ACLS protocol vs Real life

ERNurse752, RN · Mar 14, 2006

We don't use a lot of lido anymore...mostly amiodarone. Most docs already have preferences. In my own experience, I have seen better results with amio.

snowfreeze, BSN, RN · Mar 14, 2006

The doctor is running the code but suggesting something in the manner, Hey doc...would you like me to set up amiodarone? It will take a while for the new ACLS to take root. I saw a lot of amiodarone 14 years ago in an open heart unit. Then it went away because of its effects, lido toxic patients were common back then too. New drug, Cardizem arrived and all the nurses asked,, what the heck is that, give me the lidocaine. Adenosine got my attention but now I see it has an adverse effect on asthma patients and some other COPD patientsh airway swelling

neneRN, BSN, RN · Mar 14, 2006

Depends on the doc, some of our older ones still go with Lido, whereas the newer ones go straight to the Amio.

TazziRN, RN · Mar 14, 2006

Depends on the doc, some of our older ones still go with Lido, whereas the newer ones go straight to the Amio.

Ditto. I use both, depending on who's doing the ordering.

zacarias, ASN, RN · Mar 14, 2006

I believe Lidocaine research shows it doesn't work. Of course, why then did it work to stabilize the ventricles of patients during all these previous years? Who knows? Anyone know where we can find solid research published on this?

Trauma Columnist · Mar 14, 2006

We use both also - MD preference. Personally I think Amio works much better -however its also VERY expensive.

Undecided7 · Mar 14, 2006

If the doctor doesn't want to follow ACLS/current accepted standards of care and there is a poor outcome, isn't that kinda asking for a lawsuit? I realize amio is expensive, but if someone needs it- chances are it's not going to be a huge expense compared to being in the ICU, invasive interventions, etc. At that point, would a family member say, "Please use the less expensive/less effective drug first??" I guess what I'm saying is that if it were MY family member and the old doc didn't feel he needed to stay up on current standards- I would sue. Now, if there is a good reason why it wasn't used and in that particular case lidocaine WAS appropriate that's different. We as nurses have to take CEU's and recertify, etc. What if we said, "Oh, well that's how I did it 30 years ago! Why change now?" :uhoh3:

EricJRN, MSN, RN · Mar 14, 2006

When I took ACLS a couple of months ago, I'm pretty sure that either Amio or Lidocaine could be used. Did something change?

The reasons I had heard for the hesitation to go 100% with Amio:

- In the ARREST trial, using Amiodarone in the prehospital setting got more people to the ER alive, but it didn't increase survival to discharge. One researcher described it as 'changing the location of death' - instead of being DOA at the ER, these patients died later in the ICU instead.

- The extremely long half-life of Amiodarone. Would you want to risk pulmonary damage, thyroid issues or hepatotoxicity with a drug that was only half-gone in almost 60 days?

purplemania, BSN, RN · Mar 14, 2006

I think the real question is do you insist on following ACLS protocol if the MD does not? That is an issue for the CNO and maybe medical staff to create a policy. Our CRNA's are required to follow ACLS protocol.

sharann, BSN, RN · Mar 15, 2006

Thanks.

neneRN, BSN, RN · Mar 15, 2006

As far as liability, I don't think you're gonna find any doc who will just use one drug if its not working; they're gonna try different things; i.e., you might have a doc who tends to go for Lido first, but if the pt isn't responding to it, of course they're going to try Amio or get the cardiologist involved, they're not going to say, Oh Lido didn't work, sorry that's it. ACLS is the standard, but is ultimately up to the physician in deciding what is appropriate; Lido may not be the one recommended to be your first choice, but it is still a good drug that works.

I remember one case in particular, a stable Vtach, where we tried Amiodarone in the ER, didn't work, so called in the pt's cardiologist who came and attempted cardioversion x 3, that didn't work, so went to Lido and the pt converted. I've had better results in general with Amio but have seen good results with Lido too.

Another case was a guy in semi stable V tach (keeping a good pressure but having chest pain) given Lido in the field without success, so EMS had also given Amio prior to pt getting to ER; the Amio worked. Then 5 min after the guy arrived, he went back into V tach. So the ER doc had me give another Lido bolus, which converted him; then put him on both Amio and Lido gtts. An hour later, the cardio had me d/c the Lido gtt. An hour after that the pt went back into V tach, got another Amio bolus and converted again. Who could tell after all that which of the drugs was the one that worked?

I guess my point is that you give whatever works for the pt, and that could be either one.