The 2015 ILCOR/AHA/ERC advanced life support guidelines (ACLS)

A summary of the new 2015 ILCOR/AHA/ERC advanced life support guidelines

The 2015 ILCOR, AHA, and ERC advanced life support guidelines are now out. This will be a brief review of what I think are the most important or interesting changes in the guidelines based on my first read through them. (I noticed some minor differences between the AHA and ERC versions of these guidelines, but nothing worth spending much time on.)

If I had to take away just 2 learning points, they would be:

  1. These guidelines are very similar to the 2010 guidelines. There are no changes important enough to warrant paying for another ACLS course. If you know the 2010 guidelines, just keep providing good patient care.
  2. As always, the science is weak. Only 1% of recommendations were “level A”, meaning high quality evidence from more than one RCT. The most common phrase I encountered reading through these guidelines was “may be reasonable”. This phrase is essentially meaningless and can easily be translated into “may not be reasonable”. Tread with care.

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Local anesthetic toxicity

A simplified approach to the initial assessment and management of emergency department patients with local anesthetic toxicity

Case

You are looking after a 30 year old woman with an isolated femur fracture, and decide to help manage her pain with a nerve block. Unfortunately, your ultrasound machine was broken so you attempted to do the femoral nerve block blind, using bupivacaine. Shortly after injecting the anesthetic, she complains of a headache, dizziness, and numb lips. Then she loses consciousness. You glance at the monitor and notice a wide complex tachycardia.


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The Simplified Approach to PEA (non-traumatic)

A simplified approach to the initial assessment and management of emergency department patients in PEA

Case

A 60 year old woman is brought into your resus room VSA with CPR in progress. The paramedics tell you that she had a witnessed arrest and bystander CPR was performed for 4 minutes before they arrived on scene. They found her in PEA, took over CPR, started an IV, and rapidly transported as they were only 5 minutes out…


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