ACLS question

[aCRNAhopeful]

Hey everyone,

Take a look at the pulseless VT/VF algorithm. Your patient goes into VF so you start BLS and shock ASAP. Then, according to ACLS, you give NO drugs for the next two minutes while you continue CPR, check rhythm again, still VF so shock again and now you can give epi or vaso. My question is, in the real world, does anyone actually wait for a full cycle of cpr before giving pressors? That leads me to my next question. If you continue to follow down the algorithm you are giving your epi or vaso and another 2 min of cpr then recheck, if still VF then you finally get around to giving amiodarone. That's after three rhythm checks of being in VF when in the real world their probably going to get an amio bolus and gtt with ROSC if not sooner. So once again, in the real world, do you follow the algorithm verbatim or do you simply use it as a guideline and give the drugs sooner than what the algorithm says. Just curious and thanks!

[ckh23, BSN, RN]

The protocols are just a guideline. However it seems like we give drugs as soon as possible, but in reality if someone is coding and you start CPR by the time you get the crash cart and pads on you are probably somewhere between 1-2 mintues of CPR. I have been part of codes where it's Vfib, shock and check rhythm instead of going straight into CPR. They are just guidelines and sometimes they are followed to the letter and others not so much.

[detroitdano]

The algorithms are based off of real world data, if people could actually be level headed during a code and use evidence-based practice like we do for everything else drugs should come second.

[aCRNAhopeful]

The algorithms are based off of real world data, if people could actually be level headed during a code and use evidence-based practice like we do for everything else drugs should come second.

That's how I feel. There may be a very good reason to wait to give epi or vasopressin later rather than sooner. I would surmise that in early CPR the myocardium may still be quite viable, now you give a massive dose of epi and increase myocardial O2 demand worse than it already is and could actually do more damage than good. Or 40 units of vasopressin which would certainly cause coronary vasospasm in a pt with spontaneous circulation, could it be that the same thing happens in the early stages of a vfib arrest and CPR? I've seen a lot of panicked people during codes lately who are overusing drugs far beyond the ACLS protocols and I think it could be doing more harm than good. Just chill out people!

[FIREMEDIC-CCRN]

You also have to remember that ACLS guidelines are not just for hospital patients who already have an IV established, numerous staff, and crash carts right next to their rooms, ACLS is vital in the prehospital care of these patients. Time and time again studied have shown that acls meds have little value in code situations without quality CPR, that is why you have seen such a big push to get away from medications and intubation as the priority things and concentrate on what works, that being good quality CPR and defib. It is not usually the meds that are bringing these people back in the hospital but the fact that we can intervene within a minute or so. It used to be unacceptable to bring a cardiac arrest into the ER without attempting to intubate the patient, now it is almost standard that we quickly drop a king LT or do basic BVM and concentrate on CPR/Defib.

[CCL RN, RN]

You also have to remember that ACLS guidelines are not just for hospital patients who already have an IV established, numerous staff, and crash carts right next to their rooms, ACLS is vital in the prehospital care of these patients. Time and time again studied have shown that acls meds have little value in code situations without quality CPR, that is why you have seen such a big push to get away from medications and intubation as the priority things and concentrate on what works, that being good quality CPR and defib. It is not usually the meds that are bringing these people back in the hospital but the fact that we can intervene within a minute or so. It used to be unacceptable to bring a cardiac arrest into the ER without attempting to intubate the patient, now it is almost standard that we quickly drop a king LT or do basic BVM and concentrate on CPR/Defib.

Exactly! Combitube, IO, good quality CCC CPR, and defib are the pts best chances. Then to ICU for hypothermia protocol!

The studies are pretty convincing that all drugs seem to do is increase complications, but not increase survivability.

[momthenRN]

I just took ACLS today. They were re-emphasizing high quality CPR in all non perfusing rhythms. Also, the drugs are secondary in a sense to the CPR and the shocking for Vtach/Vfib. I think we need to slow down and see if shocking and CPR works first then go to the drugs. We do too much too fast at time,...