2011 Updated ACLS Guidelines

mike

3/23/2011 12:56:32 PM #

I heard that Atropine is now out of the protocol for ACLS but am unable to find anything from the AHA that states this. Where did you first hear of this?
Thank you.

orlanda enriquez

4/2/2011 2:53:28 PM #

With all due respect I am simply puzzled and confused by some of these changes that it makes me wonder  the rationale. then again who am I to
challenge your wisdom.  I am simply a CCU nurse with 27 years of experience.  I know Lidocaine is an old drug and perhaps that is the problem.  Perhaps there isn't the enough enthusiasm, funding to do studies on older drugs such as atropine, lidocaine or for that matter Dobutamine for renal perfusion.  We at the bedside prove time and time again that these drugs work in the way that were intended.  It is so frustrating so see the evidence at the bedside being disregarded.  Perhaps these drugs are no longer "evidence based" because they are not profitable!  I have no evidence for saying this just logic.
I recently had a patient that would have died if it weren't for lidocaine stabelizing his VT.  He had an MI, was on the hypothermia protocol.  Vt continued despite Amiodarone, Procanimide and  he was even becoming refractory to the shocks.  He was going to die!  As a last resort at the suggestion of an older nurse, Lidocaine was started, controlled his VT, was rewarmed and went to the cath lab for stenting.  

ACLS Classes

4/18/2011 6:43:30 PM #

I am a little confused by you saying Atropine is out. The new guidelines state:

"For symptomatic or unstable bradycardia, intravenous infusion of chronotropic agents is now recommended as an equally effective alternative to external transcutaneous pacing when atropine is ineffective."

I understand for Asystole or PEA, no more Atropine, but is 0.5mg of Atropine for sinus brady still used?

Thanks.

dane

6/4/2011 11:50:21 PM #

actually atropine used for mobitz 2 or complete heart block will help.  It will either speed up your block to a 3rd degree or send them to ventricular standstill. A lot of people don't remember this. Kinda scary!!!!

J.Small

6/6/2011 2:37:49 PM #

Mohammed:  Can you please post referances.  I just obtained an ACLS pocketguide and still see atropine and epinephrine used as before.

Lowly.paramedic

9/23/2011 6:44:54 PM #

I am not a big fan of ACLS, I can understand alot of the reasoning behind it for a busy metro EMS service where you throw a rock and it bounces of 3-4 hospitals  before it hit the ground, but what about the rural areas where the old stuff works, where when you get to the closest ED the doctor is even there yet and is still on the way. Another point why  would you give a person having coded with a heart attack EPI as often as ACLS guidelines  say to and increase the work load and oxygen demand of  the heart that have never made any sense to me, makes sense in a truama situation but will never in a cardiac induced CODE. I use it but streach the 5 min mark as long as possible. just a side note amioderone  prehospital is a joke  when lidocaine works just fine and has proven it self  time over time.  If you are going to  send someone to ride along to push 150 MG  over 10 min  then that is fine, but I would rather  give a dose of Lidocaine and start a drip  seen it work with good out comes several times, also seen a doctor give amiodrone for PSVT, didnt work,lol.