X-Message-Number: 27398
Date: Wed, 30 Nov 2005 08:18:18 +0100
From: Eugen Leitl <>
Subject: [: [ccm-l] Summary of BCLS/ACLS Changes]

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----- Forwarded message from Scott <> -----

From: Scott <>
Date: Tue, 29 Nov 2005 00:52:37 -0500
Subject: [ccm-l] Summary of BCLS/ACLS Changes
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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.

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.

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.
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 

Continue 30:2 until advanced airway placed
With airway, ventilations are asynchronous at 8-10 per minute

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 

These two have been combined into 1 algorithm.
Major differences are hypoglycemia and elevated 
ICP have been added to the mnemonic of reversible causes.

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
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