The brand new ACLS & BCLS guidelines were published last week. Not huge changes, but some good stuff! The free full text is available at the Circulation website. It takes hours to make your way through all of it. I boiled it down to just the facts and posted a summary on the Crashing Patient Site.
ACLS 2010 Guidelines Summary
In this EMCrit Podcast I discuss some of the highlights that I think are particularly important.
There have also been many questions about the head impulse testing discussed in episode 33. I have an easier method; check out this post.
Podcast: Play in new window | Download (18.4MB)
Hi, my name is Scott Weingart. 
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I have been waiting for the blogosphere to make a summary, it’s impossible for us newbred family docs to read all that material. Thank you Scott, I’m taking your podcast to the gym right now!
Thanks for the summary, very well received.
A question popped up on another forum, and I would love your input. Say you are performing your typical ACLS routine, and don’t feel a carotid/femoral pulse during a rhythm check, but you do either see organized contractions on bedside u/s, or get a weak doppler-able pulse. And lets say you don’t have fancy realtime endtidal capnography to help your management (as I don’t).
My assumption is that the patient now has ROSC, but has a BP of say 40/25, if I had an Aline.
(1) Do you hold compressions, or do you think continued compressions could have a positive impact here
(2) Do you use pressors / partial dose epi to help this? Just fluids? Prayer? Voodoo dance?
A-line 40/25 is not going to generate a pulse, so I would keep giving compressions or that heart is going to stop again. I would push 20 mcg of epinephrine every minute or so to get the BP up. Once you have the diastolic above 4o-50 mm Hg without compressions, you can switch the patient over to standard pressor drip.
All opinion, no evidence for this level of stuff.
scott
Great summary, I’ve been spreading it around to the juniors at NMH when we talk about the new guidelines.
glad you like them
–scott
Hey Scott,
Great summary and thanks for taking the time to grind through it. I’m still surprised that ultrasound has still not become mandate in ACLS. I understand that not every institution has this, but don’t you think it’s time for a ACLS recommendation; at least for cardiac standstill during pulse checks?
Haney
Haney,
Ultrasound is in there for cause of arrest. (Class IIb, LOE C)
Scott
Scott,
I forget if this is the podcast where you suggested to use a metronome for good quality CPR, but regardless, I wanted to let you know I took your advice… and I think it works well. I actually got a free metronome ap for my droid phone (always in my back pocket, and the price was right). We tried it out the other day during an arrest when one of the techs was giving pretty crappy 200 times a minute compressions… 2 minutes of good compressions later we had ROSC. Now that is likely a happy coincidence, but everyone in the room liked the beeping to keep the rate near optimum. I think a couple medics downloaded the ap for use on scene also.
Jon
Excellent!!! I am the pharmacist consultant for NYC REMSCO, love to be able to speak to you about many topics, wish the state would have allowed us to use Fentanyl for the TH vs MCO, i understand the lower dose of midazolam would preserve neuro functions and keep the pt intact to allow ED staff to assess more accurately. My real career quest is ED pharmacy. Love to share ideas with you, John Freese with his promotion is so busy these days!!! , he is great!!! Based on what your saying (back to your lecture) End Tidal seems to be the crux of overall monitoring of the whole enchalada!!! The A Line is totally new paradigm for me!!! Bye Bye Atropine do you agree??? Also CBA from ABC-lots of alphabet soap
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