X-Message-Number: 27398 Date: Wed, 30 Nov 2005 08:18:18 +0100 From: Eugen Leitl <> Subject: [: [ccm-l] Summary of BCLS/ACLS Changes] --jhQht7fi+MUdnHMm Content-Disposition: inline ----- Forwarded message from Scott <> ----- From: Scott <> Date: Tue, 29 Nov 2005 00:52:37 -0500 To: Subject: [ccm-l] Summary of BCLS/ACLS Changes X-Mailer: QUALCOMM Windows Eudora Version 7.0.0.16 Here is a brief summary of the major changes I have picked out from the 2005 guidelines. These are the changes that affect our treatment in the ED and ICU for adults. BCLS There is a huge emphasis on well-performed, uninterrupted CPR. The buzz words now are * Push Hard (Adequately compress the chest) and * Push Fast (100 per minute) Allow Chest to recoil completely after each compression. A new ratio of compressions to ventilations has been established for one and two rescuer CPR: 30 Compressions to 2 Ventilations (this is considered 1 cycle) Ventilations should be given over ~1 second; they should be sufficient to just cause chest rise. The detrimental effects of over- and hyperventilation are emphasized. ACLS The most striking change to ACLS is again, the stressing of the importance of well-performed, continuous chest compressions. To this end, all interruptions of compressions are limited. Any interruptions should take less than 10 seconds. Sequencing: Perform ABCs as we always have. Perform CPR until an AED or manual defib is available. If V-Fib or V-tach is present, administer a Single Shock at 360 J (for monophasic defibs. Biphasics should have a device-specific, single energy setting picked by the manufacturer) Do not perform a pulse check, but instead immediately restart CPR for 5 cycles (~2 minutes) Now perform a rhythm check; only check pulse if there is a possibly perfusing rhythm. If still v-fib/v-tach, shock again at 360 J Follow this with another 2 minutes of CPR Just to reiterate: No more 200 or 300 J shocks. No more stacked shocks No more interrupting CPR for extended pulse checks. CPR ? RHYTHM CHECK ? CPR ? SHOCK sequence (repeated as needed). The only interruptions to CPR should be advanced airway placement, rhythm checks, or defibrillations. Plan all interventions around effective CPR. CPR should be restarted between the time of identification of a shockable rhythm and the charging/preparation of the defib. Ventilations Continue 30:2 until advanced airway placed With airway, ventilations are asynchronous at 8-10 per minute Drugs Give drugs IV or IO; ET route is allowed, but deemphasized Give drugs during rhythm checks or during CPR, have them prepared prior to the rhythm check. Avoid interrupting CPR to place lines. Start EPI after the second shock Give Epi 1 mg every 3-5 minutes Vasopressin may take the place the 1st or 2nd epi dose in V-Fib/V-Tach/Asystole, but this is deemphasized. If still in V-Fib/V-Tach, give antidysrhythmics after the third shock, Amio if available; lido if not. Magnesium for Torsades. PEA/Asystole These two have been combined into 1 algorithm. Major differences are hypoglycemia and elevated ICP have been added to the mnemonic of reversible causes. Regards, Scott --- Scott Weingart, MD Assistant Professor of Emergency Medicine Mount Sinai School of Medicine ----- End forwarded message ----- -- Eugen* Leitl <a href="http://leitl.org">leitl</a> ______________________________________________________________ ICBM: 48.07100, 11.36820 http://www.leitl.org 8B29F6BE: 099D 78BA 2FD3 B014 B08A 7779 75B0 2443 8B29 F6BE --jhQht7fi+MUdnHMm Content-Description: Digital signature Content-Disposition: inline -----BEGIN PGP SIGNATURE----- Version: GnuPG v1.4.1 (GNU/Linux) iD8DBQFDjVI6dbAkQ4sp9r4RAk06AJ4+Vcl3c4p28qt29dgHsXxfTmYB6wCglBwV ONc3d7S7wBHM9RQuo7EtYtk dL -----END PGP SIGNATURE----- --jhQht7fi+MUdnHMm-- Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=27398