Background Er' title='3.0.2 Background Er' />Learn about Glumetza Metformin Hcl may treat, uses, dosage, side effects, drug interactions, warnings, patient labeling, reviews, and related medications. Noregistration upload of files up to 250MB. Not available in some countries. Background Er' title='3.0.2 Background Er' />PPT New ACLS Guidelines Power. Point presentation free to view. Title New ACLS Guidelines 1. New ACLS Guidelines. LCDR Phil Colmenares MD MPH Emergency Medicine Department Portsmouth Naval Medical Center 2. SwB5Y.gif' alt='3.0.2 Background Er' title='3.0.2 Background Er' />Objectives. Highlight changes in drug therapy Review some of the evidence for the changes 3. Relation of Collapse to CPR and. Defibrillation to Survival. Collapse to CPR interval min 1 5 1. Probability of Survival. Collapse to Defibrillation Shock minValenzuela et al. Circulation 1. 99. ACLS 5. ACLS 6. ACLS 7. ACLSDrugsAlgorithms ACS Stroke 8. ACLSDrugsAlgorithms ACS Stroke Electrolyte Abnormalities 9. ACLSDrugsAlgorithms ACS Stroke Electrolyte Abnormalities Toxicology 1. ACLSDrugsAlgorithms ACS Stroke Electrolyte Abnormalities Toxicology Environmental 1. ACLSDrugsAlgorithms ACS Stroke Electrolyte Abnormalities Toxicology Environmental Asthma 1. ACLSDrugsAlgorithms ACS Stroke Electrolyte Abnormalities Toxicology Environmental Asthma Anaphylaxis 1. Background Er' title='3.0.2 Background Er' />ACLSDrugsAlgorithms ACS Stroke Electrolyte Abnormalities Toxicology Environmental Asthma Anaphylaxis Trauma 1. ACLSDrugsAlgorithms ACS Stroke Electrolyte Abnormalities Toxicology Environmental Asthma Anaphylaxis Trauma Pregnancy 1. No Transcript 1. AHA ECC Milestones. PAD1. 99. 2 JAMA1. JAMAILC1. 96. 6 NRCNSF AHA1. JAMA1. 97. 3 7. 4 JAMAChain of Survival. The Wonder Years Rapidshare. Learn about Pravachol Pravastatin Sodium may treat, uses, dosage, side effects, drug interactions, warnings, patient labeling, reviews, and related medications. Currents in ECCAEDPALS1. MTM1. 96. 0 CPRACLSBCLS 1. Linking AHA Evidence Based Guidelines to ACLS Treatment Recommendations. EVIDENCEQUALITYRECOMMENDATIONLevel 1 large randomized clinical trials Level 2 smaller randomized clinical trials Level 3 prospective, controlled, nonrandomized cohort studies Level 4 historic, nonrandomized cohort or case control studies Level 5 case series, no control group Level 6 animal or mechanical model Level 7 extrapolations from existing data theoretical analyses Level 8 rational conjecture common sense common practice. Class I Class II Class II a Class II b Class III Indeterminate 1. AHA Class Recommendations 1. AHA Recommendations definitely helpful, excellent Level I evidence acceptable, probably helpful good supportive evidence acceptable, possibly helpful fair supportive evidence not indicated, may be harmful not recommended insufficient data 2. Ventricular Fibrillation. OLDVFVTShock X 3. Epinephrine. Class IIa. Shock Lidocaine Bretylium Mg. SO4 Procainamide High Dose Epi. Class IIa. Class IIb 2. Ventricular Fibrillation. OLDNEWVFVTVFVTPrimary ABCDShock X 3. Shock X 3. Secondary ABCDEpinephrine Vasopressin Class IIb or Epinephrine Class Indeterminate. Class IIa. Shock Shock. Lidocaine Bretylium Mg. SO4 Procainamide High Dose Epi. Class IIa. Amiodarone Mg. SO4 Procainamide Lidocaine High Dose Epi. Class IIb. Class IIb. Class Indeterminate 2. High Dose Epinephrine. Stiell, et al. NEJM 1. Human, RCT n. 65. Survival and neuro outcomes not improved Callaham, et al. JAMA 1. 99. 2 Human, RCT n. Increased ROSC and higher admission rates Survival and neuro outcomes not improved 2. Standard Dose Epinephrine SDE vs High Dose Epinephrine HDE for Out of Hospital Cardiac Arrestp. SDE N2. 60 HDE N2. Patients. 13. 10. ROSC in the Field. Admission. Survival to Discharge. Callaham, et al. JAMA, 1. ROSC return of spontaneous circulation. High Dose Epinephrine. Stiell, et al. NEJM 1. Human, RCT n. 65. Survival and neuro outcomes not improved Callaham, et al. JAMA 1. 99. 2 Human, RCT n. Increased ROSC and higher admission rates Survival and neuro outcomes not improved. Behringer, et al. Ann Intern Med 1. Human, Retrospective cohort study n. Increasing epi dose associated with poorer outcomes 2. Vasopressin. Linder, et al. Anesthesiology 1. Human, Descriptive Study n. Vasopressin hormone levels are greater in patients with ROSC vs those with no ROSC Linder, et al. Heart 1. 99. 6 Human, Descriptive Study n. Same result as above 2. Epinephrine vs Vasopressin. Linder, et al. Circulation 1. Pigs, RCT n. 28 Vasopressin results in higher coronary perfusion pressures Prengel, et al. Crit Care Med 1. 99. Pigs, RCT n. 16 Vasopressin provided higher SVR and higher MAPs Reversible cardiac depressant effect with vasopressin. Wenzel, et al. J Am Coll Cardiol 2. Pigs, RCT n. 17 Survival Epi 06 0 vs Vasopressin 66 1. Vasopressin group had full neurologic recovery wo cerebral pathology 2. Epinephrine vs Vasopressin. Linder, et al. Lancet 1. Human, RCT n. 40 Survival to admission Epi 3. Vasopressin 7. 0 p. Survival to 2. 4 hr Epi 2. Vasopressin 6. 0 p. Survival to discharge Epi 1. Vasopressin 4. 0 p. Epinephrine vs Vasopressin for Out of Hospital Cardiac Arrest. Epinephrine N2. 0 Vasopressin N2. P0. 0. 67. 06. 0P0. Patients. 40. P0. ROSC2. 4 h Survival. Survival to Discharge. Linder, et al. Lancet 1. ROSC return of spontaneous circulation. Ventricular Fibrillation. OLDNEWVFVTVFVTPrimary ABCDShock X 3. Shock X 3. Secondary ABCDEpinephrine Vasopressin Class IIb or Epinephrine Class Indeterminate. Class IIa. Shock. Shock. Lidocaine Bretylium Mg. SO4 Procainamide High Dose Epi. Class IIa. Amiodarone Mg. SO4 Procainamide Lidocaine High Dose Epi. Class IIb. Class IIb. Class Indeterminate 3. Organization of Evidencefor a Particular Intervention. Author year n2. Excellent. Good. Supporting 1. Knoop 7. Kelty 8. Mueller 7. 4 4. Jackson 8. Sisson 8. 5 4. 0 6. Weinstein 6. 3 1. Guevarra 9. 5 2. Barbaella 8. Kelley 7. 4 2. 3 Fair. Net Class Indeterminate. Fair. 35. Good. NeutralOpposing. Excellent. 87. 65. Level 3. 1Quality and Level of Evidence Analysis Magnesium in VFVT Cardiac Arrest. Author year nExcellent. Good. Supporting. Fair. 3, 5, 6 8. 1 1. Cannon 8. 74. 1 Low Mg 2. Miller 9. 5 6. 2 3. Perticone 9. 2 2. Thel 9. 7 1. 56 5. Tzivoni 8. 4 3 torsade 6. Tzivoni 8. 8 1. 2 torsade 7. Tzivoni 8. 8 5 PMVT 8. Other torsade studies 8. Fair. Good. NeutralOpposing. Excellent. 48. 76. Level 3. 2Magnesium for In hospital Cardiac Arrest. PNSMagnesium N7. Placebo N8. Patients. 30. 20. ROSC2. 4 h Survival. Survival to Discharge. Thel et al. Lancet 1. ROSC return of spontaneous circulation. Magnesium in VFVT Cardiac Arrest. CONPRO One excellent level 2 One fair level 4 One fair level 5 Three fair level 5 Mg torsade One fair level 7 Current practice level 8 Net Class IIB low Mg level Unclassified routine use 3. Quality and Level of Evidence Analysis Procainamide in VFVT Cardiac Arrest. Author year nExcellent. Good. Supporting 1. Giardina 7. 3 2. Greenspan 8. Jawad. Kanber 7. 4 1. Marchlinski 8. 4 5. Oseran 8. 5 6. Redding 6. Stiell 9. 5 2. 05. Wynn 8. 5 9. Yoon 7. Other EP Lab Studies. Fair. 2, 4 5, 8 1. Fair. Good. 3NeutralOpposing. Excellent. 87. 65. Level 3. 5Procainamide in VFVTCardiac Arrest. CONPRO One good level 7 Two fair level 7 One fair level 4 One fair level 5 Fair human level 7 Current practice level 8. Net Unclassified for persistent VTVF Class IIB for recurrent VTVF 3. Quality and Level of Evidence Analysis Lidocaine in VFVT Cardiac Arrest 1. Alexander 9. 9 4. Anastasiou 9. 4 1. Babbs 7. 9 4. Borer 7. Carden 5. 6 2. 3 6. Chow 8. 6 7. Dorian 8. Echt 8. 9 9. Harrison 6. Harrison 8. 1 1. Haynes 8. Herlitz 9. 7 1. 36. Kentsch 8. 8 2. 0 1. Kerber 8. 6 1. 5. Lazzara 7. 3 1. 6. Lazzara 7. 8 1. 7. Lie 7. 4 1. 8. Olson 8. Redding 6. 8 1. 05 2. Sadowski 9. 9 9. Spear 7. Vachiery 9. Van. Walraven 9. Weaver 9. 0 1. 99 2. Other MI trials 2. MI Meta analyses. Author year nExcellent. Good. Supporting. Fair. 51. 24, 9, 1. Current Practice. Fair. 1, 2. 0 2. 62. Good. 2, 3, 6 7, 8, 1. NeutralOpposing. Excellent.