New ACLS????

[Wildcard]

After having spent more than half my life running codes, we are now being told to do EVERYTHING different. Can someone explain to me why Im not supposed to check for a pulse after a sucessful defib but continue CPR for two minutes? Other than the near contious compressions, I have to disagree with most every change. How about NOT defibbing unwitnessed arrests untill two minutes of CPR have been done? Can someone explain this to me? Lynn maybe? Is it working any better?

 

[fdog]

Sheesh. You know how it is:

Every two years some new changes will be rammed down our throats, based upon someone's pet research project (which did not address the gestalt of emergency ops, and instead addresses a single variable or two).

In two more years, this too shall all be changed.

Just look at the last 10-20 years: More O's. Less O's. Faster. Slower and deeper. Different ratios. Ratios that you need a crib sheet for. Call first. Call last. Bicarb. No bicarb. Rapidkill. Ect...

I can't say I've seen any increase saves since we implemented this latest round of "the usual changes", nor any worse. But then I can't say it's implemented exactly as described, either, there's a lot of inertia.

<shrugs> I guess the change-fest is as inevitable as the tides...

All the best, James

 

[Wildcard]

Oh ya and leavemdead is first line again! ***? Amio is telling people NOT to use it except in life threating dysrythems but ACLS still say use it all the time....Bout time for MAST pants to make a come back too, isn't it?

 

[Cacia]

well, tournequets are still popular in Iraq...

one handed ones, even.

My x has been traumatized lately by arresting passengers on his flights. Poor baby...he said about them him handing him Adenosine "damn, you can really mess somebody up with that stuff!" No labs, no x-rays, no ABG's....just him and the Adenosine.

Can't wait to see your notes, WC.

shocking only once? at 200 ? so many people seemed to convert after the second or third...I thought.

 

[Wildcard]

Only once at 360, no screwing around here....We never had the prilivage of labs and such, just the ole Lifepack and out judgement to stop someones heart.
I started teaching people NOT to use tournequets years ago but Iraq is different, there are needed there.

 

[Dive-aholic]

I don't know what the rationale for compressions after defib is. But the rationale I've heard for the increase in compressions is that it's better to get the drugs circulated than to waste time reassessing. I'm not sure I agree with all the changes either. I haven't gone through the new update yet and haven't seen the new protocols being used in any of the codes I've worked lately.

As for Levophed, personally, I'm glad it's back in vogue. It's a great drug and very useful, especially for patients who are septic. When nothing else works, Levophed and Phenylephrine are both great drugs. I haven't had anyone that wasn't already heading that way die just because they were on Levo. In fact, I'd have to say over 97% of the patients I've had on Levo have survived and gone home with minimal problems.

 

[Wildcard]

It was one of many drugs that went crashing out of vogue so quickly I didn't expect to see it back. I am glad to see calcium starting to make a comeback, used in the second round of drugs, it has done wonders ar times.
The ratioanl for CCP or continus chest comressions is to kep the intrathoraic pressure up, which I am all for but not checking for a pulse after ? viable rythem returns?
Realy good vino with dinner tonight, sorry for teh typos.

 

[Dive-aholic]

I understand the intrathoracic pressure logic, but if we have a pulse and the heart is doing what it needs to, what's the risk of damaging the good we've done?!?!

 

[Cacia]

that was my question too.

your myocardium is trying to get organized electrically and ....if you manipulate that rigorously, well....I just wonder.

 

[Wildcard]

Ya, it was an unusual class today. Usualy it's medics and nurses. Today a baby ( I swear sh is 12) RT, two nurses and three docs, oh ya, and me the lone medic in the class. Myself and the docs were all shaking our heads.