I guess it's a 'no-win situation' Adrian. If the guidelines were too woolly
and general, certain people would be hopping up and down accusing the
various resuscitation organisations of sitting on the fence and not being
bold enough to commit themselves to anything. Best evidence is not a static
process and most medical practice is updated every few years. Surely the
fact that they are taking note of current evidence and advancing (rather
than performing a u-turn) lends more credibility to the process rather than
less.
With regards to Amiodarone, the advice is that it is given centrally if at
all possible. However, in the emergent situation with no central line in
situ, it is acceptable to give it peripherally.
For example, the cardiac arrest dose is advocated as a bolus 300mg
peripheral dose (they are already in the worst possible situation so there
is no mileage in giving a slow infusion or waiting for a central line).
Peri-arrest dosages are either 150mg IV over 10 mins or 300mg IV over 1 hour
depending on the situation.
Andy
-----Original Message-----
From: The list will be of relevance to all trainees including undergraduates
and [mailto:[log in to unmask]]On Behalf Of Adrian Fogarty
Sent: 11 January 2001 21:50
To: [log in to unmask]
Subject: Re: Resus Guidelines
What slightly irritates me about these amendments is that, for example, some
of us have been using atropine for slow EMDs for years, and have even been
known to shock pulseless SVTs, much to the chagrin of our local resus
officers. Now it's OK!! With some of the evidence base being "tentative" as
you put it, isn't it about time for the resus council to allow some more
flexibility in practitioners' approach, or at least to be less didactic? At
least that way they wouldn't be seen to perform embarrassing U-turns every
few years and they might command a little more credibility among a wider
audience!
One question Andrew, how do they recommend one gives the amiodarone, i.e.
centrally or peripherally, fast or slow? Brits don't like to give peripheral
amiodarone but I know this practice is common in other countries...
Adrian Fogarty
----- Original Message -----
From: Andrew Lockey
> Advanced Life Support
>
> Drugs
> - Amiodarone 300mg IV to be considered in cardiac arrest due to pulselss
VT or
> VF after the third shock.
> - No "high dose" epinephrine any more
> - No bretyllium any more
> - Atropine 3mg for PEA < 60 bpm
> - Amiodarone preferable to lidocaine for peri-arrest tachyarrhythmias
>
> Algorithm
> - Amiodarone is now include in the universal cardiac arrest algorithm as a
> consideration (see above)
> - there is a new peri-arrest algorithm for atrial fibrillation
> - narrow complex tachcardia with no pulse with no palpable pulse should
now be
> cardioverted (previously recoomended that it was treated as PEA with
> epinephrine for some bizarre reason!)
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