msmedic_student Posted July 13, 2006 Share Posted July 13, 2006 First, I would like to say hey to everyone because I am new here and this is my first post. Also, I would like to ask everyone what their thoughts are of the new ACLS protocols for the tx of VFIB and pulse less VTACH. I am a medic student at the end of my second semester, and we are finishing Cardiology,Pharmacology, and Medical Emergencies. During my experiences in the field as a "student" the seasoned medics (of which I all respect, for their continued help and constructive criticism) are still doing the current protocols. Which in a code situation is some what confusing in contrast to what we are learning. The teachers insist on us learning the new way because it's the way that we will be tested on the National Registry. There is not much difference in the two protocols, I was just wondering what every body's thoughts were on the subject. Thanks in advance for the input and once again I am glad to be a member. Link to comment Share on other sites More sharing options...
Ace844 Posted July 13, 2006 Share Posted July 13, 2006 First, I would like to say hey to everyone because I am new here and this is my first post. Also, I would like to ask everyone what their thoughts are of the new ACLS protocols for the tx of VFIB and pulse less VTACH. I am a medic student at the end of my second semester, and we are finishing Cardiology,Pharmacology, and Medical Emergencies. During my experiences in the field as a "student" the seasoned medics (of which I all respect, for their continued help and constructive criticism) are still doing the current protocols. Which in a code situation is some what confusing in contrast to what we are learning. The teachers insist on us learning the new way because it's the way that we will be tested on the National Registry. There is not much difference in the two protocols, I was just wondering what every body's thoughts were on the subject. Thanks in advance for the input and once again I am glad to be a member. welcome, to EMTCITY and good luck with everything. If you do a search, the button is located in the upper R hand portion of your screen you will find many answers to your ?. Good luck, ACE844 Link to comment Share on other sites More sharing options...
Ridryder 911 Posted July 13, 2006 Share Posted July 13, 2006 First welcome to the city... continue your close observation skills. Now, with the question. Some services do not use AHA guidelines at all. Many EMS physicians feel that they are antiquated, are not efficient enough, what ever the criteria might be. I work occasionally at a state of the art, Cardiology hospital that performs world wide cardiac research, and AHA /ACLS is considered ajoke and similar to what Red Cross first aid is to Paramedics. Second, the new criteria is just now being distributed. New ACLS text has not yet been distributed as well as the new ACLS tests, so many have not had a "transition" course yet. As well, even the NREMT will even take both criteria until early 2007. Give them some time... Good luck in school, R/r 911 Link to comment Share on other sites More sharing options...
msmedic_student Posted July 13, 2006 Author Share Posted July 13, 2006 Thanks for your input on the situation. ACLS is hard enough sometimes (esp. when your new). I like as much help as I can get esp. from the guys who have been out there for awhile. Have a good one! Link to comment Share on other sites More sharing options...
chbare Posted July 13, 2006 Share Posted July 13, 2006 Msmedic_student, welcome to the city. Ridryder 911 has given good advice. AHA puts out guidelines and many physicians do not necessarily follow these guidelines. Be flexible about what you learn and do not get caught up in that follow the algorithm blindly mentality. The term Betty Crocker medicine comes to my mind. Good luck in your education and I hope to hear that you get to put a paramedic credential on your "I love me wall." Take care, chbare. Link to comment Share on other sites More sharing options...
Asysin2leads Posted July 14, 2006 Share Posted July 14, 2006 Speaking of V-fib protocols, lets have a quick scenario. You have a 26 y/o male with no cardiac history who collapsed while playing softball. Said patient converts to a NSR, a good, clean, beautiful NSR with nary a PVC or anything resembling a wide complex as far as the eye can see, with return of pulse and even takes some attempts at breathing after one defibrillation at 200 joules. IV established, patient intubated. Now the tricky part, should we be good and bolus him with Lidocaine or say "it probably wasn't an irritable foci that through in into v-fib, so lets not play with his heart rhythm since he's NSR." Discuss. Link to comment Share on other sites More sharing options...
MrSpykes Posted July 14, 2006 Share Posted July 14, 2006 I would leave it alone and monitor and supportive measures into the ED. There has been some studies that question the efficacy of Lidocaine prophylacticly. If PVC's come about all the sudden and they are malignant then i would use the Lido but otherwise I would hold off and monitor. Link to comment Share on other sites More sharing options...
tinman694 Posted July 14, 2006 Share Posted July 14, 2006 If we did so, it would be a violation of protocols...probably with serious consequences...(like your license to practice) We don't have the new protocols--so it would be 15 drops and haul them in...but then again, down in the deeeep south we are beyond slooooow in changing anything.... I will still call in and speak with the doc before blindly following the protocols--which is something you should be learning to do and should practice doing--you are the smart hands for the physician and they need to be in on what you are doing. It is very confusing to a new student to be taught one thing, but observe something else in the field--you should always learn the textbook first backwards and forwards before 'branching out'--period. You can learn the shortcuts with more field experience after you have completed your 'formal' education and testing. Geez...I am sounding more and more like my High School Trig teacher every day! Link to comment Share on other sites More sharing options...
redwolfef6 Posted July 14, 2006 Share Posted July 14, 2006 Speaking of V-fib protocols, lets have a quick scenario. You have a 26 y/o male with no cardiac history who collapsed while playing softball. Said patient converts to a NSR, a good, clean, beautiful NSR with nary a PVC or anything resembling a wide complex as far as the eye can see, with return of pulse and even takes some attempts at breathing after one defibrillation at 200 joules. IV established, patient intubated. Now the tricky part, should we be good and bolus him with Lidocaine or say "it probably wasn't an irritable foci that through in into v-fib, so lets not play with his heart rhythm since he's NSR." Discuss. Here in Denver, we are supposed to set up an Amiodarone drip. Lidocaine is no longer in the Denver Met protocols. I am a medic in El Paso county as well (Colorado Springs area) Our protocols there don't recognize Amiodarone- strictlyLidocaine. Link to comment Share on other sites More sharing options...
chbare Posted July 14, 2006 Share Posted July 14, 2006 I think the emphasis should be on patient monitoring and finding out why a 26 y/o male was found in V Fib. His ABC's are intact and he is showing signs of brain function. Get a set of vitals, BGL, EtCo2 value and wave form printout, and try to obtain a history if possible. I cannot see pushing drugs and potentially messing up a good thing. (patient with a pulse that is showing signs of brain function) Take care, chbare. Link to comment Share on other sites More sharing options...
Recommended Posts