wonder what the opinion is on the "new" ACLS guidelines

[MassED]

I just took my recert today for ACLS and found it to be incredibly dumbed-down. I am shocked the primary focus is on compressions, mainly. It is a lot easier than it was two years ago, but is this better for us, as nurses?

[hypocaffeinemia, BSN, RN]

I am not referring to those saves of those "near codes" - as we've all had those...

If they went pulseless and in vfib/vt how is it a "near code" and not a code?

[hypocaffeinemia, BSN, RN]

Cardene (Nicardipine) must not be the drug of choice for chronic angina or HTN. I've never seen it used.

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I mentioned earlier that while Cardene is a CCB, it has some specificity to cerebral vessels, so it utilized more for neuro.

[MassED, BSN, RN]

If they went pulseless and in vfib/vt how is it a "near code" and not a code?

I didn't write that there was any pulselessness or shockable rhythm - I mean someone who is nearly coding, i.e. being ambu'd - needs to be intubated... immediate intervention - TCP for complete heart block, Torsades and needs Mag.... that kind of thing.

[MassED, BSN, RN]

I mentioned earlier that while Cardene is a CCB, it has some specificity to cerebral vessels, so it utilized more for neuro.

sounds like a drug likely used mainly in the unit, then..... ?

[CritterLover, BSN, RN]

sounds like a drug likely used mainly in the unit, then..... ?

i first started using it on neurotrauma patients, about six years ago. neurosurgery likes it quite a bit.

over the last few years, i've been seeing it replace nipride some in post-surgical vascular patients (fem-pops, carotids, endoscopic aaa repairs, etc)

however, our er did like to use it for htn emergencies. sometimes we used labetalol drips, sometimes cardene drips. i personally prefer the cardene, since it doesn't have the same effect on heart rate that labetalol has.

where i work now, i see it quite a bit in l&d (probably because they can't hang it, so they call me to do so while waiting on an icu bed -- they may not use it all that often; but when they do, i know about it). they use it for pih/preeclampsia that isn't responsive to mag, hydralazine, and iv push labetalol (our l/d doesn't use labetalol drips).

it isn't quite as potent as nipride, but the side effects are less, and it is easier to titrate: it isn't weight-based, and small dosage adjustments don't have the same profound effects.

[hypocaffeinemia, BSN, RN]

sounds like a drug likely used mainly in the unit, then..... ?

Depends on the hospital.

Where I work, I almost never see it used- but we don't do any non-ischemic neuro. For HTN emergencies we use good ole SNP as its halflife makes it easy to adjust and stop as necessary.

Where I do my clinicals, they do a lot of neurovascular surgeries and I see it used fairly routinely there.

[MassED, BSN, RN]

i first started using it on neurotrauma patients, about six years ago. neurosurgery likes it quite a bit.

over the last few years, i've been seeing it replace nipride some in post-surgical vascular patients (fem-pops, carotids, endoscopic aaa repairs, etc)

however, our er did like to use it for htn emergencies. sometimes we used labetalol drips, sometimes cardene drips. i personally prefer the cardene, since it doesn't have the same effect on heart rate that labetalol has.

where i work now, i see it quite a bit in l&d (probably because they can't hang it, so they call me to do so while waiting on an icu bed -- they may not use it all that often; but when they do, i know about it). they use it for pih/preeclampsia that isn't responsive to mag, hydralazine, and iv push labetalol (our l/d doesn't use labetalol drips).

it isn't quite as potent as nipride, but the side effects are less, and it is easier to titrate: it isn't weight-based, and small dosage adjustments don't have the same profound effects.

interesting timing - yesterday i had a hypertensive female r/o aaa and used labetalol to bring down her pressure.... cardene does have a few more s/e than labetalol, perhaps that's why it's not used in the er much....

[Altra, BSN, RN]

Good morning all.

Just for you, MassED ... successful code last night.

60ish female from home, no CPR administered by family prior to EMS arrival, report of feeling "weak" the past few days. Sustainable rhythm established after EMS interventions at the scene ... transported to ER ... v fib again as they were pulling up to our door. Again successfully resuscitated, currently with stable rhythm and breathing over & above the vent in the unit.

[MassED, BSN, RN]

Good morning all.

Just for you, MassED ... successful code last night.

60ish female from home, no CPR administered by family prior to EMS arrival, report of feeling "weak" the past few days. Sustainable rhythm established after EMS interventions at the scene ... transported to ER ... v fib again as they were pulling up to our door. Again successfully resuscitated, currently with stable rhythm and breathing over & above the vent in the unit.

thanks for the report - sounds like it all worked together for her benefit.... do you know what was the response time for EMS to get to her after the 911 call?

[XB9S, BSN, MSN, EdD, RN, APN]

thanks for the report - sounds like it all worked together for her benefit.... do you know what was the response time for EMS to get to her after the 911 call?

I'd be interested to know what neurological outcome is eventually as well in as it appears that she had time down without CPR.

[CritterLover, BSN, RN]

interesting timing - yesterday i had a hypertensive female r/o aaa and used labetalol to bring down her pressure.... cardene does have a few more s/e than labetalol, perhaps that's why it's not used in the er much....

actually, i would say it has fewer side effects than labetalol.

the potential side effects (as defined by a drug book) may be more, but in practice, cardene is very well tolerated.

it has minimal effects on heart rate, and has a pretty reliable titration guide (easy to understand, even for a new or inexperienced nurse).

i think it is just newer, and it isn't so much better than other drugs to warrant an accelerated acceptance.

our younger docs would order it as the first-line drip for uncontrolled htn; "older" docs would use other drugs first.

its big selling point is that it doesn't have cyanide as a metabolic by-product ...

just wanted to add....

all in all, i've used it more in the ed than in icu, 'cause those surgeons just don't want to give up their nipride. i know this because i remember not being comfortable with cardene until after the six months where i worked er full-time (i went there from a surgical icu).

given that, i think its use (along with many other things in health care) is very regional. you may not be familiar with it just because it isn't commonly used in your part of the country. my area has a very advanced neurosurgical specialty, so we see many neuro innovations before other parts of the country (while -- in my opinion -- we lag behind in cardiology innovations). this influence may have made us more receptive to cardene.

[MassED, BSN, RN]

actually, i would say it has fewer side effects than labetalol.

the potential side effects (as defined by a drug book) may be more, but in practice, cardene is very well tolerated.

it has minimal effects on heart rate, and has a pretty reliable titration guide (easy to understand, even for a new or inexperienced nurse).

i think it is just newer, and it isn't so much better than other drugs to warrant an accelerated acceptance.

our younger docs would order it as the first-line drip for uncontrolled htn; "older" docs would use other drugs first.

its big selling point is that it doesn't have cyanide as a metabolic by-product ...

just wanted to add....

all in all, i've used it more in the ed than in icu, 'cause those surgeons just don't want to give up their nipride. i know this because i remember not being comfortable with cardene until after the six months where i worked er full-time (i went there from a surgical icu).

given that, i think its use (along with many other things in health care) is very regional. you may not be familiar with it just because it isn't commonly used in your part of the country. my area has a very advanced neurosurgical specialty, so we see many neuro innovations before other parts of the country (while -- in my opinion -- we lag behind in cardiology innovations). this influence may have made us more receptive to cardene.

i'm sure you are correct. what i found with cardene (in my trusty little emergency and critical care pocket guide) is the s/e: edema, hypotension, dizziness, h/a, tachycardia, n&v, facial flushing, vein irritation, and to change iv site after 12 hours.

with labetalol: s/e: hypotension, nausea, sweating, dizziness

seems as though cardene has a few more risks associated with it... but probably personal preference and like you wrote, age-related preference as well.