BLS and ACLS guidelines... what would you change?

[redundantbassist]

As many of you know, the BLS guidelines will be updated in October. Hopefully it will bring a positive change to out of hospital cardiac arrest survival. But I figured it would be interesting to see what you guys would do if given the opportunity to modify the guidelines.
So... lets say you have a voice in the writing of the AHA's new CPR and ECC guidelines. You may modify any guideline you like (BLS for HCP, ACLS, PALS, even lay responder CPR/AED.) What would you change?

 

[NomadicMedic]

Continuous compressions, SGA placed by BLS. No transport for any arrest other than refractory VF/VT or cold water submersion. Work every arrest on scene until ROSC or termination.

I mean, really... It's all about compressions and early defib.

We screw up more arrests by mucking about with ET tubes and meds. It should be a focus on good, 100% full on BLS resuscitation untold ROSC or termination. Then we can start the ALS (if it's warranted).

 

[avdrummerboy]

I would emphasize and I believe that this is the way that it's going, B-L-S interventions above all else, good quality compressions and early defibrillation are what will matter! Also, what was said above sums it up quite nicely

 

[redundantbassist]

Continuous compressions, SGA placed by BLS. No transport for any arrest other than refractory VF/VT or cold water submersion. Work every arrest on scene until ROSC or termination.

I mean, really... It's all about compressions and early defib.

We screw up more arrests by mucking about with ET tubes and meds. It should be a focus on good, 100% full on BLS resuscitation untold ROSC or termination. Then we can start the ALS (if it's warranted).

Agreed. It has also been shown that there is a lower survival rate with a longer perishock pause, so I would emphasize compressions while an aed is charging for BLS.

 

[jwk]

Continuous compressions, SGA placed by BLS. No transport for any arrest other than refractory VF/VT or cold water submersion. Work every arrest on scene until ROSC or termination.

I mean, really... It's all about compressions and early defib.

We screw up more arrests by mucking about with ET tubes and meds. It should be a focus on good, 100% full on BLS resuscitation untold ROSC or termination. Then we can start the ALS (if it's warranted).

Hmmm, you may not get ROSC without as least some ALS measures. Clearly good, uninterrupted BLS with early defib is the emphasis, but it's not everything in every case.

It will be very interesting seeing what changes come down in October - right after I renew my ACLS in September.

 

[EpiEMS]

Hmmm, you may not get ROSC without as least some ALS measures.

The goal shouldn't be ROSC alone, the goal ought to be survival to neurologically intact discharge, though, and even the 2010 guidelines (the highlights to the 2010 ECC guidelines, see pg. 15) say "[t]here is no definitive clinical evidence that early intubation or drug therapy improves neurologically intact survival to hospital discharge." Then again, at least ALS care doesn't (if done subordinate to good CPR & defibrillation) cause harm...unlike our other old soon to be gone standby SMR...

 

[RedAirplane]

Continuous compressions, SGA placed by BLS. No transport for any arrest other than refractory VF/VT or cold water submersion. Work every arrest on scene until ROSC or termination.

I mean, really... It's all about compressions and early defib.

We screw up more arrests by mucking about with ET tubes and meds. It should be a focus on good, 100% full on BLS resuscitation untold ROSC or termination. Then we can start the ALS (if it's warranted).

Some places around here already have compressions only by BLS except in kids/drownings/etc.

Would you transport a multisystem multitrauma patient in full arrest, or work on scene delaying the trauma center? Just curious/confused.

 

[Flying]

Would you transport a multisystem multitrauma patient in full arrest, or work on scene delaying the trauma center? Just curious/confused.

Depends on whether you think the cause of the cardiac arrest is correctable. You describe a situation that is very likely to be observed in blunt trauma w/ significant energy transfer (unbelted car crash, high falls).

This thread touched on this: http://emtlife.com/threads/trauma-codes-to-work-or-not.41343/

 

[joshrunkle35]

Get rid of Amiodorone

 

[NomadicMedic]

Some places around here already have compressions only by BLS except in kids/drownings/etc.

Would you transport a multisystem multitrauma patient in full arrest, or work on scene delaying the trauma center? Just curious/confused.

No and no. I don't work or transport obvious trauma arrests.

 

[Tigger]

Some places around here already have compressions only by BLS except in kids/drownings/etc.

Would you transport a multisystem multitrauma patient in full arrest, or work on scene delaying the trauma center? Just curious/confused.

The vast majority of trauma arrests should never make it to the ambulance, much less a trauma center.

 

[MackTheKnife]

Get rid of Amiodorone

Curious. Why say get rid of it?

 

[NomadicMedic]

Curious. Why say get rid of it?

Because it's expensive and Lidocaine works just as well? Maybe?

 

[MackTheKnife]

Because it's expensive and Lidocaine works just as well? Maybe?

Thanx. Never used amiodarone. Used Lidocaine and it worked great. Back in the day (80's), we had Bretylol as a secondary.

 

[NomadicMedic]

Thanx. Never used amiodarone. Used Lidocaine and it worked great. Back in the day (80's), we had Bretylol as a secondary.

Yep. However, the elves that worked in the bretylium mine all went on strike and that was the end of that.

 

[Bullets]

Maybe short the cycle of updating this stuff? Get rid of the ACLS/PALS cards all together and just teach updated practices as they come along. Possibly get rid of Epi. SGA as front line airway control

and my favorite, hands on defib!

 

[NomadicMedic]

Maybe short the cycle of updating this stuff? Get rid of the ACLS/PALS cards all together and just teach updated practices as they come along. Possibly get rid of Epi. SGA as front line airway control

and my favorite, hands on defib!

The whole thing is a money grab from the AHA. Pointless that NREMT requires this stuff.

 

[MackTheKnife]

I'm looking forward to the IV single-malt Scotch for acute DTs.

 

[EpiEMS]

Maybe short the cycle of updating this stuff? Get rid of the ACLS/PALS cards all together and just teach updated practices as they come along. Possibly get rid of Epi. SGA as front line airway control

and my favorite, hands on defib!

Love it. +1,000 internets for you, sir.

In all seriousness, this is totally the way to go. Can't help but wonder if there's any evidence for a need for active practitioners to recert these merit badges every couple of years...

 

[thelapow]

Delay intubation, adobt CCR and merge it with acls