New ACLS Guidelines - EMTLife.com - The #1 Online Forum for EMS-Related Discussion

Ridryder911 · 11-29-2005, 10:04 AM

After reviewing the new ACLS guidelines

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** · 11-29-2005, 01:01 PM

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 · 12-06-2005, 01:33 AM

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** · 12-06-2005, 09:57 AM

Quote:

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 Dickinson 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 · 12-17-2005, 07:27 PM

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...................

Ridryder911 · 12-17-2005, 08:47 PM

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

11-29-2005, 01:01 PM	#2
Jon Community Leader Community Leader Join Date: Nov 2004 Location: Southeastern PA Posts: 7,796 Training: EMT-Paramedic	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 __________________ EMTLife.com used to be my life. Now there are pesky distractions like school, work, and friends. But I still like this place. The views expressed here are mine and do not reflect the official opinion of my employer(s) / Companies or the organization(s) through which I access the Internet N3VZG By Popular Demand, the Cert and Merit Badge Sash: NREMT-P, PA EMT-P, ACLS, PALS, ITLS, GEMS, BLS Instructor, BCLS, PA Act 235, OCAT, PATH, And I once stayed at a Holiday Inn Express.

12-06-2005, 01:33 AM	#3
richmedic101 Forum Probie Join Date: Dec 2005 Location: Richmond, VA Posts: 10	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. __________________ </div><table border=\'0\' align=\'center\' width=\'95%\' cellpadding=\'3\' cellspacing=\'1\'><tr><td>QUOTE </td></tr><tr><td id=\'QUOTE\'>EMS equals organized chaos</td></tr></table><div class=\'signature\'>

12-17-2005, 08:47 PM	#6
Ridryder911 Premium+ Member EMS Guru Join Date: Mar 2005 Posts: 5,847 Training: RN, BSN, CCP	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 __________________ Knowledge is a powerful tool! R.N.,BSN, CCRN,CEN,CCEMT/P

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11-29-2005, 10:04 AM	#1
Ridryder911 Premium+ Member EMS Guru Join Date: Mar 2005 Posts: 5,847 Training: RN, BSN, CCP	After reviewing the new ACLS guidelines 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 __________________ Knowledge is a powerful tool! R.N.,BSN, CCRN,CEN,CCEMT/P

12-17-2005, 07:27 PM	#5
Flight-LP Forum Deputy Chief Join Date: Jun 2005 Location: Houston, Texas Posts: 1,470 Training: Critical Care Paramedic	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...................