firemedic0227
Forum Lieutenant
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I have been having trouble with the new ACLS guidelines because unfortunately I took ACLS literally 2 weeks before the new stuff came out. Any suggestions on how to decipher the new from the old?
I was told to learn the Hypothermic protocol for ROSC and I was like we haven't been told any of that during class which was done on the 17th
I don't remember off the top of my head what the current ACLS guidelines are for adenosine and amiodarone. In regards to the power setting for biphasic, I believe that hasn't changed from, "Use the manufacturer's recommended settings."
1st dose amiodarone is 300, second is 150, then move onto lidocaine
I believe he was referring to VT with pulses sicne he was comparing Adenosine and Amiodarone. In that case the initial dosing of Amiodarone would be 150mg over 10 minutes.
As far as hypothermia protocol is concerned, AHA only recommends that it be initiated as early as possible post resuscitation in the victim who is unable to respond to verbal commands. They do not have a specific protocol, however mention that the current best practice is to lower the patient's body temperature to between 32 and 34 degrees celsius within 2-4 hours post resuscitation, and maintain that temperature for 24 to 48 hours. They recommend multiple methods, up to and including cold saline, air cooling devices, and circulated cold water devices, to name a few.
1st dose amiodarone is 300, second is 150, then move onto lidocaine
1st dose of adenosine is 6, then 12 and 12, max of 30
its still use manufacturers recommendation on the biphasic monitor
Lido is not in the new ACLS guidelines
The new ACLS guidelines outline that as if you have ROSC and pt is still unresponisive you can hang 1-2L NS at about 84 degrees
SVT gets a start at 50, then works up to 200J if they cant convert at a lower setting
We do hypothermia during cardiac arrest. Medical director says it is improving outcomes.
Hypothermia DURING cardia arrest? Very interesting. I would like to see the research on that.
The thing I find most fascinating about your comment is that hypothermia is listed specifically as one of the reversible causes of arrest, so it stands to reason that it should be avoided until ROSC is achieved.
Hypothermia DURING cardia arrest? Very interesting. I would like to see the research on that.
The thing I find most fascinating about your comment is that hypothermia is listed specifically as one of the reversible causes of arrest, so it stands to reason that it should be avoided until ROSC is achieved.
As long as you keep them above 92-94 degrees F, you should be somewhat OK. Then you could drop them a little more once you get them back and stabilized.
The current science recommends that a patient who is mildly hypothermic when ROSC is achieved should not be actively re-warmed, but does not recommend inducing hypothermia prior to achieving ROSC.
The evidence around hypothermia therapy and the time period that it should be instituted is still being evaluated. While we do know that earlier tends to be better, the results were not all that dramatically different between patients who had hypothermia within minutes of ROSC vs. patients who had hypothermia initiated up to two hours later.
With that in mind, while earlier initiation of hypothermia shows better neurological outcomes, if hypothermia during resuscitation reduces the chances of ROSC, does the potential neurological benefit exceed the potential risk of persistent arrest?
Also, I wonder if the family of a patient who had hypothermia induced DURING resuscitation, and did not achieve ROSC, would have a platform for litigation? Hypothermia is a known reversible cause of pulseless arrest. Is inducing hypothermia during resuscitation possibly trading one cause of arrest (most likely ACS in the adult patient) for another (hypothermia)? Even though we could likely determine the initial etiology of arrest, would it be possible to reliably determine that it was the initial etiology and not the hypothermia that caused the arrest to persist?
Just food for thought anyway...