• Thoughts from a clinician – the 2015 Guidelines.

    by Klint Kloepping. Last modified: 04/11/15

    With much anticipation the 2015 American Heart Association Guidelines have graced us with their presence.  After reading through the guidelines and seeing the changes that have come to pass with a lot less pomp and circumstance than I had imagined.  The changes were highlighted by several leaders of the FOAMed world.  BoringEM gave us the best run down of all of them.  Go to www.boringem.org to read through their thoughts on the new guidelines.

    The best part of the guidelines, in my opinion, is the recognition that Ultrasound is a great tool and we can use it in advanced life support.  There is a big push for the use of EMS Point of Care Ultrasound (EMSPOCUS) and I fully support it.  All of the work being done by clinicians all over the world with the use of ultrasound has finally been recognized and found a place in the new guidelines.  Eventually we will see ultrasound having a permanent place in the emergency medicine world and this is a good start.  For more information on ultrasound use in emergency medical services, visit http://emspocus.com/.

    Another shout out to the American Heart Association for including Extracorporeal Membrane Oxygenation or ECMO as a possible treatment.  It is because of all of the hard work of individuals like Joe Bellezzo, MD, Zack Shinar, MD, and Scott Weingart, MD that ECMO in cardiac arrest is gaining steam.  ECMO has been used for years in the pediatric population and now, thanks to the guys at edecmo.org, it is being used in cardiac arrest patients.  These guys started the ED ECMO podcast based on using ECMO in cardiac arrest patients.  The idea came from overseas and these gentleman have lit the fire here in the United States.  Anything you need to know about ED ECMO can be found at www.edecmo.org.

    Vasopressin being pushed out of the cardiac arrest algorithm is not an earth shattering change, in my opinion.  I feel that a lot of providers had either never used it or used it intermittently in cardiac arrest.  So, not a huge culture change there.  Taking vasopressin out was not the change that a lot of providers were both hoping for and expecting.  For now epinephrine is still the king of all the cardiac arrest medications.  For how much longer?  That remains to be seen.  What we do know is that we still use epinephrine and if the rhythm converts to a non-shockable rhythm, use more. According to the latest guidelines, there is a thought process that we may be able to get the patient to a perfusing rhythm if we give epi quickly with conversion to non-shockable rhythm. Again, not another earth shattering move in the algorithm, but still worth noting.

    There is something to be said for standardizing the joule energy delivery for all phases of the ACLS algorithms.  This is a reprieve for all who struggled to remember the escalating doses of joules for each synchronized cardioversion or defibrillation.  For a long time in the services that I have been privileged to work with have all been standard delivery of energy for every shock delivered.  This is making ACLS easier without the escalating doses and I feel it makes it more user friendly in the field management of cardiac arrest.

    All in all, there are several good changes that came along with the new guidelines.  Most of the changes are things that were being practiced by some, but not are a part of the treatment algorithm.  Care for the patient with chest pain, cardiac arrest, or a pediatric case is still being driven by all of you, the providers.  On behalf of all of my colleagues I want to say thank you for the passion and the drive you show every day.  It is because of all of you that these changes have come to be and are going to make a difference in the very near future.  Stay safe, fight the good fight, and always question the status quo.

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    Klint Kloepping

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