2010 Cardiac Care Guidelines

Well, it is once again time for a new set of guidelines for basic and advanced cardiac care to be produced. This includes basic life suport, ACLS, PALS and NRP.
The changes have been fairly aggressive and directed at bettering well aimed basic life support. The advance life support guidelines have seen more of a schematic remodeling rather than intervention based changes. Rather than a top down approach, it seems to be circular in nature. Think, Act, Evaluate!

Our friend Dr Scott Weingart will discuss some of the changes with us here.

Podcast

http://blog.emcrit.org/?powerpress_pinw=823-podcast


Podcast Notes

http://emcrit.org/1-resus/new-acls-guidelines.htm

Scott talks about his podcast on intra arrest management in the above podcast, here it is for your reference.

Intra-Arrest Management Podcast

http://blog.emcrit.org/?powerpress_pinw=734-podcast

ABC is Now CAB

Here is the new way that CPR is done. As a health care professional, a pulse check is reqired before starting compressions.

C irculation

A irway

B reathing

We will be updating our clinical guidelines to reflect the changes. The role out will be April 1, 2011. Several folks from the primary and advanced care cadres will be steering the changes, along with clinical operations and the medical director.

Push Dose Pressors Get You Out of Pickles

Bolus dose pressors and inotropes have been used by the anesthesiologists for decades, but they have not penetrated into standard emergency medicine practice. I don’t know why. They are the perfect solution to short-lived hypotension, e.g. post-intubation or during sedation.
They also can act as a bridge to drip pressors while they are being mixed.

Our guidelines describe the use of push dose epinephrine in several instances, a well as the accompanying formulary. I think it is important to be familiar with the other push dose pressors as they may be used by practitioners in the ICU. Check out this pod cast and the accompanying notes by Dr Scott Weingarten.

Click Here for printable sheet with mixing instructions

POD Cast

http://blog.emcrit.org/?powerpress_pinw=76-podcast

Ephedrine

I don’t use this one much anymore, listen to the podcast to hear why.

Onset-Near Instant

Duration-1 hour

Mixing Instructions:
Take a 10 ml syringe with 9 ml of normal saline
Into this syringe, draw up 1 ml of ephedrine from the vial (vial contains Ephedrine 50 mg/ml)
Now you have 10 mls of Ephedrine 5 mg/ml

Dose:
1-2 ml every 2-5 minutes (5-10 mg)

No extravasation worries!


Epinephrine

Do not give cardiac arrest doses (1 mg) to patients with a pulse
Has alpha and beta-1/2 effects so it is an inopressor

Onset-1 minute

Duration-5-10 minutes

Mixing Instructions:
Take a 10 ml syringe with 9 ml of normal saline
Into this syringe, draw up 1 ml of epinephrine from the cardiac amp (amp contains Epinephrine 100 mcg/ml)
Now you have 10 mls of Epinephrine 10 mcg/ml

Dose:
0.5-2 ml every 2-5 minutes (5-20 mcg)
No extravasation worries!


Phenylephrine

Phenyl as a bolus dose is just the best! It is clean, quick, and never causes trouble.
It is pure alpha, so no intrinsic inotropy, but increases in heart perfusion can improve cardiac output.

Onset-1 minute

Duration- 20 minutes

Mixing Instructions:
Take a 3 ml syringe and draw up 1 ml of phenylephrine from the vial (vial contains phenylephrine 10 mg/ml)
Inject this into a 100 ml bag of NS
Now you have 100 mls of phenylephrine 100 mcg/ml
Draw up some into a syringe; each ml in the syringe is 100 mcg

Dose: 0.5-2 ml every 2-5 minutes (50-200 mcg)
No extravasation worries!