New BLS and ACLS Guidelines--How do you feel about the changes?

suzanne4, RN · Jan 3, 2006

There are many companies providing ACLS, BCLS, PALS, etc. But most facilities are actually only recognizing those cards from AHA and the American Red Cross. If you take a course from one of the other groups, you will normally see that their card states following protocols of AHA or the American Red Cross.

Change comes about because of changes in medicine and the way that we treat patients, and finding ways that work better. And some things that were deleted have been brought back. Such as the precordial thump. I have resuscitated too many patients thru the years to not try that if I do not have a defibrillator right at arm's length. And now it is back again as something to be considered.

Now, you actually see fewer drugs than we used to have to be responsible for. Many have been removed from the cards.

The biggest changes are actually coming at the lay-person level, where the breaths have essentially been removed from the cards. They were finding that too many were not starting CPR because they did not have some type of protective barrier available to them. It was then tested, and found that if you can deliver enough compressions at the proper depth and rate, then you would still be getting blood pumping and oxygen to the brain.

traumahawk99 · Jan 3, 2006

How do you feel about the continuous changes. Its every 4-5 years now.
I know many did not adapt to well to the ECC 2000 ACLS guidelines as far as drug changes.
So what do you think? And whats next?
Im curious as there are more and more agencies providing CPR certification now days. Are they going to change as well? Why do we have so many?
We have ASHI, NSC, Red Cross, AHA, and another i cant think of at the moment providing cpr certification.........
SO what are your opinions?

i think it's a GREAT thing and will save lives. emergency medicine has been lagging as a science, and the modifications of technique based on evidence of patient outcomes is long overdue.

if something works better, why not use it? soon enough, we'll be doing things like cooling the body temperature of folks who've had heart attacks. if it saves lives and provides an opportunity for much fuller recovery, i think retraining is a small price for a healthcare worker to pay. after all, that's what we're in this business to do.

i will only too happily line up to get recertified under the new guidelines :).

bobnurse · Jan 4, 2006

There are many companies providing ACLS, BCLS, PALS, etc. But most facilities are actually only recognizing those cards from AHA and the American Red Cross. If you take a course from one of the other groups, you will normally see that their card states following protocols of AHA or the American Red Cross.
Change comes about because of changes in medicine and the way that we treat patients, and finding ways that work better. And some things that were deleted have been brought back. Such as the precordial thump. I have resuscitated too many patients thru the years to not try that if I do not have a defibrillator right at arm's length. And now it is back again as something to be considered.
Now, you actually see fewer drugs than we used to have to be responsible for. Many have been removed from the cards.
The biggest changes are actually coming at the lay-person level, where the breaths have essentially been removed from the cards. They were finding that too many were not starting CPR because they did not have some type of protective barrier available to them. It was then tested, and found that if you can deliver enough compressions at the proper depth and rate, then you would still be getting blood pumping and oxygen to the brain.

There are quite a few changes at the HCP level as well. The 30:2 compression to ventilation ratio made national news.

lee1 · Jan 4, 2006

Does anyone have a website to the changes???

mitchsmom · Jan 4, 2006

http://www.americanheart.org/presenter.jhtml?identifier=3035674

There is a link there to a great booklet with all the changes!

"PDF of the 2005-2006 Winter issue of the ECC free quarterly newsletter, Currents.

This special edition of Currents presents the new material most relevant to instructors, compares it with the former guidelines, and gives you the scientific reasoning behind the change in compact and reader-friendly form.

The issue also includes links to the full guidelines document with all the references as well as an article on the evidence evaluation process, both available to you free online."

suzanne4, RN · Jan 4, 2006

There are quite a few changes at the HCP level as well. The 30:2 compression to ventilation ratio made national news.

That really only involves learning one rule, and again it focuses on what they came up with in the lay person guide, bagging, or rescue breathing, is not nearly as important as getting good compressions in. You can do just as well or even better with that.

I salute the changes, especially if it will save more lives.

bobnurse · Jan 4, 2006

what do you think about the 1 shock at the highest jules setting? and 1 shock every 2-3 minutes?

EricTAMUCC-BSN, BSN, RN · Jan 4, 2006

Bob, The new guidelines make sense although the number of compressions to breaths was bewildering, but I have become accepting. I was under the assumption that hyperventilation was the way to go with rising lactic acid levels , however if you have no perfusion i guess hyperventilation is not much good now is it?

In regards to increased energy for defibrillation I agree that your first shock is your golden shock, haven't seen many patients turn around after multiple shocks and walk out of the hospital.

In addition to Mitch'sMom's post there is also some good stuff in the AHA guidlines that appeared in the journal, "Circulation" in November.

http://circ.ahajournals.org/content/vol112/24_suppl/

I found the following particularly interesting:

There is insufficient evidence to support or refute CPR before defibrillation for in-hospital cardiac arrest.