AZCEP

Dispatch: Respond to area of XYZ for reported bomb threat, when in area turn off comm equipment. Radio silence for a good 4 hours!

While reading some of the posts, I just kept thinking of some of the panel's from "The Far Side" by Gary Larson. Can anyone else visualize the image of the Almighty in his workshop, sitting on a stool, holding his toes, and saying "Good gravy, I'm a fool" or is it just me?

To throw a wrench in the works, one of the doctors at the AZ Heart Institute in Tuscon published a study that is in favor of 200 uninterrupted compressions in the space of two minutes before any ventilations. This has actually proven to be useful for the patient that has been in an unwitnessed arrest for longer than 4 minutes before EMS arrival. Our medical director is actively pushing for more of our arrest patients to receive this type of CPR, and is also pushing it in the ED.

The standard that you are held to in following ACLS are guidelines only. Anyone with MD/DO behind their name, and the associated sheepskin on the wall can perform any number of things at their own discretion. Even your medical director can change what he wants you to do based on his/her own feelings about how well the "guidelines" will work. As providers, we need to be sure that we understand when and how something will or will not work. Then use it accordingly.

If you have both available to you, first you should push yourself away from the table and consider yourself blessed. With that out of the way, let's consider how the two drugs are different for a moment. Epi has alpha and beta stimulating properties that will make the myocardium work harder/faster with a limited amount of oxygen available, as well as increase the pressures that the heart has to work against. Just wait for the first ROSC that you get using just Epi. You will swear to all that what you see is SVT because of the chronotropic effects. With Vasopressin, you get the benefit of increased vasoconstriction without the beta effects on the myocardium. More blood returning to the myocardium without the heart trying to rip itself out of the chest. Each agent will have better times to use it. Vasopressin for the AMI patient that codes for example. Epi for the septic/anaphylactic/asthma patient that goes into hypoxic arrest. Just because they show up in a protocol in a particular order doesn't mean that we should follow them blindly. An important line to remember from ACLS is "you will need to be a thinking cook".