New ACLS Guidelines

Ridryder911

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After reviewing the new ACLS guidelines :blink: Here are some of the recommendations for "hospital use".. hmm they didn't address EMS as of yet for ACLS.

Agressive CPR with good depth .. at a rate 100/min ventillations 8-10 minute. is the main key !

(If the patient is monitored) No longer stair stacks shocks .. initial rhythm V-fib.. then shock at 360 (monophasic) and 200 (bi-phasic) or whatever has been proven to be successful on that monitor. Then aggressive CPR for at least 5 cycles/ventilation's = 2minutes.

Then check rhythm, pulse .. now give the medication.. either 1 dose of Vasopressin instead of the 1'st or 2'nd dose of Epi. If you choose Epinephrine then continue every 3-5 minutes (as usual). They do stress that administration of medications should be orchestrated with pulse checks.

Airways devices should be installed after aggressive CPR has been performed and up to > 5 minutes before secure airway is okay.
LMA & Combitube are allowable and are recommended as long as you can continuously monitor placement such as ETC02 or Colormetric Co2 can be utilized.

VF or VT after 2-3 shocks Cordorone should be administered; you can use Lidocaine still .. & no there is no change in morbidity & mortality ( but their still pushing Corodorne)

IV or I/O is prefferredover ETT route of medications. ( Better buy stock in the FAST or EZ I/O now !)

Post- Resuscitation-- needs to support myocardial & organ functions
Be sure to closely monitor B/P
Temperature .. too cold or to hot...
Glucose usage in the body
and yes lowering the body to hypothermic level can be successful ** however more research needs to be performed!**

Recommendation of pre-hospital XII lead is endorsed to reduce door to drug or cath lab time.
EMT's should be allowed to administer ASA to patients with chest pain that do not have allergies or GI problems

Stroke- tPA is strongly suggested in ischemic strokes, if CLEARLY DEFINED PROTOCOLS are used
Stroke units can increase outcome

Now this one I thought was weird stating... Medical Emergency Team (MET) shows promising benefits but; cannot be recommended at this time

I am sure there will be more clarification with time for the pre-hospital phase of ACLS... I really recommend listening to the videos until we have the books published. PALS also has some new recommendations as well..

Be safe,
R/R/ 911
 

Jon

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R/R:

Did they change Cordarone vs. Lidocane from an either/or, that they now recommend Cordarone?

What about Epi vs. Vasopressin - still either or, or is one prefferred?

Jon
 

richmedic101

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Our new protocols rolled out around May of 2005 with Amiodarone and Epi pushed together in an effort to combat Amios hypotensive side effects. We are also pushing Vasopressin and Epi every 5 minutes alternating. In addition, we are to perfrom 90 seconds of solid CPR prior to defibrillation. Lastly, we have been utilizing the Autopulse since late 2003. Our OMD (Dr. Joseph Ornato) will be releasing the results of these changes on 13 December 2005. I have had a sneak preview and there are impressive numbers coming to light. I'll keep everyone posted on the findings.
 

Jon

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Originally posted by richmedic101@Dec 6 2005, 01:33 AM
Our OMD (Dr. Joseph Ornato)

Cool.

I heard him speak at EMS Today 2005. He made some very good cases in "controversies of resuscitation” And I think he was also part of the roundtable discussion.

I’m blessed to have Dr. David Jaslow as my Medical Director at work, and at my Medic program.

Also, Ed ****inson spoke at my EMT graduation and is the Medical Director for the ALS service that covers my house.


Never hurts to read your medical director’s articles in JEMS/EMS ;)

Jon
 

Flight-LP

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It is great to see AHA finally starting to catch up on the times, but I truly hate the way they push Amio as the new 'wonder drug' anti-dysrhythmic. There is nothing wrong with Lidocaine and I have yet to see any statistical research of value that suggests any increase in conversion. Just my opinion, but personally I don't use it...................
 
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Ridryder911

Ridryder911

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I am not a big fan of Cordarone as well. Our ER physicians prefer it in V-tach, ectopi beats, etc. I have seen it work well in these situations. In v-fib arrest I believe that it is iregardless.

Be safe,
R/R 911
 
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