


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## Ridryder911 (Mar 29, 2009)

I was informed that Vasopressin has had some remarkable outcomes in pediatric arrest and to look for some changes in the new PALS. As well, Amiodarone has had some very disappointing outcomes and to look at it as the new Bretylium. 

R/r 911


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## reaper (Mar 30, 2009)

8jimi8 said:


> One ACLS instructor that I spoke with preferred vasopressin first because of its peripheral effects.  He explained that a heart in AMI is already oxygen starved and that epinephrine only made it work harder.  Seems logical to me.



I would hope that Epi would make a heart work harder in an AMI! Why would you give Epi or Vaso to a pt with an AMI?


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## reaper (Mar 30, 2009)

That would be nice. I have never been found of Amiodarone any ways!


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